Prevention Of Diabetic Retinopathy

Posted on October 1, 2008
Filed Under Diabetes |

The involvement of the retina of the eye in patients with diabetes mellitus (diabetic retinopathy) is the most frequent cause of new cases of blindness among adults 20 to 75 years of age. During the first twenty years of the disease, nearly all type 1 diabetic patients and more than 60% of type 2 diabetic patients develop this serious complication. In the diabetic group in which the disease appears earlier (diabetes type 1), 85% of cases of blindness has been attributed to diabetic retinopathy. In type 2 diabetes (in which diabetes appears later, from 40 years), one third of cases of blindness (even with some level of vision, someone unable to work) has been attributed to diabetic retinopathy.

What is diabetic retinopathy?
Diabetic retinopathy is a serious complication of diabetes mellitus, characterized by the appearance of small microscopic dilatations in the tiny blood vessels that irrigate the innermost membrane or retina of the eye, hemorrhages, exudates, alteration veins and growth of new blood vessels in the membrane and the rear surface of the vitreous that fills the eye.
Vision loss that occurs in this complication is the result of several mechanisms of action.

Risk Factors
The main risk factors include age, duration of diabetes mellitus and degree of control, hypertension and excess cholesterol in the blood.

The duration of diabetes is probably the most powerful predictive factor for the development and progression of retinopathy. The degree of control of blood sugar has been implicated in numerous scientific studies as a major factor, some studies that used an intensive treatment of diabetes with insulin showed a very substantial reduction in the risk of retinopathy.

The protective effect of good control of sugar has also been confirmed in patients with type 2 diabetes. A major study conducted in the United Kingdom is now 6 years showed that an improvement in blood sugar control reduces the risk of developing retinopathy and nephropathy (kidney involvement), and possibly neuropathy (nerve involvement) . The overall complication rate of the small blood vessels was reduced 25% in patients receiving intensive treatment compared with those receiving conventional treatment.
This important study also showed that a tight control of blood pressure in these patients reduced the progression of diabetic retinopathy and the risk of deterioration of visual acuity and reduce deaths related to diabetes and stroke.

Measures to prevent diabetic retinopathy
Interventions that have shown benefit in preventing diabetic retinopathy are:
* Good control of diabetes
* Comprehensive control of hypertension
* Quit Smoking
* Laser photocoagulation in patients with lesions in early stages.

Laser photocoagulation has proven effective to reduce significantly the severe loss of vision and slow the progression of retinopathy. Is a technique that involves the destruction of new blood vessels formed in the retina or the vitreous hemorrhage by administration of multiple shots of a laser beam. Unfortunately and despite its effectiveness, this technique fails to restore the hearing loss.

It is very important to consider that diabetic retinopathy is manifested by little or no visual or ophthalmic symptoms until vision loss is shown. Since this treatment aims to prevent such loss and retinopathy may be asymptomatic, it is essential to identify and treat these patients early, at the beginning of the disease. To achieve this, the diabetic patients should be routinely evaluated to detect the disease in a stadium that can be treated.

In this sense, it is interesting to observe the following recommendations:
* Patients with type 1 diabetes should be examined by an ophthalmologist from 3 to 5 years after being diagnosed with his illness.
* Patients with Type 2 diabetes should be evaluated by an ophthalmologist as soon as possible after being diagnosed.
* All diabetic patients should be examined annually by an ophthalmologist with expertise in the diagnosis of diabetic retinopathy. If cases are detected progressive retinopathy, checks should be made more frequently.
* Given that pregnancy is a factor that may accelerate the progression of diabetic retinopathy, diabetic women who become pregnant should be examined by an ophthalmologist in the first trimester of pregnancy and periodically throughout it.
* It should start treatment with laser photocoagulation in diabetic patients type 2 diabetic retinopathy lesions in initial stages to prevent the progression of complications and blindness.

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