เบาหวานกับจอประสาทตา...รักษาก่อนจะสาย

“The sweetness in my heart… is too low” This symptom may not be very good for those in love, but when it comes to health, letting the (level of) sweetness get too high is not a good thing, especially for those who are (mildly) sweet-toothed and need to control their sugar levels well. Otherwise, it may progress to cause the problem of “diabetes and the retina”, which can lead to loss of vision.
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The chance of diabetic patients developing diabetic retinopathy is as high as 30%. Today, we have invited Dr. Anyanee Noranitchaikul, an ophthalmologist at the Eye Disease Clinic, Phyathai 3 Hospital, to provide knowledge and recommend self-care methods to prevent diabetes from affecting our retina.
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<h4>What is “diabetic retinopathy” and how does it occur? 
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“Diabetes” is a condition where blood sugar levels are higher than the set limit, or above 126 milligrams per deciliter. Dr. Anyanee explained the reason why diabetes can affect vision as follows:
“Diabetes is a disease that damages blood vessels throughout the body due to high sugar levels. Therefore, any organ with small blood vessels that require a high amount of oxygen will be affected first. There are three main sites: the retina, the nervous system, and the kidneys. 

The blood vessels supplying these areas lose their ability to transport blood and oxygen due to ballooning into sacs, leakage, and rupture outside the vessels. The tissues at the ends of these vessels become oxygen-deprived. When the peripheral retinal tissue lacks oxygen, it produces substances that stimulate the retina to grow new blood vessels. These newly formed vessels, created urgently under resource-deficient conditions, are abnormal and grow perpendicular to the original vessels, protruding into the vitreous humor, causing the retina to lift and resulting in retinal detachment due to these new vessels. 

In the early stages, diabetic retinopathy shows no symptoms, and patients can see normally. However, signs can be detected by doctors only through retinal examination. In the late stages, new blood vessels may rupture into the vitreous humor, and a strong cough or sneeze can cause sudden vision loss. 

This condition is called diabetic retinopathy. Additionally, diabetes can affect the eyes by causing cataracts. While most people develop cataracts around age 60 or older, diabetic patients tend to develop cataracts earlier, around age 50, with some starting even sooner. Similarly, glaucoma, which often follows diabetic retinopathy, occurs as a complication from new blood vessels blocking the eye’s drainage angle.”
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<h4>Know early, prevent to avoid… diabetic retinopathy 
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Although not everyone with diabetes will develop diabetic retinopathy, diabetes is a chronic disease that cannot be completely cured. Moreover, the day diabetic retinopathy symptoms are detected is not the day the disease started. Therefore, Dr. Anyanee recommends that once you know you have diabetes, you should get your eyes checked immediately.
“Normally, when diagnosed with diabetes for the first time, it is recommended to have an eye exam right away. Theoretically, type 1 diabetes rarely causes retinopathy within the first 3-5 years. However, type 2 diabetes, which is common in older adults, shows that 45% of patients already have diabetic retinopathy at the time of diagnosis. This is because we do not know how long the patient has had diabetes before diagnosis. Therefore, the diagnosis date does not mean the disease just started; it could have been 3, 5, or 10 years earlier. Not everyone with diabetic retinopathy has severe symptoms. If blood sugar is well controlled, detected early, and treated promptly, it will not progress to the stage of retinal scarring, retinal detachment, or complicated glaucoma.”
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<h4>How is diabetic retinopathy treated? 
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For patients diagnosed with diabetic retinopathy, the treatment approach depends on the stage of the condition. Dr. Anyanee elaborated on this as follows:
“If the condition is mild to moderate, or when doctors detect blood vessel sacs and small areas of leakage, no treatment is needed yet. However, frequent follow-up exams are necessary to monitor and prevent progression to severe stages or new blood vessel growth. 

If the condition is severe, characterized by widespread oxygen deprivation in the retinal tissue, retinal swelling, pus, or cotton-wool spots indicating oxygen deficiency, or new blood vessels forming, this is the severe stage. Treatment involves injecting anti-VEGF drugs into the vitreous to suppress blood vessel growth. After controlling the vessels, laser therapy may be considered to destroy peripheral tissue. Since oxygen supply is low, reducing oxygen consumption by peripheral tissue is necessary, which is achieved by reducing tissue respiration. In summary, treatment includes both injections and laser therapy. 

If the condition is very advanced or if blood vessels have caused retinal detachment, surgery is required to remove the fibrous tissue caused by the blood vessels and reattach the retina. The chance of vision recovery depends on the disease stage. If treated with injections and laser, vision often returns close to normal, but laser treatment narrows the visual field because the treated area is destroyed. Central vision remains clear, but peripheral vision narrows, or brightness decreases. 

For surgical cases, vision recovery is about 50% because much of the retina is damaged. In cases of retinal detachment, surgery may sometimes fail due to fibrous tissue pulling on the retina, making treatment complex and vision unlikely to return to normal. Therefore, patients should take care of themselves by having eye exams immediately upon diabetes diagnosis and follow up as scheduled. There is a wide window for treatment if patients do not miss appointments. Besides attending appointments, controlling factors that damage blood vessels such as blood pressure, cholesterol, and blood sugar is crucial. Patients must strive to keep these within normal ranges and change their attitudes and behaviors because diabetes is a lifelong condition. Discipline and the right mindset are essential to live with it and to monitor and prevent factors that damage blood vessels or cause complications.”
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Dr. Anyanee Noranitchaikul 
Corneal Ophthalmologist 
Eye Center, Phyathai 3 Hospital

Patients with diabetes have up to a 30% chance of developing diabetic retinopathy. Therefore, once diagnosed with diabetes, they should undergo an eye examination to find ways to prevent eye-related diseases.

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Diabetes and Diabetic Retinopathy... Treat It Before It's Too Late

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