Diabetic Retinopathy

Diabetic Retinopathy: A Silent Enemy of Vision

Diabetic retinopathy (DR) is the leading cause of irreversible blindness in working-age adults (20-65 years). It is estimated that 1 in 3 people with diabetes will develop it at some point in their lives. Its danger lies in the fact that it doesn't present symptoms until its advanced stages, making annual fundus examinations crucial for early detection.

What is Diabetic Retinopathy?

It is a vascular complication of diabetes that damages the small blood vessels of the retina, causing:

✔ Fluid leakage (macular edema).

✔ Abnormal vessel formation (neovascularization).

✔ Hemorrhages and retinal detachment.

Risk factors:

Poorly controlled diabetes (HbA1c >7%).

Time of onset: >10 years with type 1 or type 2 diabetes.

Uncontrolled high blood pressure.

Pregnancy (diabetic retinopathy can progress rapidly).

Why is an Annual Fundus Examination Vital?

A dilated fundus examination is the only way to detect early signs, such as:

🔹 Microaneurysms (red dots on the retina).

🔹 Hard exudates (lipid deposits due to vascular leaks).

🔹 Retinal hemorrhages.

Alarming Facts:

90% of cases of blindness due to DR are preventable with timely diagnosis (WHO).

In Mexico, only 30% of diabetics undergo an annual fundus examination (ENSANUT).

Serious Complications if Left Untreated

1. Diabetic Macular Edema (DME)

Accumulation of fluid in the macula (central area of ​​vision).

Symptoms: Blurred vision, image distortion (metamorphopsia).

Treatment: Intravitreal injections of anti-VEGF (Aflibercept, Ranibizumab) or focal laser.

2. Proliferative Diabetic Retinopathy (PDR)

Abnormal vessel growth that bleeds easily.

Risks:

Vitreous hemorrhage (bleeding inside the eye, vision of "dark cobwebs").

Tractional retinal detachment (urgent vitrectomy surgery).

Treatment: Laser panphotocoagulation (PRP) + anti-VEGF injections.

3. Neovascular Glaucoma

Abnormal vessels block aqueous humor drainage, raising intraocular pressure.

Intense pain and rapid vision loss.

Requires urgent surgery (drainage valves).

How is it diagnosed?

Dilated fundus examination (ophthalmoscopy).

Optical Coherence Tomography (OCT): Evaluates macular edema.

Fluorescein angiography: Identifies damaged blood vessels.

Diabetic Retinopathy (DR) Classification:

Mild non-proliferative: Microaneurysms.

Annual follow-up.

Moderate non-proliferative: Hemorrhages, exudates.

Follow-up every 6 months.

Severe non-proliferative: >20 hemorrhages in 4 quadrants.

Follow-up every 3 months or sooner, depending on severity.

Proliferative Neovessels: Vitreous hemorrhage.

Emergency treatment.

Current Treatments

Intravitreal injections: Anti-VEGF (Eylea®, Lucentis®) or steroids (Ozurdex®).

Laser:

Focal: For macular edema.

Panphotocoagulation (PRP): In proliferative retinopathy.

Vitrectomy: For vitreous hemorrhages or retinal detachment.

Note: No treatment works if diabetes control is poor.

Prevention: The Key to Saving Vision

✔ Strict glucose control (HbA1c <7%).

✔ Annual fundus examination (from the moment of diabetes diagnosis).

✔ Blood pressure and cholesterol monitoring.

✔ Quit smoking (doubles the risk of DR).

Urgent Message for Diabetic Patients

"If you have diabetes, your sugar is damaging your eyes even if you don't realize it."

Blindness due to DR is irreversible, but preventable with timely checkups.

Don't wait for symptoms: Macular edema and proliferative retinopathy don't hurt or give warning.