Diabetes is the most common endocrine disease in the world and in our country. Its incidence is increasing day by day. Type 1 diabetes has more eye complications than type 2 Diabetes.
Diabetes in the eye can cause retinopathy, cataract, extraocular muscle paralysis, optic neuropathy, sudden refractive changes, dry eye, glaucoma, susceptibility to superficial infections, decreased corneal sensation, delayed wound healing, more intense inflammation in previous intraocular surgeries.
Dibetic retinopathy is the most important risk in terms of vision. The most important risk for diabetic retinopathy is the duration of diabetes. While the risk of developing retinopathy after 10 years is 50% in an individual diagnosed with diabetes before the age of 30, this risk increases to 90% after 30 years. Poor control of diabetes is also important for retinopathy progression. A high level of HbA1C is a factor that seriously increases diabetic retinal damage. Apart from this, pregnancy, hypertension, nephropathy, smoking, hyperlipidemia, previous cataract surgery, obesity and anemia will accelerate diabetic retinopathy. Nephrotic syndrome, which is characterized by high blood sugar, obesity, and hyperlipidemia, increases all the symptoms of diabetes.
Diabetes is primarily a vascular disease (angiopathy). Over time, vascular pathologies form the clinical situation. The most intolerant organs to vascular wall damage are the eyes and kidneys. Therefore, retinopathy occurs at the same time as nephropathy. Any situation that increases the vascular wall stress naturally accelerates angiopathy, thereby deepening the retinopathy damage. Vision loss due to diabetic retinopathy is one of the preventable eye diseases. For this reason, patients diagnosed with Type 1 Diabetes should be called for retinal examination 5 years later, and those diagnosed with Type 2 Diabetes should be called immediately.
Treatments should be planned according to the level of diabetes, laser (panretinal photocoagulation) if necessary, intraocular steroids if necessary, and intraocular anti-VEGEF applications if necessary. Even in this process, blood sugar regulation is very important. No treatment modality is sufficient for a diabetic patient with poor regulation, and retinopathy continues to progress.
Diabetic cataract development occurss due to the conversion of increased glucose in the blood to sorbitol. Because sorbitol is toxic to the lens. The treatment of cataract is surgical, but more complications develop during and after surgery than in non-diabetic patients. Posterior capsule opacities and macular edema are also proportionally higher in cataract surgeries of diabetic patients. Eye muscle paralysis, related strabismus, diplopia and ptosis (low upper eyelid) can be seen in diabetic neuropathy. With the effect of neuropathy, sensory defects in the cornea also cause dry eye. If patients have high eye pressure (glaucoma), the damage to the optic nerve also increases with diabetes. In some patients, Diabetic Neuropathy develops and the optic nerve is affected, and the patients' vision suddenly decreases.
Diabetes is a progressive vascular disease (angiopathy). Clear information about retinal vessels can be obtained with a simple retinal examination without any invasive procedure. In this way, it is possible to have information about the vessels in all the bodies of diabetic patients. Therefore, the detection of diabetes facilitates predictions about its progression, adequacy in treatment and other complications. Therefore, regular retinal follow-up of diabetic patients is strongly recommended.