Prevention and treatment of diabetic retinopathy

Author: Yang Xiufen, deputy chief physician, Beijing Friendship Hospital, Capital Medical University

Reviewer: Huang Yingxiang, Chief Physician, Beijing Friendship Hospital, Capital Medical University

"Doctor, I haven't controlled my blood sugar well these past two days, and my blood pressure is also high. Suddenly, black shadows appeared in front of my eyes, and I couldn't see anything all of a sudden." A diabetic patient in the ophthalmology clinic said anxiously and anxiously. This is a common complaint in the ophthalmology clinic. Some diabetic patients often come to the ophthalmology clinic when they suddenly lose their sight.

Diabetes is a chronic disease that seriously threatens human health and is often accompanied by complications of multiple tissues and organs. As of 2023, there are about 537 million patients worldwide. The number of diabetes patients in China has reached 141 million, and the prevalence rate of the population is as high as 11.2%, ranking first in the world! Diabetes has become an important public health problem in my country. Diabetic retinopathy, commonly known as "diabetic retinopathy", is one of the common and most serious complications of diabetes. About 1/3 of diabetic patients suffer from diabetic retinopathy to varying degrees. The above-mentioned diabetic patient suddenly lost his sight. Judging from his chief complaint and medical history, the patient is already in the proliferative stage of diabetic retinopathy. At this time, the patient is likely to be unable to distinguish the largest letter E on the eye chart, or even the fingers raised in front of him. He can only see the shaking hand shadow in front of him. Patients at this stage often need repeated ophthalmic treatments, which is time-consuming, labor-intensive, and expensive. The visual prognosis may not be as expected. Even if both the doctor and the patient have paid, the disease still progresses. Therefore, advanced diabetic retinopathy seriously affects vision, and the blindness caused by it belongs to "refractory blindness". At present, diabetic retinopathy has become the leading cause of blindness among people of working age. However, the blindness caused by diabetic retinopathy is "avoidable blindness", so early detection and reasonable treatment are the key to reducing the incidence of visual disability in diabetic patients. Prevention is better than cure!

Next, let’s talk about some knowledge about diabetes and its complication, diabetic retinopathy, so that more diabetic patients can pay attention to and understand the prevention and treatment of diabetic retinopathy.

1. What are the risk factors for diabetic retinopathy?

1.Diabetes duration

The longer the course of diabetes, the higher the incidence of diabetic retinopathy. More than 80% of diabetic patients with diabetes for more than 15 years will have diabetic retinopathy to a greater or lesser extent.

2. Blood sugar control level

Poor blood sugar control, persistent high blood sugar levels, or large fluctuations in blood sugar levels greatly increase the risk of developing diabetic retinopathy. On the contrary, if blood sugar levels can be controlled at normal levels, it is possible to avoid the occurrence of serious complications of diabetes.

3. Hypertension

High blood pressure or unstable blood pressure control will greatly increase the risk of intraocular hemorrhage, which is an important risk factor for retinopathy.

4. Hyperlipidemia

Hyperlipidemia is also one of the important risk factors affecting vascular diseases.

5. Individual Differences

For some patients, the disease progresses rapidly even if their blood sugar is well controlled; in a very few patients, although they have had diabetes for a long time, they do not develop retinopathy.

2. What are the symptoms of diabetic retinopathy?

Early manifestations of diabetic retinopathy: Long-term high blood sugar levels in the blood of diabetic patients lead to damage to retinal blood vessels and overflow of intravascular substances, which manifest as retinal microaneurysms, hemorrhages and exudations in the fundus. This stage does not affect the patient's vision, and has little impact on life and work. Patients often do not have any symptoms. Patients at this stage often do not need treatment, and strictly control blood sugar levels and have regular ophthalmology clinic visits. The process from no retinopathy to retinopathy is a process of quantitative change to qualitative change. Once fundus lesions occur, diabetic patients need to better control blood sugar to prolong the progression cycle of diabetic retinopathy and avoid visual impairment from progressing to the point of affecting life.

