Diabetic retinopathy occurs when there is a problem with one’s vasoregulation, meaning blood flow in the vessels becomes dysfunctional (Chen et al., 2022). These vasoregulation problems are caused by the increase in glucose in the body, which affects the blood vessels in the retina, the inner layer of the eye where light is converted to images (Mahabadi & Khalili et al., 2023). On the retina is the macula, where an individual’s most sensitive and accurate vision occurs; thus, if an individual has improper vascular flow, fluid can build up and push on the retina (Chen et al., 2022). These physiological disruptions can lead to diminished vision or vision loss.
Diabetic retinopathy can be manageable if diagnosed early on. Diagnosing DR can include taking ultra wide fundus photos of the retina, allowing optometrists or ophthalmologists to easily see the majority of the retina, and using Optical Coherence Tomography, which images a cross section of the retina (Park & Roh, 2016). The early stage of DR is called non-proliferative diabetic retinopathy and is characterized by leaking of blood vessels, causing microaneurysms and possible swelling of the macula (Wang & Lo, 2018). The later stage of DR is called proliferative diabetic retinopathy and can worsen vision problems due to hemorrhaging in the eye and retinal detachment (Wang & Lo, 2018).
After diagnosing the diabetic retinopathy, discussing treatment methods is critical as to not further one’s vision loss. One of the most common treatments is the use of laser photocoagulation, which prevents further vision loss but does not restore it (Wang & Lo, 2018). Less frequently used are intravitreal steroids, and, in advanced cases of DR, surgery is performed (Wang & Lo, 2018). It is important for diabetics to visit their optometrist or ophthalmologist to monitor their ocular health.
References
Chen, Y., Coorey, N. J., Zhang, M., Zeng, S., Madigan, M. C., Zhang, X., Gillies, M. C., Zhu, L., & Zhang, T. (2022). Metabolism Dysregulation in Retinal Diseases and Related Therapies. Antioxidants (Basel, Switzerland), 11(5), 942. https://doi.org/10.3390/antiox11050942
Jenkins, A. J., Joglekar, M. V., Hardikar, A. A., Keech, A. C., O'Neal, D. N., & Januszewski, A. S. (2015). Biomarkers in Diabetic Retinopathy. The review of diabetic studies : RDS, 12(1-2), 159–195. https://doi.org/10.1900/RDS.2015.12.159
Mahabadi N, Al Khalili Y. Neuroanatomy, Retina. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545310/
Park, Y. G., & Roh, Y.-J. (2016). New diagnostic and therapeutic approaches for preventing the progression of diabetic retinopathy. Journal of Diabetes Research, 2016, 1–9. https://doi.org/10.1155/2016/1753584
Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., Colagiuri, S., Guariguata, L., Motala, A. A., Ogurtsova, K., Shaw, J. E., Bright, D., Williams, R., & IDF Diabetes Atlas Committee (2019). Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes research and clinical practice, 157, 107843. https://doi.org/10.1016/j.diabres.2019.107843
Sapra A, & Bhandari P. Diabetes Mellitus. [Updated 2022 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551501/
Wang, W., & Lo, A. C. Y. (2018). Diabetic Retinopathy: Pathophysiology and Treatments. International journal of molecular sciences, 19(6), 1816. https://doi.org/10.3390/ijms19061816
I found an article that discusses treatments of diabetic retinopathy (Lin, K., Hsih, W., Lin, Y., Wen, C., & Chang, T. (2021). Update in the epidemiology, risk factors, screening, and treatment of diabetic retinopathy. In Journal of Diabetes Investigation (Vol. 12, Issue 8, pp. 1322–1325). Wiley. https://doi.org/10.1111/jdi.13480). The pan-retinal laser photocoagulation (PRP) treatment intrigued me the most, from what you have found do you think this is a good way to combat vision loss, or should there be more focus on preventative care?
ReplyDeleteThe aspects of your post that stood out to me most were the intravitreal steroids and hemorrhaging in the eye! I was curious why they wouldn't use a pharmaceutical treatment as often as a laser based treatment so I focused my search on that point. Looking on PubMed, I found an article that discussed diabetic retinopathy (DR) pathogenesis and treatment. It stated that angiogenesis or the formation of blood vessels can lead to further hemorrhaging, and that intravitreal glucocorticoids can be used as treatment but sparingly as the anti-angiogenic and anti-inflammatory effects only last three months and common side effects such as secondary glaucoma and cataracts develop in one-third of patients. After reading that I can understand why laser based treatment seems preferred, laser based treatment that stops DR development does seem safer then using glucocorticoids that may lead to glaucoma or cataracts!
ReplyDeleteKollias, A. N., & Ulbig, M. W. (2010). Diabetic retinopathy: Early diagnosis and effective treatment. Deutsches Arzteblatt international, 107(5), 75–84. https://doi.org/10.3238/arztebl.2010.0075
Hello Emma, excellent article! I like how you format your blog, making it easy to understand, while still include all the information for us to learn about DR :)
ReplyDeleteThe thing that stuck out to me are some of the common treatments of DR. I would love to learn more about it, especially the photocoagulation since it is the most common one. I found an article on PubMed, and it stated that laser photocoagulation is when "light energy is applied to the retina with the aim of stopping the growth and development of new blood vessels" (Evans, et al. 2014). It makes me wonder about complications with photocoagulation and long-term effects since blood vessels serve as a nutrient source bringing to the eye. Besides interventions such as photocoagulation, are there preventative care that the optometrist or ophthalmologists can recommend for DR patients and patients in general? :)
The article I found is:
Evans JR, Michelessi M, Virgili G. Laser photocoagulation for proliferative diabetic retinopathy. Cochrane Database Syst Rev. 2014 Nov 24;2014(11):CD011234. doi: 10.1002/14651858.CD011234.pub2. PMID: 25420029; PMCID: PMC6823265.