Preservation of vision in diabetes

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Visual preservation in diabetes: complex guide

Diabetes, a disease characterized by an increased blood sugar, has a serious effect on many organs, including eyes. Diabetic retinopathy, diabetic macular edema, glaucoma and cataracts are the most common eye diseases associated with diabetes, and they can lead to a significant deterioration in vision and even blindness if they are not detected and treated in time. This comprehensive guide is devoted to strategies for preserving vision in diabetes, covering prevention, early diagnosis, treatment and self -control.

I. Understanding risks: eye diseases associated with diabetes

The first step towards preserving vision is the awareness of risks associated with diabetes. Understanding the pathogenesis of each disease will make it possible to make more conscious decisions regarding prevention and treatment.

  • Diabetic Retinopathy (DR):

    • Pathogenesis: The high level of blood sugar damages small blood vessels in the retina, photosensitive tissue located in the rear of the eye. These vessels can weaken, leak blood and liquid (non -spheret diabetic retinopathy – NDR), or in response to a lack of oxygen, the retina can produce new, but fragile and easily bleeding vessels (proliferative diabetic retinopathy – PDR).
    • Stages:
      • INSTRUCTIVITIVATIVE DIABIC RETINOPAIT (NDR): The early stage, characterized by microanevrisms (tiny bloating in the walls of blood vessels), hemorrhages and lipid deposits. Vision can be normal or slightly worsened.
      • Reproliferative Diabetic Retinopathy (PPDR): Vascular changes become more pronounced, signs of ischemia (lack of oxygen) appear in the retina.
      • Proliferative diabetic retinopathy (PDR): The most severe stage, characterized by the growth of new vessels on the surface of the retina and optic disk. These vessels are easily bleeding, which can lead to hemorrhage into the vitreous body (hemophthalm) and the formation of scar tissue, which can cause detachment of the retina and loss of vision.
    • Risk factors: Duration of diabetes, poor control of blood sugar, high blood pressure, high cholesterol, pregnancy, smoking.

  • Diabetic macular edema (DMO):

    • Pathogenesis: The accumulation of fluid in the makul, the central part of the retina, responsible for acute vision. DMO often accompanies DR, but can arise independently. Damaged retinal vessels pass the liquid and proteins into the macula, causing its edema and deformation.
    • Symptoms: Turning vision, distortion of objects, reducing visual acuity, especially when reading and driving.
    • Risk factors: Duration of diabetes, poor control of blood sugar, high blood pressure, high cholesterol.

  • Glaucoma:

    • Pathogenesis: A group of diseases characterized by progressive damage to the optic nerve, which leads to a loss of peripheral vision. Diabetes increases the risk of glaucoma, especially open -angle glaucoma, the most common type. Increased intraocular pressure (IPD) is the main risk factor for damage to the optic nerve for glaucoma. Diabetes can affect the drainage system of the eye, making it difficult to outflow of intraocular fluid and increasing the IOA. In addition, new vessels formed with PDR can block the drainage system, leading to neovascular glaucoma, especially aggressive form.
    • Types of glaucoma associated with diabetes:
      • Open -angle glaucoma: The most common type is characterized by a gradual increase in ICD and a slow, often inconspicuous narrowing of the field of view.
      • Neovascular glaucoma: It develops as a complication of PDR when new vessels block the drainage system of the eye.
    • Risk factors: Duration of diabetes, poor control of blood sugar, high blood pressure, family history of glaucoma.

  • Cataract:

    • Pathogenesis: The clouding of the lens of the eye, which leads to a deterioration in vision. Diabetes accelerates the process of cataract formation, and can also lead to the development of earlier and aggressive forms. The high level of blood sugar can change the structure of proteins in the lens, which leads to their aggregation and clouding. In addition, diabetes can affect the activity of enzymes involved in maintaining the transparency of the lens.
    • Symptoms: Turning vision, deterioration of vision at dusk, increased sensitivity to bright light, double in the eyes, a change in the perception of colors.
    • Risk factors: Duration of diabetes, poor control of blood sugar, age, smoking, ultraviolet radiation.

II. Prevention: Diabetes control – the key to preservation of vision

The most effective way to prevent or slow down the development of eye diseases associated with diabetes is strict control of blood sugar. Control of other risk factors also plays an important role.

  • Maintaining the optimal blood sugar level:

    • Regular monitoring: Regularly measure blood sugar with a glucometer and record the results. Discuss the results with the doctor to adjust the treatment plan.
    • Compliance with a diet: Adhere to a balanced diet with a low sugar content, saturated fats and treated carbohydrates. Use a lot of fruits, vegetables and whole grains.
    • Regular physical exercises: Physical activity helps reduce blood sugar and improve insulin sensitivity. Strive at least 150 minutes of moderate physical exercises per week.
    • Medication: Take medications prescribed by the doctor in diabetes in accordance with the instructions.

