Diabetic retinopathy is a damage to the retina (the light-sensitive inner lining of the back of the eye) associated with the systemic disease diabetes mellitus. Diabetic retinopathy is the leading cause of blindness among adult Americans.
What causes diabetic retinopathy?
Diabetes mellitus (also simply called diabetes) is characterized by an altered metabolism of carbohydrates and lipids, resulting in a chronic elevation in blood sugar (hyperglycemia). Hyperglycemia can lead to long-term changes in the circulatory and nervous systems in the body. The hyperglycemia experienced by diabetics is related to an inability to produce sufficient insulin, a resistance to the effects of insulin, or both.
The diagnosis of diabetes is made based on a person’s fasting plasma glucose (FPG) levels (commonly referred to as the fasting blood sugar). An FPG level of 126 mg/dL or higher indicates the presence of diabetes mellitus.
Diabetic retinopathy is a complication of diabetes in which the tiny blood vessels in the retina are damaged by the disease. Damage to the retinal blood vessels can cause a number of problems. In some cases, the damaged blood vessels leak fluid and lipids under the macula, the most sensitive part of the retina that allows us to see details. The fluid causes the macula to swell, blurring vision. In other cases, the retinal blood vessels can become blocked, causing portions of the retina to cease functioning because of lack of oxygen and nutrients.
In its advanced stage, diabetic retinopathy is characterized by the growth of fragile blood vessels along the retina and into the clear, gel-like vitreous that fills the inside of the eye. These tiny blood vessels can break open and bleed, causing vision to be obscured and permanent damage to the retina.
How common is diabetic retinopathy?
Over 18 million Americans—approximately 6.3 percent of the population—have diabetes. All people with diabetes—those with Type 1 diabetes (previously called juvenile onset diabetes) and those with Type 2 diabetes (previously called adult onset diabetes)—are at risk of developing diabetic retinopathy.
According to the National Eye Institute, nearly half of all people with diabetes will develop some degree of diabetic retinopathy in their lifetime. The longer a person has diabetes, the more likely they are to have diabetic retinopathy. After having diabetes for 15 years, about 80% of Type 1 diabetics will have some degree of retinopathy.
Risk factors for diabetes (and therefore diabetic retinopathy) include:
- Obesity (more than 20% heavier than your ideal body weight)
- A family history of diabetes
- Hypertension (blood pressure of 140/90 or higher)
- Having a high density lipoprotein (HDL or “good cholesterol”) reading of 35 mg/dL or lower
- Elevated triglyceride levels (250 mg/dL or higher)
- Having been diagnosed with gestational diabetes during a pregnancy or having given birth to a baby weighing 9 pounds or more
- Being a member of a high risk ethnic group (Type 2 diabetes is more common among Native Americans, African Americans, and Hispanic Americans)
What are the symptoms of diabetic retinopathy?
Diabetic retinopathy often has no early warning signs. There is no pain, and vision may remain unaffected until the disease becomes severe.
If leaking blood vessels cause swelling of the macula (called macular edema) central vision will become blurred, making it hard to see clearly when driving or reading. Vision may get better or worse during the day, depending on the degree of edema.
If leaking blood vessels cause bleeding in the eye, symptoms will vary based on how much blood is involved. With relatively limited bleeding, the visual disturbance may appear as spots floating in your visual field. These spots may go away after a few hours.
If bleeding is more severe, vision may suddenly become severely clouded. This can occur overnight during sleep. It may take months for the blood to clear from the eye, or it may not clear at all.
What is the treatment for diabetic retinopathy?
There are two treatments for diabetic retinopathy – laser surgery and vitrectomy. These surgical treatments are typically used only when diabetic retinopathy is in an advanced stage.
Laser surgery can be used to seal leaking blood vessels in the retina or to shrink fragile new blood vessels. Laser surgery is typically performed on an outpatient visit or in the doctor’s office. You will be able to go home the same day.
Laser surgery usually cannot restore vision that has already been lost. Therefore, early detection of diabetic retinopathy is the best way to prevent serious vision loss from the disease.If a significant amount of blood has leaked into the vitreous, a vitrectomy may be required to restore vision. In this procedure, the surgeon makes a tiny incision in the sclera and gently suctions out the bloody vitreous, replacing it with a sterile clear fluid. After the surgery, you may be able to go home the same day or you may be asked to stay in the hospital overnight.
Can diabetic retinopathy be prevented?
It’s estimated that 50% of people with Type 2 diabetes are unaware of their condition. In some cases, detection of their diabetes takes place during a routine eye exam.
During a routine eye exam, your eye doctor will examine your retina and look for early signs of diabetes. These signs include:
1. Small hemorrhages from leaking blood vessels
2. Macular edema
3. Areas of pale retina (called cotton wool spots) where blood supply has been obstructed
4. Yellowish, waxy-appearing deposits in the retina caused by localized retinal edema.
If your eye doctor (Optometrist or Ophthalmologist) detects signs of early diabetic retinopathy, they may refer you to an internist and/or an ophthalmologist who is a retinal specialist for additional testing and/or treatment.
