糖尿病視網膜病變:原因、症狀、治療

Early symptoms: None
Later symptoms: loss of central vision, blurred or wavy central vision, drusen.

Diabetic retinopathy (DR) is a common complication of diabetes. It is the leading cause of blindness among adults in the United States. It is characterized by progressive damage to blood vessels in the retina, the light-sensitive tissue at the back of the eye that is necessary for good vision. The progression of DR is divided into four stages:

  • Mild nonproliferative retinopathy (microaneurysm)
  • Moderate nonproliferative retinopathy (occlusion of certain retinal blood vessels)
  • Severe non-proliferative retinopathy (more blood vessels are blocked, resulting in insufficient blood supply to the retina, resulting in the growth of new blood vessels)
  • Proliferative retinopathy (most advanced stage).

The risk of DR can be reduced through disease management, including good control of blood sugar, blood pressure, and dyslipidemia. Early diagnosis and prompt treatment of DR can reduce the risk of vision loss; however, up to 50% of patients do not receive eye examinations or are diagnosed too late for treatment to be effective. It is the leading cause of blindness among working-age adults aged 20-74 years in the United States. An estimated 4.1 million and 899,000 Americans have retinopathy and sight-threatening retinopathy, respectively.

Two stages of diabetic eye disease

Diabetic eye disease has two main stages.

NPDR (non-proliferative diabetic retinopathy)

This is the early stage of diabetic eye disease. Many people with diabetes have this condition.

In NPDR, tiny blood vessels leak, causing the retina to swell. When the macula swells, it is called macular edema. This is the most common cause of vision loss in people with diabetes.

Additionally, with NPDR, blood vessels in the retina may close. This is called macular ischemia . When this happens, blood cannot reach the macula. Sometimes, tiny particles called exudates form in the retina. These can also affect your vision.

If you have NPDR, your vision becomes blurry.

PDR (proliferative diabetic retinopathy)

PDR is a more advanced stage of diabetic eye disease. This happens when the retina begins to grow new blood vessels. This is called neovascularization. These fragile new blood vessels often leak into the vitreous. If there is just a little bit of bleeding, you may see some black floaters. If the bleeding is excessive, it may block all vision.

These new blood vessels can form scar tissue. Scar tissue may cause problems in the macula or lead to retinal detachment.

PDR is so severe that it can steal your central vision and peripheral side vision.

What happens when you have diabetic retinopathy?

You may have diabetic retinopathy and not know it. This is because it often has no symptoms in its early stages. As diabetic retinopathy worsens, you may notice the following symptoms:

  • Seeing that the number of patients with floaters is increasing,
  • blurred vision,
  • Vision sometimes changes from blurry to clear,
  • Seeing blank or dark areas in your field of vision,
  • Poor night vision, and
  • Notice colors appearing faded or faded
  • Loss of vision.

Diabetic retinopathy symptoms usually affect both eyes.

Diabetic Retinopathy Diagnosis

Place drops into your eyes to dilate your pupils. This allows your eye doctor to look inside your eye through special lenses.

Your doctor may perform an optical coherence tomography (OCT) scan to take a closer look at the retina. The machine scans the retina and provides detailed images of its thickness. This helps your doctor detect and measure macular swelling.

Fluorescein angiography, or OCT angiography, helps your doctor understand the condition of the blood vessels in the retina. Fluorescent angiography uses a yellow dye called luciferin, which is injected into a vein (usually in the arm). The dye travels through your blood vessels. As the dye passes through the retinal blood vessels, a special camera takes pictures of the retina. This can show if there are blockages in the blood vessels or fluid leakage. It also shows whether there are abnormal blood vessel growths. OCT angiography is a newer technology that does not require dye to view blood vessels.

Can diabetic retinopathy disappear?

Your treatment depends on what your eye doctor sees in your eye. Treatment options may include:

medical control

Controlling blood sugar and blood pressure can prevent vision loss. Carefully follow the diet recommended by your nutritionist. Take the medicines prescribed for you by your diabetes doctor. Sometimes, good sugar control can even restore some of your vision. Controlling blood pressure keeps the blood vessels in your eyes healthy.

drug

One type of drug is called an anti-VEGF drug. These include Avastin, Eylea and Lucentis. Anti-VEGF drugs can help reduce macular swelling, slow vision loss, and may improve vision. This medicine is given by injection (injection) into the eye. Steroid medications are another option for reducing macular swelling. This can also be done by injection into the eye. Your doctor will advise you on how many injections you need over time.

laser surgery

Laser surgery can be used to help seal leaky blood vessels. This can reduce retinal swelling. Laser surgery can also help shrink blood vessels and prevent them from growing again. Sometimes more than one treatment is needed.

vitrectomy

If you have advanced PDR, your eye doctor may recommend a surgery called vitrectomy. The ophthalmologist removes vitreous gel and blood from leaky blood vessels in the back of the eye. This allows the light to focus correctly on the retina again. Scar tissue from the retina may also be removed.

5 Ways to Prevent Vision Loss from Diabetic Retinopathy

  • If you have diabetes, talk with your primary care doctor about how to control your blood sugar. High blood sugar can damage retinal blood vessels. This can lead to vision loss.
  • Do you have high blood pressure or kidney problems? Ask your doctor about ways to manage and treat these problems.
  • Visit your eye doctor regularly for dilated eye exams. Diabetic retinopathy may be detected before you notice any vision problems.
  • If you notice changes in vision in one or both eyes, call your eye doctor immediately.
  • Get treatment for diabetic retinopathy as soon as possible. This is the best way to prevent vision loss.

Do you have diabetes and need an eye exam?

Changes in blood sugar levels can affect your vision. Make sure your blood sugar is under control at least a week before your eye exam. Glasses work best when worn when your blood sugar levels are stable!

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