  • Control of blood pressure and cholesterol level:

    • Regular monitoring of blood pressure: Regularly measure blood pressure and take measures to maintain it within normal limits (usually below 130/80 mm Hg).
    • Compliance with a low salt and fat diet: Limit the consumption of salt, saturated fats and trans fats. Use products rich in potassium and magnesium.
    • Medication: Take medications prescribed by the doctor to reduce blood pressure and cholesterol in accordance with the instructions.

  • Healthy lifestyle:

    • Refusal of smoking: Smoking worsens blood circulation and increases the risk of eye diseases.
    • Maintaining a healthy weight: Excessive weight increases the risk of diabetes and its complications.
    • Regular physical exercises: In addition to controlling blood sugar, physical exercises help reduce blood pressure and cholesterol.
    • Sufficient sleep: A lack of sleep can worsen control of blood sugar.
    • Stress management: Chronic stress can increase blood sugar.

III. Early diagnosis: regular eye examinations – the key to preservation of vision

Early diagnosis of eye diseases associated with diabetes is crucial for preventing loss of vision. Regular eye examinations allow you to identify diseases in the early stages, when treatment is most effective.

  • Examination frequency:

    • Type 1 diabetes: The first eye examination should be carried out 5 years after the diagnosis.
    • Type 2 diabetes: The first eye examination should be carried out immediately after the diagnosis.
    • Further examinations: After the first examination of the eyes, annual examinations must be carried out if there are no signs of eye diseases. If you have discovered signs of diabetic retinopathy or other eye diseases associated with diabetes, you may require a more frequent examination.
    • Pregnancy: Women with diabetes planning pregnancy or pregnant women need to undergo eye examination in the first trimester and regularly observed during pregnancy and after childbirth.

  • Diagnostic procedures:

    • Expansion of the pupils: Drops for expanding the pupils allow the doctor to better see the retina and visual nerve.
    • Ophthalmoscopy: Settage examination using an ophthalmoscope.
    • Tonometry: Measurement of intraocular pressure to detect glaucoma.
    • Optical coherent tomography (OKT): The visualization method, which allows you to get detailed images of the retina and macula to detect DMOs and other diseases.
    • Fluorescence angiography (phage): The method of visualization of blood vessels of the retina using a contrast agent introduced into Vienna. The phage allows you to identify abnormal vessels and areas of ischemia.
    • Perimetry: Testing of the field of view to detect glaucoma and other diseases that affect the visual nerve.

IV. Treatment: Modern methods for preserving vision

Currently, there are many effective methods of treating eye diseases associated with diabetes that can slow down the progression of the disease and maintain vision. The choice of treatment method depends on the type and stage of the disease.

  • Treatment of diabetic retinopathy (DR):

    • Monitoring the level of sugar in the blood, blood pressure and cholesterol level: This is the main method of treatment at all stages of others.
    • Lasersnaya coagulation: Used for the treatment of PDR and DMO. Laser rays are used to destroy abnormal vessels and reduce macula edema.
      • Focal laser coagulation: It is used to treat the DMO caused by leaking vessels.
      • Panretinal laser coagulation (PC): It is used to treat PDR by destroying the peripheral part of the retina, which reduces the need for oxygen and suppresses the growth of new vessels.
    • Intravitreal injections of anti-VEGF drugs: Anti-VEGF preparations (for example, Afliebercept, Bevacizumab, Ranibizumab) block the vascular endothelium factor (VEGF), which stimulates the growth of new vessels and causes macula edema. Anti-VEGF injections are introduced directly into the vitreous body of the eye.
    • Intravitreal injections of corticosteroids: Corticosteroids (for example, triamcinone) have anti -inflammatory effects and can be used to treat the DMO. However, corticosteroids can increase intraocular pressure and risk of cataracts.
    • Vitrectomy: The surgical procedure in which the vitreous body is removed to remove blood and cicatricial tissue, as well as to restore the exfolved retina. Vitrectomy is used to treat PDR complications, such as hemophthalmos and retinal detachment.

  • Treatment of diabetic macular edema (DMO):

    • Intravitreal injections of anti-VEGF drugs: Are the main method of treating DMO.
    • Intravitreal injections of corticosteroids: Can be used in cases where anti-VEGF drugs are ineffective or contraindicated.
    • Lasersnaya coagulation: Focal laser coagulation can be used for the treatment of DMO caused by rejoicing vessels.

