One of the risks of poorly controlled diabetes is vision loss due to something called diabetic retinopathy. Experts discuss the treatments and difficulties faced by patients with this condition.
Poorly controlled diabetes can cause significant retinal damage, potentially leading to permanent vision loss. Diabetic retinopathy is the leading cause of blindness in working-age adults worldwide.
The spread of the disease is worrying for experts. It is projected that by 2030, there will be 130 million patients suffering from it, and by 2045, 161 million.
Some symptoms or signs that warrant a visit to a specialist include blurred vision, blank or dark areas in the visual field, poor night vision, and the appearance of spots or flashes.
Dr. Edgar Alejandro Rosales, in an article titled Clinical and epidemiological characterization of patients with diabetic retinopathy in the first consultation, published at the Dr. Rodolfo Robles Valverde Eye and Ear Hospital, describes that 2,806 clinical records of patients who attended the retinovascular clinic for the first time in 2018 were identified, through an Excel database.
Of the above figure, 357 clinical records of patients diagnosed with retinopathy were identified. One in ten patients who attended for the first time had a diagnosis of retinopathy due to diabetes. 63.8% of the population was female, and the remaining 36.2% was male. Their ages ranged from 27 to 84 years, according to the study.
Why does diabetes affect the eyes?
Sugar should be present in the blood and stored in certain parts of the body, but if it’s present in excess, it can reach the eyes, the nerves in the legs, the kidneys, and the heart, causing various problems. These are the complications of diabetes.
For her part, Lilyan León Nieto, an ophthalmologist at Visualiza, comments that the retina, the inner layer that covers the eye and allows vision, is affected by high blood sugar levels, which destroy the veins that supply blood to the eye, harming its health and vision. “It affects the ability to see and could even reduce independence,” she explains.
Damage to the blood vessels in the retina can cause them to swell and leak fluid. They can also close, impeding blood flow. Occasionally, new, abnormal blood vessels form in the retina. All of these changes can lead to vision loss, according to the Mayo Clinic.
One suggestion is for all patients to know their glycated hemoglobin levels. This periodic test indicates their blood sugar level over the past three months. It’s essential to know this information, along with their name, phone number, or address. If you only perform the test by pricking your finger, you’ll only know their blood sugar level at that moment, but not how it will change throughout the day.
“This condition affects the lives of Guatemalans, reducing their ability to work, especially in tasks that require vision, such as using computers and reading reports,” says León Nieto.
The ophthalmologist also points out that other conditions related to high blood sugar include dry eyes, complications with cataracts, glaucoma, and anterior ischemic optic neuropathy, an eye disease that causes sudden vision loss.
It’s important to recognize that diabetes itself doesn’t affect the immune system, but uncontrolled diabetes does. When blood sugar levels are very high, a person with diabetes may experience decreased immune system activity, which worsens infections. However, if the person’s condition is under control, they are no more at risk of getting sick than someone without diabetes.
Obesity, overweight, and physical inactivity are among the main causes of the increase in diabetes cases.
“Understanding diabetes is essential to improving patients’ conditions. We must implement actions that provide them with a better quality of life. The disease can present symptoms such as frequent urination, excessive thirst, dry mouth, unintentional weight loss, blurred vision, lack of energy, fatigue, slow-healing wounds, recurring skin infections, and tingling or numbness in the hands and feet. Recognizing these symptoms allows for early diagnosis, which prevents or delays complications in patients,” explains Andrés Rojas, AstraZeneca’s medical director for Central America and the Caribbean.
What assessments should be performed for retinal monitoring?
Fabiola Prado, an internist, diabetes specialist, and doctor of education, comments that this disease is a serious condition. “With regular exams and good diabetes control, it is possible to protect eye health and avoid serious complications. We recommend that all people with diabetes have a retinal photo of both eyes taken at least once a year to protect their vision and prevent further problems.”
Diagnosis includes medical tests such as blood glucose, fasting glucose, glycosylated hemoglobin, and blood glucose monitoring, all performed under medical supervision. Once the disease is confirmed, treatment will depend on the type of diabetes and may include daily insulin injections or specific medications that stabilize insulin production.
Available treatments
León Nieto explains that there are multiple treatments for each case. These include intravitreal injections, which prevent the formation of abnormal vessels and macular edema (inflammation of the macula of the eye). There is also laser photocoagulation, which prevents the progression of abnormal vessels, and vitreoretinal surgery, which eliminates hemorrhages and repairs retinal detachments. This last option is for severe cases.
Lost vision often cannot be recovered. The idea is to prevent it and maintain good comprehensive care that allows the patient to adopt healthy habits, says León Nieto.
“In severe cases, where the patient has no option for medical treatment and has lost their sight, they may need psychological support and guidance to return to their daily activities,” he says.
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