Most cases of Type 2 diabetes can be managed through proper diet and exercise. Daily exercise and a high fiber diet with restricted amounts of carbohydrates, cholesterol, and saturated fat can improve overall health and help lower blood glucose levels. In cases where diet and exercise cannot sufficiently reduce blood glucose levels, oral medicines or injections of insulin may be added to the treatment plan.
If you have been diagnosed with diabetes, you should have an annual dilated eye exam to monitor the health of your retina. (Depending on your individual needs, your eye doctor may recommend more frequent exams.) Annual eye exams are also recommended if you are not a diabetic but have one or more of the risk factors for diabetes listed above.
Retinopathy ya kisukari ni uharibifu wa retina (upande wa ndani wa jicho unaohisi mwanga) unaohusishwa na ugonjwa wa mfumo wa kisukari. Ugonjwa wa kibofu cha macho unaosababishwa na kisukari ndio kisababishi kikuu cha upofu miongoni mwa Wamarekani wazima. Ni nini husababisha ugonjwa wa retinopathy ya kisukari? Ugonjwa wa kisukari (sukari ya kisukari) ni ugonjwa wa kawaida unaosababishwa na mabadiliko ya kimetaboliki ya wanga na lipidi, na kusababisha ongezeko la sukari ya damu (hyperglycemia). Hyperglycemia inaweza kusababisha mabadiliko ya muda mrefu katika mfumo wa mzunguko wa damu na mfumo wa neva katika mwili. Hyperglycemia inayopatikana na wagonjwa wa kisukari inahusiana na kutokuwa na uwezo wa kutengeneza insulini ya kutosha, upinzani kwa athari za insulini, au zote mbili. Ugonjwa wa kisukari huamuliwa kwa kuzingatia kiwango cha sukari ya plasma ya mtu akiwa amechoka (FPG) (kwa kawaida inajulikana kama sukari ya damu ya kumcha). Kiwango cha FPG cha 126 mg DL au zaidi kinamaanisha kuwa na ugonjwa wa kisukari. Retinopathy ya kisukari ni ugonjwa wa kisukari ambao husababisha mishipa midogo ya damu katika retina kuharibiwa na ugonjwa huo. Uharibifu wa mishipa ya damu ya retina waweza kusababisha matatizo kadhaa. Katika baadhi ya kesi, mishipa ya damu iliyoharibiwa huvuja maji na lipidi chini ya macula, sehemu nyeti zaidi ya retina ambayo inaruhusu kuona maelezo. Kioevu hicho husababisha macula kuvimba, na hivyo kufanya mtu asione vizuri. Katika visa vingine, mishipa ya damu ya retina inaweza kufungwa, na kusababisha sehemu za retina kuacha kufanya kazi kwa sababu ya ukosefu wa oksijeni na virutubisho. Katika hatua ya juu, retinopathy ya kisukari ni sifa ya ukuaji wa mishipa ya damu dhaifu kando ya retina na katika wazi, gel-kama vitreous kwamba kujaza ndani ya jicho. Mifupa hiyo midogo ya damu inaweza kuvunjika na kutokwa na damu, na hivyo kusababisha upofu wa kuona na kuharibika kwa retina. Ugonjwa wa retinopathy ya kisukari ni wa kawaida kadiri gani? Zaidi ya Wamarekani milioni 18 - karibu asilimia 6.3 ya idadi ya watu - wana ugonjwa wa kisukari. Watu wote wenye ugonjwa wa kisukari - wale walio na ugonjwa wa kisukari wa Aina ya 1 (walioitwa mapema mapema) na wale walio na ugonjwa wa kisukari wa Aina ya 2 (walioitwa mapema mapema) - wako katika hatari ya kuendeleza retinopathy ya kisukari. Kulingana na Taasisi ya Kitaifa ya Macho, karibu nusu ya watu wote wenye ugonjwa wa kisukari watapata ugonjwa wa retinopathy ya kisukari katika maisha yao. Kadiri mtu anavyoendelea kuwa na ugonjwa wa kisukari, ndivyo anavyozidi kuwa na ugonjwa wa retinopathy. Baada ya miaka 15 ya ugonjwa wa kisukari, asilimia 80 ya wagonjwa wa kisukari wa aina ya 1 watakuwa na retinopathy. Ugonjwa wa kisukari (kwa hivyo retinopathy ya kisukari) ni pamoja na: - Uzito (zaidi ya 20% nzito kuliko uzito wako wa mwili wa kawaida) - Historia ya familia ya kisukari - Hypertension ( shinikizo la damu la 140% au zaidi) - Kuwa na kiwango cha juu cha lipoprotein (HDL) au cholesterol nzuri ya 35 mg (dL) au chini - Viwango vya triglycerides vya juu au 50 mgdL au zaidi) - Kuwa na ugonjwa wa kisukari wakati wa ujauzito au kuzaa mtoto mwenye uzito wa pauni 9 au zaidi - Kuwa mwanachama