  • Glaucoma treatment:

    • Eye drops: Used to reduce intraocular pressure. There are several types of eye drops that reduce the IOA, including analogues of prostaglandins, beta-blockers, alpha agonists and carbooangidrase inhibitors.
    • Laser treatment: It can be used to reduce intraocular pressure.
      • Selective laser trabeculoplasty (SLT): It is used to improve the outflow of intraocular fluid through the drainage system of the eye.
      • Laser iridotomy: It is used to treat close -up glaucoma by creating a hole in the iris, which facilitates the outflow of intraocular fluid.
    • Surgical treatment: It may be required if eye drops and laser treatment are ineffective.
      • Trabeculectomy: A surgical procedure in which a new path for the outflow of intraocular fluid is created.
      • Implantation of drainage devices: A surgical procedure in which a small device for an outflow of intraocular fluid is implanted in the eye.
      • Microtinating glaucoma surgery (MIGS): Less invasive surgical procedures that can be used to reduce intraocular pressure.

  • Cataract treatment:

    • Surgical treatment: The only effective method for treating cataracts. Cataract surgery consists in removing a clouded lens and artificial lens implantation. This is a common and safe procedure.

V. Self -control and eye care: Active participation in the preservation of vision

In addition to regular eye examinations and compliance with the doctor’s recommendations, self -control and proper care of the eyes play an important role in preserving vision in diabetes.

  • Regular vision monitoring:

    • Ammler test: Use the AMSler test to independently check for visual distortion, which may be a sign of DMO.
    • Regular reading and checking visual acuity: Pay attention to any changes in visual acuity.

  • Correct lighting:

    • Sufficient lighting: Provide sufficient lighting when reading, working and performing other tasks.
    • Avoid bright light: Avoid the effects of bright light that can weigh the eyes.

  • Eye Protection from the Sun:

    • Wearing sunglasses: Wear sunglasses with protection against ultraviolet radiation when staying on the street.

  • Regular breaks when working at the computer:

    • Rule 20-20-20: Every 20 minutes take a break and look at an object located at a distance of 20 feet (6 meters) for 20 seconds.
    • Adjusting the brightness and contrast of the monitor: Adjust the brightness and contrast of the monitor to reduce the load on the eyes.

  • Moisturization of the eyes:

    • Using artificial tears: Use artificial tears to moisturize the eyes, especially if you feel dry and discomfort.

  • Proper nutrition:

    • The use of products useful for the eyes: Use products rich in antioxidants, such as fruits, vegetables and green tea.
    • Omega-3 fatty acids: Omega-3 fatty acids contained in fish and linen seed are useful for the health of the eyes.

  • Timely seeking a doctor:

    • Immediately seeking a doctor for any change in vision: When any changes in vision, such as clouding of vision, distortion of objects, the appearance of floating flies or flashes of light, immediately consult a doctor.

VI. Psychological support: overcoming fear and anxiety

The diagnosis of diabetes and the risk of developing eye diseases can cause fear and anxiety. It is important to receive psychological support and learn how to cope with stress.

  • Appeal to a psychologist or psychotherapist: A psychologist or psychotherapist can help you cope with fear, anxiety and depression associated with diabetes.
  • Support groups: Participation in support groups for people with diabetes can help you feel less single and receive support from other people who are faced with similar problems.
  • Relaxation techniques: Explore relaxation techniques such as meditation, yoga and deep breath to reduce stress and anxiety.
  • Active lifestyle: Maintaining an active lifestyle, including regular physical exercises and social contacts, can help improve mood and reduce stress.

VII. Future areas: research and new technologies

Studies in the treatment of eye diseases associated with diabetes are constantly developing. New technologies and treatment methods promise even more effective ways to preserve vision.

  • New Anti-VEGF drugs: New anti-VEGF drugs with a longer effect and a lower injection frequency are being developed.
  • Gene therapy: Gene therapy can be used to restore damaged retinal cells and prevent the development of eye diseases.
  • Artificial intelligence (AI): AI can be used to automatically analyze the images of the retina and identify signs of diabetic retinopathy in the early stages.
  • New methods of laser coagulation: New methods of laser coagulation are developed, which are more accurate and less traumatic for the retina.
  • Telemedicine: Telemedicine can be used to screening for diabetic retinopathy in remote areas where there is no access to qualified medical care.

VIII. Conclusion

Preservation of vision in diabetes requires a comprehensive approach, including strict control of blood sugar, regular eye examinations, timely treatment and active self -control. The adoption of these measures can help prevent or slow down the development of eye diseases associated with diabetes and maintain vision for many years. Regular visits to the ophthalmologist, active participation in their own treatment and following the advice of experts-this is the key to the successful struggle with diabetic lesions of the eyes and preservation of high quality life. Remember, early detection and timely treatment can prevent serious consequences and maintain your vision.

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