Diabetes negatively affects the condition of the visual system.The ophthalmologist often becomes the first doctor whose patient suspects he has the first signs of diabetes.
Vision in diabetes is attacked by many pathologies, in medicine, there is even a term "diabetes for the eyes".
Complications of diabetes in the eyes
At the heart of diabetes is a violation of glucose metabolism and metabolism. During the development of pathology, nerve fibers and blood vessels are damaged, resulting in human vision.
The degree of damage to the eye depends on the type of disease:
In type 1 diabetes, slow damage to the retinal vascular system occurs. It is possible to notice a decline in vision in this type of diabetes 10-15 years after diagnosis.
Type 2 diabetes is distinguished by the presence of diabetic retinopathy as early as the time of diagnosis. Blindness can occur in the absence of effective treatment.
The degree of complications of diabetes that appear on the visual apparatus depends not only on the type of lesion but also on its duration, level of compensation, age of the patient, and the presence of chronic diseases.
Negative processes in the vascular system, which developed on the background of the main pathology, lead to circulatory disorders in the fundus.
Vessels clog, expand, and increase their permeability. The retina of the eye membrane loses its oxygen supply, leading to dysfunction of the visual apparatus.
This diagnosis means thinning and fragility of the eye vessels, leading to regular retinal bleeding. Vision is constantly diminishing during this process.
There are 4 stages of diagnosis progression:
Soft, non-proliferative. Small aneurysms are diagnosed in the retina, which is swelling of blood vessels. At the sites of protrusion of the altered wall of the vascular system, there is a high risk of rupture with subsequent bruising.
Retinopathy is moderate, which is also considered nonproliferative. As the disease progresses, the blood vessels lose their outline and swell. Their ability to pass blood through them is reduced.
Macular modification is observed in the retina, and the fundus is covered with microaneurysms. The visual apparatus loses the ability to perceive small parts of the image.
Severe retinopathy is the last stage of the disease, which is non-proliferative in nature. At this stage, most of the capillaries that feed the eyes are blocked, which leads to the active growth of new blood vessels.
On the background of growth factors, the solid structure's scars, bleeding and exudates appear. As a result, retinal tissue suffers from a lack of necessary nutrition.
The last stage of diabetic retinopathy is proliferative in nature. New veins actively grow on the inner surface of the retina, growing into vitreous. The newly created system is fragile, leading to damage and new bleeding.
On the background of the formed hematomas, hard scar tissue is formed, which gradually separates the retina from the membrane. It's called a tow snowflake.
The work of the visual apparatus with a diagnosis of diabetes changes gradually. Initially, edema compresses light-sensitive cells.
The death of these components of the visual apparatus in turn leads to the creation of an incomplete image. Where the retina is absent, the ability to see is also not present.
Diabetic macular edema
Macular edema occurs as a complication of retinopathy in diabetes. In the background of this phenomenon, the central vision is reduced. Macular edema, required for a linear image before the eyes, is usually characteristic of type 2 diabetes.
The symptom manifests itself at any stage of retinopathy but usually progresses in advanced cases. It is common to divide macular edema into 2 types:
diffuse, in which the permeability of the entire capillary network increases,
focal - permeability is characteristic only for the local zone of aneurysm formation.
Against the background of edema, the severity of the visual reflection of the reality of the fall, the pigment epithelium is affected by dystrophy.
- Initial,
- Immature,
- Mature,
- Milky or overripe.
- The diabetic type of cataract is characteristic of patients with diabetes at an early age. In this regard, uncompensated diabetes is especially dangerous, in which cataracts develop rapidly.
Vision regression can be reversed only at an early stage of development by normalizing carbohydrate metabolism.
Cataract progression is characterized by strong opacification of the lens of the eyeball and the development of myopia. Microcirculation is disturbed and iris dystrophy develops.
Against the background of rapidly developing diabetes, glaucoma develops in which the intraocular pressure increases significantly.
Glaucoma is accompanied by the following negative symptoms:
- The outflow of moisture is disturbed by the action of new growing vessels,
- Normal blood circulation is disturbed, which is typical for retinopathy in general,
- Eye tissues suffer from ischemia and hypoxia, numerous bleeding vessels of the eye vessels occur,
Due to the increased intraocular pressure, the nerve endings are compressed and there is a slight deviation of the eye disc.