Late-stage manifestations of diabetic retinopathy: The ice is three feet thick, and it didn’t freeze overnight. As the course of diabetes prolongs, fundus lesions worsen, and symptoms become complex and varied. A large number of retinal blood vessels in diabetic patients are blocked, and the retina is ischemic and hypoxic for a long time, which breeds "neovascular vessels" with incomplete vessel walls. Such abnormal blood vessels are prone to repeated preretinal hemorrhage and vitreous hemorrhage, and then the formation of proliferative membranes on the retina, traction retinal detachment, etc. The patient's vision gradually decreases, or even suddenly decreases. At this stage, eye treatment intervention is needed, which requires fundus laser or surgical treatment.

Figure 1 Copyright image, no permission to reprint

3. How to treat diabetic retinopathy?

1. Treat the primary disease

In the early stage of the disease, it is necessary to actively control blood sugar levels and complications of diabetes, such as hypertension, hyperlipidemia and kidney disease. Once diabetes is diagnosed, you must have the awareness of strictly controlling blood sugar and remember to "control your mouth and move your legs". You can eat small meals frequently. It is recommended to eat foods rich in dietary fiber or foods that slow down the rise of blood sugar, low in salt, sugar and fat. You cannot let yourself eat and drink as much as you want, and eat regularly. At the same time, you should increase exercise appropriately and choose medium to low intensity rhythmic exercises, such as jogging, aerobics, Tai Chi, etc.

Figure 2 Copyright image, no permission to reprint

Figure 3 Copyright image, no permission to reprint

2. Laser treatment

In the middle and late stages of the disease, when the retina shows severe ischemia or there is a risk of bleeding, fundus laser treatment is required. Fundus treatment is a clear and effective treatment for diabetic retinopathy and has been used for more than 50 years. Timely fundus laser treatment can stop the progression of diabetic retinopathy in 50% to 60%, but 40% to 50% of patients still have progressive fundus lesions and require subsequent surgical intervention.

Laser treatment is a destructive treatment that uses the laser effect to damage the peripheral retina irradiated by the laser, causing it to lose its function, thereby reducing the retina's oxygen demand and improving the imbalance between retinal nutrition and oxygen supply and demand to ensure the integrity of the key structures of the central retina. This is the so-called "sacrifice the car to save the driver" move, in order to preserve the patient's useful vision. Generally speaking, panretinal laser photocoagulation will be completed in 3 to 4 times, and additional laser treatment may be required at any time during regular review. Therefore, the fundus should still be reviewed regularly after laser treatment.

3. Surgery

If the patient has macular edema that affects vision, anti-VEGF (vascular endothelial growth factor) intraocular injection is required to improve macular edema and improve vision; if the retinopathy develops to the late stage, there is long-term unabsorbed vitreous hemorrhage, severe proliferative traction or tractional retinal detachment, which seriously affects or threatens central vision, surgical treatment is required. The purpose of the surgery is to remove vitreous hemorrhage, peel off the proliferative membrane, and reposition the retina. During the operation, panretinal laser photocoagulation needs to be completed at the same time.

4. How can diabetic patients prevent retinopathy?

First of all, you should have a regular physical examination every year to screen for diabetes. Once diabetes is diagnosed, you should start paying attention to eye health. Even in the absence of any eye symptoms, diabetic patients should visit an ophthalmologist regularly to check the fundus every year; if there are any eye symptoms, they should visit an ophthalmologist promptly. By regularly checking the fundus, fundus lesions can be detected early, and intervention and treatment can be carried out early. If diabetic patients can detect retinopathy in time and receive standardized treatment, most patients can get rid of the risk of blindness. Therefore, it is emphasized again: diabetic patients should control their blood sugar and check the fundus regularly, in the hope of early prevention and early treatment to avoid the occurrence of late-stage diabetic retinopathy.