Diabetes

As a result of diabetes mellitus, damage can occur within the eye. This damage does not always affect vision. This is called diabetic retinopathy. However, if these harmful abnormalities are not recognized and treated in time, blindness or visual impairment can result.

Cause

Diabetic retinopathy is a complication of diabetes in which changes occur in the blood vessels of the retina as well as in the rest of the body. The retina is poorly supplied with oxygen, which can cause vascular growth.
These changes can occur in two forms:

1. The wall of the small blood vessels changes, which can cause leakage of fluid and blood. If this occurs near the macula, vision can decrease. This condition is called diabetic maculopathy.
2. Similar changes can also occur outside the macula area and do not immediately affect vision; in case of minor abnormalities this is called diabetic background retinopathy. Further deterioration This can however lead to the growth of new blood vessels. These new blood vessels are very fragile and can easily cause bleeding in the vitreous humor inside the eye or seriously damage the retina resulting in worse vision. This is called a (pre-)proliferative diabetic retinopathy.

Situations 1 and 2 can occur at the same time.

The risk of developing retinopathy increases the longer the diabetes has existed and the better control of diabetes mellitus. After 10 years of diabetes, about half of the people (50%) have a form of diabetic retinopathy. Because it is possible to suffer from diabetes for a long time without noticing anything, it is wise to have your eyes checked as soon as diabetes has been diagnosed. Abnormalities may occur in the eyes that do not (yet) cause any complaints, but do require treatment to stop further damage. Your ophthalmologist can tell you how often you should have a check-up.

Diagnosis

During the examination by the ophthalmologist, the pupils are dilated with drops so that the retina can be viewed properly. These drops temporarily impair vision, so you are advised not to drive the car yourself. If abnormalities are found, it may sometimes be necessary to take pictures with contrast fluid: fluorescein angiography. A dye is injected into the arm. Sometimes this can make you feel a bit nauseous. With the help of this examination, the ophthalmologist can better assess the extent and severity of the abnormalities.

Treatment

The aim of the treatment is to slow down the development of retinopathy and thus prevent or limit poor vision. Laser treatment makes it possible to direct special light beams at the retina. In this treatment, part of the affected retina is switched off so that the demand for oxygen decreases and no more growth factors are produced: the unwanted (beginning) formation of new blood vessels then comes to a standstill and/or leakage decreases.

Depending on the nature of the abnormalities, one or more laser treatments are necessary. Since the damage to the retina caused by diabetes can continue for a long time, additional treatment may be necessary later.