Diabetic retinopathy is an eye disorder that occurs in people with diabetes. In the beginning, diabetic retinopathy often shows only mild symptoms or even no symptoms at all. However, if left untreated, diabetic retinopathy can lead to blindness.
Based on World Health Organization (WHO) data, diabetic retinopathy is the fifth cause of visual impairment and the fourth cause of blindness in the world. In 2010, this condition was experienced by 39.3 million people worldwide. While in Indonesia, the incidence of diabetic retinopathy in people with diabetes is 42.6%.
Causes of Diabetic Retinopathy
Diabetic retinopathy is one of the complications of diabetes . This complication causes a blockage in the blood vessels in the retina of the eye.
The retina is the layer at the back of the eye that is sensitive to light. The retina functions to change the light that enters the eye into an electrical signal that is then passed on to the brain. In the brain, the electrical signal will be perceived as an image.
In order to function properly, the retina needs a blood supply from the surrounding blood vessels. In people with diabetes, high blood sugar levels can cause gradual blockage of blood vessels so that blood supply to the retina is reduced.
Blockage of the retina will trigger the formation of new blood vessels to meet blood needs. However, these new blood vessels are not fully developed so they are prone to rupture or damage.
Risk factors for diabetic retinopathy
All diabetics are at risk of developing diabetic retinopathy, but the risk will be higher if they have the following factors:
- High cholesterol levels
- High blood pressure
- is pregnant
- Smoking habits
- Blood sugar levels are not well controlled
- High blood sugar levels ( hyperglycemia ) for a long time
Symptoms of Diabetic Retinopathy
Initially, diabetic retinopathy does not show symptoms, but over time, the following symptoms will appear:
- Vision gradually declines
- Black spots on vision
- Stains that float on vision ( floaters )
- Shadow vision
- Eye pain or red eyes
When should you go to the doctor?
If you suffer from diabetes, do an eye examination to the doctor routinely to make sure your vision is not problematic. Do not wait for the symptoms of diabetic retinopathy to get worse. Also, contact your doctor if your vision is spotty or blurry.
Pregnant women with diabetes are at high risk of developing diabetic retinopathy. Therefore, it is important for pregnant women with diabetes to undergo routine eye examinations.
Diagnosis of Diabetic Retinopathy
After asking questions and answers related to disease history and lifestyle, the doctor will look inside the eyeball with a special tool called an ophthalmoscope .
Before the examination with an ophthalmoscope, the doctor will give eye drops to dilate the pupil so that the inside of the eyeball will be clearly visible. It should be noted that the eye drops can blur vision for several hours.
During the examination, the doctor will check for signs of diabetic retinopathy, such as:
- Abnormal blood vessels
- Swelling and accumulation of blood or fat in the retina
- Growth of new blood vessels and scar tissue
- Bleeding in the center of the eyeball
- Detachment of the retina ( retinal ablation )
- Disorders of the optic nerve
When necessary, the doctor will perform further examinations, such as:
The doctor will inject dye liquid into the vein in the patient's arm. Next, the doctor will take pictures with a special camera when the dye fluid enters the blood vessels in the eyeball. Through the picture, the blockage or leakage in the blood vessels in the eye can be seen.
Optical coherence tomography (OCT)
The purpose of this examination is to provide an overview of the thickness of the retina. Through OCT, doctors can clearly see damage to the retina. OCT examination is also used to evaluate the success of therapy.
Treatment of Diabetic Retinopathy
Treatment of diabetic retinopathy depends on its severity. In patients with early stage diabetic retinopathy, treatment is not required. However, doctors will encourage patients to regularly control blood sugar levels and eye health.
Whereas in cases of advanced diabetic retinopathy, doctors can recommend a number of medical procedures, namely:
Inject medicine into the eye
The doctor will inject medicine directly into the eyeball, to prevent the formation of new blood vessels. The drug given is bevacizumab.
Vitrectomy is done by making a small incision in the eye. The purpose is to remove blood and remove scar tissue from the center of the eye.
Photocoagulation is a laser beam therapy to slow down or stop the leakage of fluid and blood inside the eyeball. This therapy is performed by firing laser beams focused on abnormal blood vessels.
Complications of Diabetic Retinopathy
If not treated immediately, diabetic retinopathy can cause serious vision impairment, even blindness . Some complications of diabetic retinopathy that may occur are:
Bleeding in the center of the eye (vitreous)
This condition occurs when blood enters the center of the eye due to the rupture of newly formed blood vessels. Leaking blood will make the eye obstructed by floating blood and cell particles. If there is enough blood leaking, the patient's vision will be completely blocked.
Although vitreous hemorrhage generally disappears in a matter of weeks or months, patients are still at risk of permanent vision loss if the retina has been damaged.
The new blood vessels that appear will stimulate the formation of scar tissue on the retina. The scar tissue will pull the retina from its position causing blurred vision, and can even trigger blindness.
When new blood vessels grow in the front of the eye, the tear duct can become blocked. This condition will trigger glaucoma , which is an increase in pressure in the eyeball that can damage nerves and cause visual impairment.
If not treated promptly, diabetic retinopathy, glaucoma, or a combination of the two, can lead to blindness.
Prevention of Diabetic Retinopathy
The way to prevent diabetic retinopathy is to prevent diabetes, that is by keeping blood sugar levels normal. Whereas for diabetics, there are a number of efforts that can be made to reduce the risk of diabetic retinopathy:
- Monitor and record blood sugar levels several times a day, then report the results to the doctor during control.
- Consuming food with complete and balanced nutrition.
- Increase intake of fruits and vegetables.
- Limit the intake of sugar and saturated fat .
- Lose weight to reach the body mass index (BMI)
- Do sports with moderate intensity, such as brisk walking, at least 150 minutes per week.
- Use blood sugar control drugs or insulin as recommended by the doctor.
- Always be alert if you feel any changes in vision.
- Stop smoking or consuming alcoholic beverages.
- Keep cholesterol levels and blood pressure normal.
- Do a routine eye examination , at least once a year.