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Last update on August 15, 2022, 3:02 pm

Diabetes causes an alteration of the blood vessels and, as a consequence, a progressive dysfunction of all the organs, including the eye.

Remberto Escoto, head of the Ophthalmology Unit of the Centers for Diagnosis and Advanced Medicine and Medical Conferences and Telemedicine (Cedimat), explains that the most frequent dysfunction associated with diabetes is diabetic retinopathy.

This problem occurs when the blood vessels that nourish the entire retina become occluded, causing ischemia, or dilate and leak fluid into the retina.

Diabetic patients should see a specialist annually.

“The retina is a layer of nerve tissue that covers the back of the eye. Light rays entering from the front through the pupil are reflected on it and then transmitted to the brain where they are perceived as images. Of course, ischemia or excessive fluid in the retina causes a decrease in vision”, says Escoto.

Symptoms In the early stages of diabetic retinopathy, the patient may not notice a change in their vision. As the retinal disease progresses, the specialist explains, some changes may be noticed such as spots or dots in the visual field, blurred or diminished vision, poor night vision, changes in color perception, among others.

The specialist details that diabetic retinopathy can manifest itself in two ways: non-proliferative and proliferative.

Non-proliferative Non -proliferative diabetic retinopathy is when the blood vessels dilate and their content, be it blood, lipids, cholesterol, among others, passes to the retina.

All this leakage of intravascular content occurs more frequently in the center of the retina, that is, the macula. As a consequence, it is accompanied by a loss of central vision, which is progressive and if not treated, it will cause an irreversible loss of vision, Escoto warns.

Proliferative Nonproliferative diabetic retinopathy is followed by a proliferative stage, which occurs when many blood vessels in the retina become occluded.

Faced with this lack of blood, the retina responds by creating new blood vessels, which are abnormal. This process is known as neovascularization or proliferation, says the doctor.

Those new vessels do not provide adequate blood flow. They are delicate and can bleed into the eye very easily. If the bleeding is small, it is possible to see dark, floating spots in the field of vision. If the bleed is large, you can block it, allowing only the difference between light and dark to be seen. Sometimes the new blood vessels can be accompanied by fibrous tissue, which can cause the retina to wrinkle or detach from its normal position.

If the process of new vessel formation continues, they spread to the iris (the part that gives the eye its color) and can interfere with the normal flow of aqueous humor. The consequence is an increase in eye pressure or neovascular glaucoma, he indicates.

Diagnosis The ophthalmologist assures that the only way to detect the condition and monitor its evolution is through a complete eye exam.

Which includes confirmation of visual acuity. A slit lamp examination should then be performed.

This instrument consists of a microscope that is used to examine in detail the front part of the eye: eyelids, conjunctiva, sclera, cornea, anterior chamber, iris and lens. Drops are then instilled to dilate the pupil.

The purpose is to see in detail the entire fundus of the eye: retina, vessels and optic nerve.

Treatment Treatment does not cure the disease and often does not restore normal vision, but it can slow the progression of visual acuity loss.

One of the most common treatments is laser photocoagulation. It consists of emitting a beam of light through the cornea and vitreous without affecting them.

This light is bright and focuses finely on the retina. Its application reduces macular edema and new vessels, says the doctor.

More sessions It is possible that as time goes by and during the follow-up of diabetic retinopathy, more than one laser session may be performed. Even so, sometimes it is necessary to associate other treatments to achieve better effects.

In the case of edema of the macula, in addition to the laser, injections of corticosteroids and antivasoproliferative agents can be used, says Escoto.

Vitrectomy “In cases where there is hemorrhage or retinal detachment, the indicated treatment is vitrectomy. This procedure consists of extracting vitreous, which plays an important role in diabetic retinopathy.

In addition, the blood is extracted, the fibrosis that accompanies the neovessels and that causes retinal detachment.

Recommendation People with type 1 diabetes should see an ophthalmologist within five years of being diagnosed and annually thereafter.

With type 2, at the time of diagnosis and annually thereafter. With gestational diabetes, in the first trimester. Pregnancy is a condition that can accelerate diabetic retinopathy.

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