The neglected disease leads to atrophy of the nerves of the visual apparatus, and blindness comes to the patient.
The process of vision loss takes place in stages, first, the boundaries of the object are blurred, after which the ability of peripheral vision disappears.
According to some experts, optical fibers in this period belong to the phase of suspended animation and can be restored with proper therapy.
Maculopathy
One of the stages of retinopathy is maculopathy. It is characterized by damage to a critical area of the eye.
This area is called the macula and is responsible for the central vision, which makes up the overall picture.
This phase is the most dangerous for eyesight, as threatening diabetes threatens complete blindness.
Diagnostic
The main method of eye research to prevent the development of retinopathy in diabetes is ophthalmoscopy. An ophthalmoscope is used for this procedure - a device that allows you to visually assess the condition of blood vessels, retina, and optic nerve.
This method will identify the initial stages of retinopathy and take steps to stop the development of damage to the visual apparatus. Another method of diagnosing the eyes during diabetes is FAGD, and that is fundus angiography using the fluorescent method.
In the examination process, a special dye is introduced into a vein, illuminating the vascular walls of the visual system under direct lamp light. This enables the detection of tears and minuscule leaks with the aid of a fluorescent substance.
Auxiliary diagnostic methods:
- Perimetry to detect lesions in edema or glaucoma,
- Ultrasonic biomicroscopy,
- Retinological tomography.
The last two diagnostic methods determine the thickness of the retina and the condition of the main nerve of the eye.
Treatment
In advanced diabetes, the loss of vision is irreversible. Therapeutic measures to initiate retinopathy are aimed at maintaining normal sugar levels.
In the presence of diabetic pathologies of the visual apparatus, it is common to use the following methods:
- Taking drugs whose action is aimed at stopping the growth of vasculitis,
- The moderate use of corticosteroids,
- Macular laser coagulation of the vessels of the visual apparatus,
- Vitrectomy - Removal of the vitreous with severe bleeding,
- By filling to eliminate the gap between the retina and the blood vessel layer.
The use of modern methods of treating retinopathy allows you to stop the process of vision loss and restore visual ability.
Prevention and recommendations
The basis of preventive measures in the presence of diabetes is a regular medical examination by an ophthalmologist and monitoring of blood glucose levels.
Eye damage in diabetes
In diabetes mellitus (DM), all eye structures suffer to one degree or another, and the ocular manifestations of diabetes are very diverse.
Often patients with diabetes are unaware of the presence of serious eye problems, which may not manifest themselves for a long time with decreased vision. Often an ophthalmologist may suspect the diagnosis of diabetes due to ocular manifestations in the early stages of the disease.
Diabetic vascular damage is widespread across the body and correlates with disruptions in all metabolic pathways. Specifically, the impairment of small blood vessels is termed microangiopathy.
It includes lesions of the retina, kidneys, peripheral nerves, and brain. Damage to large blood vessels is called macroangiopathy and is manifested by atherosclerosis of large vessels (cerebral, coronary, renal, and peripheral arteries).
Many research investigations have revealed a correlation between microangiopathy and elevated blood glucose levels. Without adequate glycemic management, the likelihood of experiencing these complications rises notably.
Diabetic retinopathy
Diabetic retinopathy (retinal damage) is a major cause of progressive and irreversible visual impairment in patients with diabetes in developed countries.
The duration of diabetes is the most important risk factor for retinopathy. The more you “experience” diabetes, the more likely you are to develop eye complications. If retinopathy is not detected in the early stages or left untreated, complete blindness will occur over time.
In people with type 1 diabetes, retinopathy is rare before reaching adolescence. In adults with type 1 diabetes, retinopathy also rarely develops in the first five years of illness.
The risk of retinal damage increases with the progression of diabetes. Intensive blood sugar control can significantly reduce the risk of this complication.
Patients with type 2 diabetes typically already have initial signs of retinal changes at the time of diagnosis. In this case, the control of blood sugar, blood pressure,
cholesterol and, if necessary, timely laser treatment plays an important role in slowing down the progression of retinopathy.
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