Diabetes and eye disease: doctor describes how to preserve eyesight from deteriorating due to this disease


Professor Dragan Veselinović, MD, Ophthalmologist, Special hospital for eye disease “Klinika Veselinović”

Around 60 million people in Europe suffer from diabetes, a disease which may cause various complications

463 million people between the ages 20 and 79 suffer from diabetes worldwide, and half of them have not been diagnosed. For X-Lab, an expert research hub by JGL, Professor Dragan Veselinović, MD, analyses in detail what this means for the timely detection of eye disease caused by diabetes.
“Every new diabetes patient requires an ophthalmological examination where an ophthalmologist assesses the condition of their eye and the posterior part of the retina and arranges for monitoring. Immediately after the first symptoms of vision deterioration appear, the patient must contact their ophthalmologist, because some complications of diabetic retinopathy require immediate intervention. The appearance of symptoms such as blurred vision, sectoral blurring in the vision field, and flashing may be a sign that the eye disease has progressed”, Professor Veselinović warns.

The World Health Organization estimates that out of the 2.2 billion people suffering from eye diseases worldwide, for at least a billion of them the disease could have been prevented. Apart from aging and genetic predispositions, eye health is influenced by many other factors we have control over ourselves, thus preventing disease and improving our health. This is why ophthalmologists, neurologists, endocrinologists, psychiatrists, rheumatologists, otorhinolaryngologists, plastic surgeons, general practitioners, pharmacists and engineers are brought together at X-Lab — the expert research hub by JGL — to analyse the latest research and, by applying a holistic approach, to share with us how to take care of our eye health and why that is important for our whole bodies.

1,463 million people between the ages 20 and 79 suffer from diabetes worldwide, and half of them have not been diagnosed. What does that mean for eye diseases caused by diabetes? How can we discover them on time if the patient doesn’t have the primary diagnosis of diabetes?

Diabetes is a global problem. This is a common and serious disease that requires expensive and long treatment. Most patients suffer from type 2 diabetes, a disease that can largely be prevented by healthy and balanced nutrition, regular physical activity and healthy living environments. At the moment, around 60 million people in the European region live with diabetes, and the number of patients shows a tendency of increasing in the next ten years.

Diabetes may damage the vision because of the changes in the microcirculation of the eye that manifest as diabetic microangiopathy and retinopathy. Damages to the posterior side of the retina are the most common cause of vision reduction or total vision loss in patients with diabetes. These changes can affect the blood vessels of the optic nerve and cause different types of ischemic optic neuropathy. Patients with diabetes have a higher prevalence of cataract and glaucoma, which in themselves can lead to a reduced visual function. However, the biggest problem with this patient group is the prevalence of diabetic retinopathy that may develop different stages unless adequate glycaemic regulation is achieved and unless the ophthalmologist prescribes appropriate therapy. The occurrence of a milder form of nonproliferative retinopathy is cause for concern and appropriate measures to stop the progression of the disease must be taken. Serious changes to the posterior side of the retina, with signs of neovascularisation and proliferation on the retina and the vitreous body, have been noted in patients with proliferative retinopathy

2 How common is diabetic retinopathy, one of the most serious complications caused by diabetes?

Diabetic retinopathy is one of the most common serious microvascular complications caused by diabetes. After ten years of living with the disease, over 50 percent of patients will develop some form of diabetic retinopathy, and 2 percent will go blind. The prevalence of diabetic retinopathy is more frequent in patients with type 1 diabetes, but bearing in mind that the number of type 2 diabetes patients is much higher, the incidence of retinopathy in that population is between 22 to 32 percent. Proliferative diabetic retinopathy and maculopathy are the most frequent causes of blindness in diabetics. They lead to serious and lasting damages to the retina and the vitreous body. It is estimated that around 1.5 adult patients with diabetes have proliferative diabetic retinopathy. According to the latest studies, almost half of the patients with proliferative diabetic retinopathy who don’t get appropriate therapy will go blind. On the other hand, if the disease is discovered in time and if appropriate therapy is administered, in 90 percent of the cases loss of vision can be prevented.

3 Considering that diabetes can lead to permanent loss of vision, does every person suffering from diabetes need to go to an ophthalmological examination regardless of symptoms?

Every newly diagnosed diabetes patient requires an examination where an ophthalmologist will assess the condition of their eye and the posterior side of the retina and arrange for monitoring. Regular ophthalmological check-ups for patients with good glycemia regulation and with no signs of diabetic retinopathy should be once a year. Patients diagnosed with diabetic retinopathy should get ophthalmological check-ups more frequently, every three to six months. Check-up frequency may depend on the age of the patient and the presence of related diseases. Immediately after the first symptoms of deteriorating visual function appear, the patient must contact their ophthalmologist without delay, because some complications from diabetic retinopathy require immediate intervention. The occurrence of Commented [SO1]: Molim provjeru autora, u izvorniku je “Nakon deset bolesti”, čini se da nešto nedostaje symptoms such as blurred vision, sectoral blurring in the vision field, and flashing may be a sign that the eye disease has progressed.

4 How can we prevent the loss of vision in patients with diabetes?

Prevention of loss of vision in patients with diabetes requires the close cooperation of the ophthalmologist and endocrinologist. Contemporary insights into the development and the causes of diabetes and the emergence of new medicinal products that support better glycaemia regulation help endocrinologists fight this insidious disease more effectively. The first requirement for the prevention of complications concerning the eyes is the establishing of good and stable glycaemic regulation. At the same time, the regulation of arterial blood pressure, lipid status, excess weight and physical activity of the patient are also extremely important. If damages in the form of diabetic retinopathy have appeared on the posterior side of the retina, this means that the ophthalmologist has to treat the consequences of a failed diabetes regulation. Both the patient and the ophthalmologist face a long and tough battle to prevent the loss of vision.

The oral application of angioprotective medication, vitamins and supplements may be justified, but is usually insufficient. At larger ophthalmological facilities such check-ups should be performed by specially educated ophthalmologists in laser photocoagulation clinics. In most patients, laser treatment performed in good time can prevent the development of the disease. Sectorial or panretinal laser photocoagulation is especially important in patients with proliferative diabetic retinopathy and developed forms of nonproliferative retinopathy. According to some cases, if performed in good time, laser treatment decreases the possibility of loss of vision in 65 to 96 percent of the cases.

Anti-VEGF therapy is used more often lately in patients with proliferative diabetic retinopathy and the presence of diabetic maculopathy. These contemporary medications, administered into the vitreous cavity, are able to stop the process of proliferation of blood vessels and thus stop the progression of the disease. Corticosteroids administered into the vitreous cavity are a treatment option for patients with advanced forms of diabetic maculopathy.

In cases of progressed disease with bleedings in the vitreous body, with signs of proliferation and tractional retinal detachment, it is essential that vitreoretinal surgery be performed, and that it be performed at clinics which have specially trained staff. Prevention, early diagnosis of diabetes and the timely recording of first changes as signs of diabetic retinopathy are the right way to prevent complications that could lead to permanent loss of vision.