Diabetic retinopathy treatment
Diabetic retinopathy is a retina disease due to high blood sugar levels that damage the blood vessels in the eye. Diabetic retinopathy happens in both type 1 and types 2 diabetes. It is dangerous, causing vision loss and blindness. However, retinopathy responds well to medical treatment (anti-VEGF drugs), laser therapy, and surgery.
One of the complications of diabetes is diabetic retinopathy - damage to the retinal vessels. Diabetes mellitus raises the glucose level in the blood (hyperglycemia), which disrupts blood circulation in the eye vessels (microangiopathy). High glucose levels harm the retina, so vision is impaired.
The retina comprises specialized nerve cells that convert light rays entering the eye into nerve impulses. Unfortunately, the visual cells receive too little oxygen due to damaged small blood vessels. As a result, eyesight progressively worse and even go blind in severe cases.
As a rule, this condition occurs more often in type 1 diabetes (prevalence is about 90%) than in type 2 (approximately 60%). Retinopathy usually develops 10 to 15 years after diabetes has been diagnosed.
Ophthalmologists, together with endocrinologists, distinguish two different stages of diabetic retinal disease:
- The initial stage is non-proliferative. It means that no new retinal vessels are formed at this phase. However, the eye tissue is already poorly supplied with blood, and the retina cells receive too little oxygen. Therefore, it causes changes in the retina.
- The initial stage often progresses to proliferative diabetic retinopathy years later, with the risk of blindness. This phase is advanced. The organism tries to compensate for the lack of oxygen in the retina by forming new blood vessels. However, these new blood vessels are unstable and leaky and tend to rupture or burst.
In addition, if damage occurs to the retina in the macula area (where vision is sharpest), doctors speak of diabetic maculopathy. Typically, fluid accumulates in the tissue (macular oedema). Therefore, patients experience difficulties, for example, when driving a car or reading.
Causes for diabetic retinopathy
Persistently high blood sugar levels cause diabetic retinal disease. Retinopathy occurs in most patients with diabetes mellitus. Glucose damages the walls of small vessels (microangiopathy). And above all, it affects the vessels of the retina.
In addition to elevated blood sugar levels, favourable factors for the development of such disorder as:
- High blood pressure (arterial hypertension);
- Elevated cholesterol;
- Chronic renal failure.
Pregnancy, smoking, hereditary predisposition, as well as the pubertal age of the patient, can also provoke the development of retinopathy.
Symptoms of retinal damage
Due to damage to the retinal nerve cells, vision gradually deteriorates. It takes years. Therefore, the initial signs of diabetic retinopathy may go unnoticed. When the changed retinal vessels are impaired, and blood seeps from them, or they overlap due to thrombosis, then the first symptoms appear:
- Blurred image;
- Poor vision in the dark;
- Haemorrhages in the eye;
- Flies and a spot before the eyes;
- A dark or empty hole in the centre of the picture.
More dangerous signs are:
- A sharp decrease in vision.
- The appearance of shines (lightning flashes).
- The momentary disappearance of a specific segment in the visual field (the formation of a veil).
Sometimes such symptoms indicate the development of retinal detachment.
How is retinopathy diagnosed?
Timely diagnosis can prevent vision loss and delay the progression of diabetic retinopathy. Ophthalmologists establish the diagnosis after a series of special studies:
- Ophthalmoscopy examines the eyes using a microscope;
- Visiometry explores visual acuity;
- Tonometry measures intraocular pressure;
- Perimetry evaluates visual fields;
- Eye ultrasound.
Fluorescein angiography is a colour study of retinal vessels in which a patient is injected with contrast, taking pictures of the eyes.
Optical coherence tomography is an innovative method that examines the layers of the retina step by step, accurately determining its integrity, thickness and presence of oedema.
Treatment of diabetic retinopathy
Depending on the form and stage of the process, doctors determine treatment options. However, blood sugar control is the best therapy, as high blood glucose levels cause diabetic retinopathy.
One treatment option that slows down or stops the process is a combination of anti-VEGF drugs and laser photocoagulation. In advanced cases, ophthalmologists recommend removing the vitreous humor (vitrectomy).
VEGF (vascular endothelial growth factor) is a substance that creates new blood vessels. The introduction of anti-VEGF drugs prevents the formation of new vessels in the retina and their bleeding. The medication is injected into the eye, namely into the vitreous body (called intravitreal injection, IVT for short).
In addition, stem cell injections into the eye are helpful for the treatment of retinopathy. Stem cells are the original structures that develop into other types of cells. This method is safe and effective for restoring retinal vessels and improving vision.
Laser therapy is used when new blood vessels have already formed in the retina (proliferative diabetic retinopathy). In such cases, the laser seals the leaking blood vessels. However, laser treatment is also useful in the severe non-proliferative stage, for example, if other risk factors are present. In several sessions, the doctor uses a laser on a particular grid to the entire retina (panretinal laser photocoagulation). Then, in the presence of macular oedema, the doctor seals leaking and sagging vessels in the macula (focal laser photocoagulation). Laser retinal therapy usually helps to stop the progression and the risk of blindness.
Vitrectomy (removal of the vitreous humor gel) makes sense in case of bleeding. After that, the formed cavity is filled with liquid or gas. It allows the light to be focused correctly on the retina again.
The prognosis for diabetic retinopathy is good if treatment is started on time. In this case, the disorder stops progressing, and there is a chance that eye changes will reverse. The success rate of surgical treatment is over 80%.
What is the best treatment for diabetic retinopathy?
The best treatment for diabetic retinopathy is a combination of laser surgery and injections of specific anti-VEGF drugs. In advanced cases, vitrectomy is performed (removal of the scrofulous body).
Do patients travel abroad for diabetic retinopathy treatment?
Of course. Medical tourism is widely developed in the field of diabetic retinopathy treatment. Eye centres abroad specialize in providing the latest therapies for diabetic retinal damage. The modern equipment of clinics allows doctors to quickly and efficiently stop the disorder.
Can I have stem cells for diabetic retinopathy?
Yes. Stem cell therapy is an innovative cure for diabetic retinopathy. The doctor injects stem cells into one of the eyes, which prevents blindness and promotes the restoration of retinal vessels.
Can I cure diabetic retinopathy completely?
Unfortunately no. Since there is no cure for diabetes, there is no cure for diabetic retinopathy either. Constantly high blood sugar levels in diabetes damage the eye vessels permanently. To prevent severe visual impairment and blindness, patients must undergo regular eye examinations by an ophthalmologist, blood glucose monitoring, and treatment with drugs or surgery.
Is diabetic retinopathy progressing fast?
The rate at which diabetic retinopathy develops depends on the type of diabetes and the level of blood sugar control. On average, 20% of patients develop retinopathy after five years of diabetes, while after 15-20 years of diabetes, more than 90% of people develop this complication.
Where can I get Diabetic retinopathy treatment?
What are the best clinics for Diabetic retinopathy treatment?
Who are the best doctors for Diabetic retinopathy?
Prof. Dr. med. Mathias Maier from University Hospital rechts der Isar Munich
Prof. Dr. med. Manfred Tetz from MEOCLINIC Berlin
Prof. Dr. med. Frank Koch from Eye Centre Frankfurt am Main
Dr. med. Detlef Deiermann from Academic Hospital Bundeswehr Berlin
Prof. Dr. med. Thomas Kohnen from University Hospital Frankfurt am Main of Goethe-University