Diabetic ophthalmopathy
is a non-inflammatory pathological process of the eyes, which is a secondary manifestation of the underlying disease - diabetes, and is caused by a violation of carbohydrate metabolism in the body.
The occurrence of diabetic ophthalmopathy is associated with general physiological, biochemical and immune disorders, one of which is a change in the properties of blood and blood vessel walls. In this case, eye tissues in diabetes mellitus are in a state of chronic oxygen starvation, which leads to damage to the retina of the eye - diabetic retinopathy. It accounts for about 70% of all cases of diabetic ophthalmopathy. The remaining third of cases of diabetic ophthalmopathy manifests itself in the form of diabetic cataract (clouding of the lens), secondary rubeous glaucoma, chronic blepharitis, cholazion, stye and transient decrease in visual acuity.
Diabetic retinopathy as one of the most common complications of diabetes mellitus
In type 1 diabetes mellitus, diabetic retinopathy
(retinal damage) occurs more often than with type 2 diabetes mellitus, and over time leads to significant weakening of vision or complete blindness. As a microvascular complication of diabetes mellitus, diabetic retinopathy is characterized by changes in the retina, active growth of newly formed vessels, and pathological processes in the area of the macula (macula).
According to the World Health Organization, the clinical course of diabetic retinopathy is divided into a number of stages:
1. Non-proliferative stage
. At this stage, an ophthalmological examination of the eyes may reveal microaneurysms, which are capillary walls protruding in the form of sacs, dilatation of the eye veins and the formation of venous loops. During this period, with preserved central and peripheral vision, a reduced level of color perception, a decrease in contrast sensitivity, and a low level of adaptation to darkness are objectively revealed.
2. Preproliferative stage
. Changes in the fundus and retina at this stage are more pronounced. Small hemorrhages, soft and dense exudates, and swelling of the corpus luteum area appear on the retina. This stage is characterized by abnormalities of the veins and capillaries of the retina. Some areas of the retina are completely deprived of blood supply due to blockage of small vessels by blood clots. Due to the involvement of the corpus luteum in the process, a decrease in visual acuity is noted at this stage.
3. Proliferative stage
. Many new fragile vessels appear on the retina and optic nerve head, which rupture and form new hemorrhages affecting the vitreous body. At the site of hemorrhages, connective tissue grows, which over time leads to retinal detachment and ruptures, as a result of which the patient may go blind.
How does diabetes affect vision?
Diabetes mellitus is a metabolic disorder characterized by elevated blood sugar levels. The main cause of this disease is insufficient production of insulin in the body, a hormone that maintains glucose concentration and regulates carbohydrate metabolism. This pathology is quite severe, it leads to the development of various complications. Diabetes mellitus also affects vision. An increase in blood sugar levels leads to deterioration of blood vessels. The tissues of the eyeballs do not receive enough oxygen. In other words, eyes with diabetes constantly suffer from lack of nutrition, especially if there is no proper treatment. This causes decreased vision. Most often, diabetics develop diabetic retinopathy - 70-80% of patients. Another 20-30% accounts for the following ophthalmopathologies:
- diabetic cataract;
- diabetic glaucoma;
- dry eye syndrome.
According to official statistics, from 5 to 20% of diabetics go blind in the first 5 years after their diabetes is diagnosed. However, according to doctors, in reality the problem is larger. Many patients do not treat diabetes, the pathology develops, and the deterioration of vision is associated with age-related changes in the body and other factors.
Let's take a closer look at the listed ophthalmopathologies. When should a patient be alert? Let's find out whether it is possible to prevent vision deterioration in diabetes.
Optic nerve changes in diabetic ophthalmopathy
Diabetic ophthalmopathy can be manifested by the following types of pathological changes in the optic nerve:
— optic atrophy
, which is a concomitant pathology of juvenile diabetes. This pathology is characterized by a progressive decrease in vision, narrowing of the visual field and blanching of the optic discs;
— papillopathy
, which occurs in a state of decompensation of the underlying disease and is characterized by sudden attacks of blurred vision, swelling of the optic disc and corpus luteum.
— anterior and posterior neuropathy of ischemic origin
. This pathology is characterized by such signs as a sharp unilateral decrease in visual acuity, sector loss in the visual field. The outcome of this process is most often partial or complete atrophy of the optic nerve.
Features of preoperative preparation
Before the operation, the patient undergoes a thorough examination by an otolaryngologist, dentist, endocrinologist and therapist. Lens phacoemulsification is not performed without the permission of these specialists. Blood tests can rule out the presence of hepatitis and HIV infection, and also check the speed of blood clotting. An electrocardiogram is required to assess heart function.
Contraindications to surgical intervention include diagnosed lens subluxation and severe renal failure. Cloudiness of a large area of the optical lens complicates the ophthalmoscopy procedure. If it cannot give a real picture of the condition of the lens, an ultrasound B-scan is performed. During this procedure, the presence of secondary diseases is determined and possible complications are predicted.
Signs and complications detected in patients with diabetic ophthalmopathy
Diabetes mellitus is accompanied by disturbances in the microcirculation of the conjunctiva of the eye. When examining the conjunctiva of the eye with a slit lamp in patients with diabetic ophthalmopathy, an increase in the tortuosity of the venules, dilation of the capillaries in the form of aneurysms, destruction of the capillaries and their blockage with blood clots are noted.
