Diabetic retinopathy

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Dr. Manrique Cordoba, Specialist in Ophthalmology

Diabetes is a pandemic that affects around 537 million people in the world. It is estimated that at least one out of every three adults has undiagnosed diabetes. In Costa Rica, one in ten adults between the ages of 20 and 79 is diabetic.

Diabetic retinopathy is a common microvascular complication of diabetes, which can lead to blindness. It is also the most frequent cause of new cases of blindness in people between the ages of 20 and 74. The onset of this pathology is correlated with a longer time of being diabetic, high glycemia levels, arterial hypertension, obesity, dyslipidemia and smoking.

At the beginning of the disease, there are usually no symptoms, but as the disease progresses, the patient may notice symptoms such as blurred vision, floaters, fluctuating vision, dark areas in the visual field or loss of visual acuity.

Within the natural history of the disease, retinal neovessels, inflammation of the central part of vision, retinal and vitreous bleeding, tractional retinal detachment and neovascular glaucoma may occur.

Screening for this disease consists of a complete examination by an ophthalmologist, including a dilated fundus examination. This screening should be performed in type 2 diabetic patients at the time of diagnosis; in type 1 diabetics, 5 years after diagnosis; and in gestational diabetes, in the first trimester of pregnancy or at diagnosis.

Treatment for diabetic retinopathy includes good glycemic control, physical exercise and good nutrition. Several treatments are available, such as laser retinal panphotocoagulation, intravitreal steroid injections, intravitreal anti-VEGF injections (Avastin, Lucentis, Eyelea) or surgery.