Diabetic retinopathy: the importance of screening – Emergency Live International

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It is therefore a relevant social problem, so much so that the World Health Organization has included it in the priority list of preventable diseases, giving specific guidelines for its screening.
In fact, the importance of screening is very high: it is estimated that diabetic patients who do not undergo regular screening have a 4-fold increased risk of developing severe retinopathy.
As the name implies, the cause of diabetic retinopathy is diabetes, a condition that affects more than 415 million worldwide, a number estimated to rise to 642 million by 2040.
There are 2 forms of diabetes:
In each case, it is a chronic and slowly progressive disease that induces complications in several target organs:
The main risk factors for the development and progression of diabetic retinopathy are:
Among these risk factors, glycemic compensation is the most important: maintaining good glycemic control (glycated hemoglobin less than 7) in fact reduces the risk of development and progression of diabetic retinopathy.
In terms of the mechanism of action, diabetic retinopathy is a neurovascular disease: it affects the neuronal and endothelial cells of the retina.
Damage to these cells leads to:
Progressive ischemia leads to the formation of neovases, which can bleed causing intraocular hemorrhage (called hemovitreo), resulting in acute vision loss.
Sometimes this event resolves with spontaneous reabsorption of the blood; other times surgical removal of the vitreal hemorrhage by vitrectomy is necessary.
Over time, untreated neovases become fibrotic and can lead to retinal detachment, a serious complication that results in abrupt visual decline and requires complex emergency surgery, often followed by failure to recover or partial recovery of vision.
These vessels can also grow on the surface of the iris (the colored part of the eye) and lead to pictures of iris rubeosis (presence of capillaries on the iris) and so-called neovascular glaucoma, a form of glaucoma characterized by a major increase in intraocular pressure with irreversible damage to the optic nerve followed by blindness and pain.
This is a complication that is unlikely to be cured by medical and surgical therapies.
It becomes symptomatic only when the pathology reaches the region of the macula, or when the severe complications that follow ischemia and the proliferating phase of the disease occur so at an already advanced stage.
This is also why a careful and early screening program is essential.
We have many weapons to make early diagnosis of diabetic retinopathy and to monitor it as best we can.
Screening, in particular, is based on ocular fundus analysis.
The first evaluation should be performed:
The interval between follow-up visits is decided by the specialist based on the presence or absence of diabetic retinopathy and its severity.
The diagnostics of retinal diseases, including that of diabetic retinopathy, has greatly advanced in recent years: today there are instruments that allow in a single visit an accurate assessment of all aspects of this disease.
The diagnostic pathway involves the performance of:
Each of these examinations gives us a piece of the ‘puzzle’ for proper final evaluation.
OCT, on the other hand, is the exam that allows us to assess increased macular thickness due to fluid accumulation (macular edema), as well as the presence of tractional epiretinal membranes (‘nonelastic,’ fibrotic tissue that is able to exert traction on the macula leading to edema formation or puncturing it in the center with severe damage on central vision) on the retina that may require surgical intervention.
Finally, autofluorescence allows the study of macular edema, while angio-OCT studies macular ischemia, edema, and shows changes even in the subclinical phase, that is, before symptoms occur.
These examinations also make it possible to check the response to possible therapies and monitor the progress of the disease.
The first step of therapy is careful monitoring of the underlying pathology, namely diabetes, motivating and informing the patient about the importance of maintaining good blood glucose levels.
The second step is a good preventive campaign that in the overall evaluation of the diabetic patient makes use of fundus examination and new generation imaging with macula study (OCT, angio- OCT and FAF).
When the disease has caused visual decline because it has affected the macula (macular edema), we have the less invasive but effective techniques of ‘grid’ or direct laser photocoagulation used for a long time in treating the edema itself:
Help in the early stages of macular edema is provided by supplements containing turmeric and similar substances.
These new therapies often allow the recovery of decent central vision with improvement in the quality of life of our patients.
When the disease affects the mid-peripheral part of the retina with ischemia and neovases, the treatment of choice is sector laser photocoagulation (for localized ischemia in one area of the retina) or panretinal (affecting all sectors when the damage is more extensive).
This treatment aims to slow down the disease and prevent the onset of serious complications.
Raising awareness among diabetic patients is very important because we need their help first and foremost to achieve the best results.
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