Diabetic retinopathy refers to the retinal changes occurring in patients with diabetes mellitus (DM). These changes affect small blood vessels in the retina and may cause vision loss in different ways; it is one of the main causes of visual loss in working-age adults.
Although defects on neurosensory function of the retina have been witnessed before vascular injuries in patients suffering from DM, early and most commonly observable clinic manifestations include microaneurysm formation and intraretinal hemorrhages. Microvascular damage consequently leads to the absence of capillary perfusion and its ischemia (infarction), higher number of hemorrhages, venous anomalies and intraretinal microvascular. At this developmental stage, the increase of vascular permeability may result in thickening of the retina (by fluid accumulation – edema) and/or exudate that may lead to the loss of central visual acuity. More advanced and serious stages may include the growth of bleeding arteries with abnormal structure and function and may evolve to glaucoma and retinal detachment.
DM’s duration is an important factor of risk associated to diabetic retinopathy development. After 5 years, approximately 25% of type I patients will have retinopathy. In type II patients with more than 30 years old suffering from DM for less than 5 years, 40% of insulin takers and 24% of non insulin takers have retinopathy. Glycemic control is the main changeable factor of risk associated to retinopathy development as well as to its therapeutic success. In most patients glycemic control is recommended for a 7% HbA1c, while in specific patients it might be helpful to establish a lower goal of 6,5%.
Retinopathy treatment recommendations are established according to severity and include intravitreal injection of anti-VEGF agents, retina’s LASER and surgery. Efficient treatment is primarily dependent on prompt intervention, even if sometimes there is a good visual acuity and absence of ocular symptoms.
Therefore, SCREENING has a crucial importance in managing the diabetic’s medical situation and should be performed EVERY YEAR!