wa kikundi cha kikabila cha hatari. Mara nyingi ugonjwa wa kibofu cha macho unaosababishwa na kisukari hauna dalili za mapema za kuonya. Hakuna maumivu, na uwezo wa kuona waweza kubaki bila kuathiriwa hadi ugonjwa huo uwe mkali. Ikiwa mishipa ya damu inayovuja husababisha uvimbe wa macula (inaitwa edema ya macular), maono ya kati yatakuwa magumu, na kufanya iwe vigumu kuona wazi wakati wa kuendesha gari au kusoma. Maono yanaweza kuwa bora au mabaya zaidi wakati wa mchana, ikitegemea kiwango cha uvimbe. Ikiwa mishipa ya damu inayomwagika husababisha kutokwa na damu katika jicho, dalili zitatofautiana kulingana na kiasi cha damu kinachohusika. Kwa kutokwa na damu kidogo, kasoro ya kuona yaweza kuonekana kama madoa yanayoelea katika uwanja wako wa kuona. Maeneo hayo yaweza kutoweka baada ya saa chache. Ikiwa kutokwa na damu ni kali zaidi, kwa ghafula uwezo wa kuona waweza kuwa na giza kubwa. Hilo laweza kutokea usiku kucha wakati wa usingizi. Huenda ikachukua miezi kadhaa ili damu iondoke jicho, au huenda isiondoke kabisa. Matibabu ya retinopathy ya kisukari ni nini? Kuna matibabu mawili ya retinopathy ya kisukari - upasuaji wa laser na vitrectomy. Kwa kawaida matibabu hayo ya upasuaji hutumiwa tu wakati ugonjwa wa kibofu cha macho unaopatikana katika hatua ya juu. Upasuaji wa laser unaweza kutumiwa kufunga mishipa ya damu inayovuja katika retina au kupunguza mishipa mipya ya damu ambayo ni dhaifu. Upasuaji wa laser kwa kawaida hufanywa katika ziara ya mgonjwa wa nje au katika ofisi ya daktari. Utaweza kwenda nyumbani siku hiyohiyo. Kwa kawaida upasuaji wa laser hauwezi kurudisha uwezo wa kuona ambao tayari umepotea. Kwa hivyo, kugundua mapema retinopathy ya kisukari ni njia bora ya kuzuia upotezaji mkubwa wa maono kutokana na ugonjwa huo.Kama kiasi kikubwa cha damu kimetiririka ndani ya vitreous, vitrectomy inaweza kuhitajika kurudisha maono. Katika utaratibu huu, daktari-mpasuaji hufanya upasuaji mdogo katika sclera na kwa upole kunyonya nje vitreous ya damu, kuibadilisha na kioevu wazi sterile. Baada ya upasuaji, unaweza kwenda nyumbani siku hiyohiyo au unaweza kuombwa ubaki hospitalini usiku kucha. Je, ugonjwa wa retinopathy wa kisukari waweza kuzuiwa? Inakadiriwa kuwa asilimia 50 ya watu walio na ugonjwa wa kisukari wa aina ya 2 hawajui hali yao. Katika visa fulani, ugonjwa wao wa kisukari hugunduliwa wakati wa uchunguzi wa kawaida wa macho. Wakati wa uchunguzi wa kawaida wa macho, daktari wako wa macho atachunguza retina yako na kutafuta dalili za mapema za ugonjwa wa kisukari. Dalili hizo zinatia ndani: 1. Ugonjwa wa damu mdogo kutokana na kuvuja kwa mishipa ya damu Macular edema Sehemu za retina (zilizojulikana kama nyuzi za pamba) ambapo usambazaji wa damu umezuiwa Maji ya rangi ya manjano, yenye umbo la nta katika retina yanayosababishwa na uvimbe wa retina. Kama daktari wako wa macho (Optometrist au Daktari wa Macho) anagundua dalili za retinopathy ya kisukari mapema, wanaweza kukuelekeza kwa daktari wa ndani na daktari wa macho ambaye ni mtaalamu wa retina kwa ajili ya upimaji wa ziada na matibabu. Kwa kawaida, ugonjwa wa kisukari wa aina ya 2 unaweza kushughulikiwa kwa kutumia chakula na mazoezi sahihi. Mazoezi ya kila siku na kula vyakula vyenye nyuzinyuzi nyingi na kiasi kidogo cha wanga, kolesteroli, na mafuta yaliyojaa yanaweza kuboresha afya ya jumla na kusaidia kupunguza viwango vya sukari katika damu. Katika kesi ambapo lishe na mazoezi hayawezi kupunguza viwango vya sukari ya damu, dawa za mdomo au sindano za insulini zinaweza kuongezwa kwenye mpango wa matibabu. Ikiwa umegunduliwa kuwa na ugonjwa wa kisukari, unapaswa kufanya uchunguzi wa macho kila mwaka ili uone afya ya retina yako. (Kulingana na mahitaji yako ya kibinafsi, daktari wako wa macho aweza kupendekeza uchunguzi wa mara kwa mara zaidi.) Uchunguzi wa macho wa kila mwaka unapendekezwa pia ikiwa wewe si mgonjwa wa kisukari lakini una moja au zaidi ya sababu za hatari za kisukari zilizoorodheshwa hapo juu.