Published in: Today Digital
Author: Dr. Roland Roy, Ophthalmologist, Retinal and Vitreous Sub-specialist of the Ophthalmology Department of the HGPS.
Diabetic retinopathy is the main cause of visual loss and blindness in adults of 20-74 years, for the subspecialists in retina and vitreous surgery is the first cause of consultation in developing countries and the second in developed countries.
The early detection of ocular diabetic disease continues to be a challenge, and we regret to observe that, although the prevalence of diabetes has been increasing rapidly in the general population, the annual average of ophthalmological consultations with fundus evaluation remains below the expected and definitely far below what is necessary.
It is estimated that by 2050, one in three adults in the United States will have diabetes. "Today, anyone who knows more than ten people probably knows a diabetic," says Dr. Roy, since it is considered that one out of every eleven people in the world suffers from the disease.
Constant observations and accumulated knowledge about the disease have caused changes in the parameters to define diabetes over the years.
In general terms, type 2 diabetes refers to the person whose condition is related to obesity and lack of physical exercise, and this does not exclude children. These patients usually initiate the treatment of their pathology with oral therapy or the combination of insulin plus oral therapy, since type 2 diabetes has an insulin resistance or a relative lack of it.
A person with type 1 diabetes is one with 80% damage to the beta cells (some cells of the pancreas). The onset of type 1 diabetes is acute and usually requires treatment with insulin from the moment of diagnosis, since the lack of it is absolute.
According to the American Diabetes Association (ADA) and the American Academy Association (AAO), the ophthalmological examination should be performed five years after diagnosis in patients with type 1 diabetes and immediately after diagnosis in patients with type 2 diabetes. This can be altered by adolescence. and any condition that greatly affects the patient's health.
The comorbidities of diabetes (complications or diseases related to diabetes itself) are divided into two major groups: microvascular events (diabetic retinopathy, nephropathy and diabetic neuropathy) and macrovascular events, which correspond to coronary vascular disease and cerebrovascular accidents.
Through the fundus examination under pupillary dilation, the presence or absence can be assessed, the extent of diabetic retinopathy can be determined and the management recommended according to the stage in which it is found.
Once the diabetic retinopathy is installed there is no remission of this, only control of the progression of the changes ... there is no cure that eliminates diabetic retinopathy at the root.
This condition is classified into two major groups, namely: "non-proliferative" (less severe) and "proliferative" (very severe), but the main cause for complaining of reduced vision is macular edema (fluid that increases the thickness of the center of the retina).
With the new diagnostic methods, such as optical coherence tomography (OCT), panoramic angiography and OCT-A (the combination of both), the advent of new intravitreal drug therapies, as well as the evolution of the therapy With laser and surgical procedures we managed to combat much better the visual damage caused by diabetic retinopathy.
1. Do different treatments cause pain or discomfort? Laser and intravitreal injections performed under topical anesthesia (drops of anesthesia) produce some discomfort and some degree of pain, but this pain is very temporary and well performed both treatments are very well tolerated by the vast majority of patients.
The surgeries are performed under anesthesia behind the eye, helped by intravenous medications that mitigate the pain or that one does not realize that bothers him. In some cases it is preferable to perform the surgery under general anesthesia.
2. Is the clinical and / or surgical treatment enough to improve vision? No. Metabolic control should go hand in hand with intraocular therapy, otherwise the long-term results will not be satisfactory and blindness will be inevitable. Hence, some patients have gone through all types of combination therapies and by the hands of many doctors and despite this the visual deterioration continues to advance steadily.
Diabetes must have a multidisciplinary management between cardiology, neurology, nephrology, endocrinology and ophthalmology, to achieve the integral health of the patient.
3. How long should I continue the injections? Everything will depend on the stage in which the retinopathy is found at the time of starting the treatment, and the patient's attachment to it. You should not expect immediate improvement, but think of one or two years of successful treatment.
4. Can you guarantee me that I will see well after treatment? In general, the doctor can not guarantee success in the treatment of any pathology. On the contrary, what we can guarantee, almost in a hundred percent, is that if one does not control the glycemia or the pressure nor the cholesterol and if one does not put treatment of injections and / or laser with or without surgery in time, the vision his as a diabetic will continue to get worse until it causes irrecoverable blindness.