A characteristic sign of diabetic ophthalmopathy when examining the iris is sclerosis of the vessels of the iris, neovascularization, i.e. formation of new blood vessels, called rubeosis. At the same time, the iris loses its elasticity and mobility, which impairs the possibility of its expansion with the help of medications. Due to rubeosis and the proliferation of connective tissue at the site of hemorrhages, the outflow of intraocular fluid is disrupted, which leads to increased intraocular pressure and the development of secondary diabetic glaucoma
. Most often, rubeous glaucoma in patients with diabetes mellitus is combined with cataracts, retinal detachment and intraocular hemorrhage.
Patients with diabetes mellitus, due to a decrease in local and general immunity, are more susceptible to the influence of stress factors and pathogens of infectious diseases. This is why diabetic ophthalmopathy often manifests itself in the form of inflammation of the conjunctiva, blepharitis, and erosive lesions of the cornea. Pathological processes do not bypass the lens, the volume of which increases, which leads to a decrease in the depth of the anterior chamber and the development of diabetic cataracts
. In addition, due to disruption of metabolic processes, there is a weakening of the capsular-ligamentous apparatus of the lens, which increases the risk of subluxation.
Recommendations for the use of drops
Eye drop solutions for patients with diabetes mellitus are prescribed and discontinued only by a doctor. At the same time, it is recommended that they be used with strict adherence to the dosage and frequency of instillations, otherwise the risk of severe side effects increases (especially in the treatment of glaucoma). The duration of a course of therapy with eye drops is on average 2-3 weeks, with the exception of glaucoma, in which drops are prescribed for a long time. Eye drop solutions can be prescribed as monotherapy or in complex therapy for hyperglycemia to prevent the development of secondary eye changes.
Principles and methods of treatment of diabetic ophthalmopathy
Since diabetic ophthalmopathy is a concomitant pathology of diabetes mellitus, its development and progression are primarily associated with the level of glucose in the blood, as well as the state of diabetes compensation. Therefore, before starting symptomatic treatment of ophthalmopathy, it is necessary to achieve optimal compensation of blood glucose levels and normalize water-salt, protein and fat metabolism.
At the initial stages of development of diabetic ophthalmopathy, they resort to conservative treatment, which involves drawing up a clear plan for taking medications for therapeutic and preventive purposes. The treatment regimen may include drugs that affect thrombus formation, antioxidants, antiplatelet agents, immunocorrective and enzymatic drugs, as well as steroidal and non-steroidal anti-inflammatory drugs. If, despite symptomatic drug treatment and correction of the underlying disease, progression of signs of the pathological process is noted, then surgical intervention is resorted to.
Currently, one of the main and effective surgical methods for treating diabetic retinopathy is laser coagulation of the retina. In addition, improved technologies for microsurgical intervention on the vitreous body are being actively developed and put into practice.
In the proliferative stage of diabetic retinopathy, vitrectomy is effective. Indications for its implementation are long-term or extensive hemorrhages in the eye, as well as retinal detachment. Modern methods of vitrectomy involve the use of silicone, perfluoride compounds, and implantation of collagen membranes of artificial origin, which significantly increases the likelihood of a favorable outcome of surgical intervention even in advanced cases.
How to prevent eye diseases in diabetes?
So, diabetes mellitus affects vision quite strongly. At the same time, an increase in blood sugar concentration is the main cause of retinopathy, cataracts and other ophthalmic pathologies. There are also a number of predisposing factors. These include:
- genetic predisposition;
- heavy visual load, habit of reading in the dark;
- constant use of electronic devices - computers, phones, tablets;
- wearing low-quality sunglasses without UV filters or complete lack of eye protection from UV rays;
- bad habits - smoking, alcohol abuse.
In most cases, severe consequences of diabetes occur in patients who neglect treatment, do not engage in prevention, and rarely visit a doctor. When diagnosing diabetes mellitus, the predisposing factors listed above should be completely excluded. What else do ophthalmologists advise?
Firstly, diabetics need to visit an ophthalmologist at least once a year. If diabetic retinopathy or other ophthalmopathologies have already been identified, then it is recommended to check the condition of the eyes 3-4 times a year. Secondly, you need to take eye vitamins. They are also available in the form of drops.
Expert opinion
Plyukhova Olga Aleksandrovna
Head. Department of Laser Therapy, ophthalmic surgeon of the highest category, Candidate of Medical Sciences
Often, in the presence of the first and second stages of the disease, a person does not notice the manifestations of the disease. Signs of pathology begin to cause discomfort already at the third (proliferative) stage of retinopathy. This is accompanied by deterioration of twilight vision, blurred contours, and distortion of the outlines of objects. Patients with type I or type II diabetes need to be diagnosed by an ophthalmologist at least once every six months.
Cataract
Cataracts occur when the lens of the eye loses its clarity. The lens sits directly behind the iris and allows the eye to focus an image, which is then projected onto the retina.
Cataracts are not necessarily caused by diabetes, but they are the most common cause in young people. Research shows that diabetes increases the likelihood of cataracts by 60%.
Cataracts are usually treated with surgery. The damaged lens is replaced with an artificial one. It is believed that the risk of this operation is minimal, about 99% of patients notice a significant improvement in vision.
