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iabetic retinopathy is a condition of the retina caused by Diabetes Mellitus. It appears in Type 1 Diabetes Mellitus in 98% of patients at 20 years of disease and in Type 2 Diabetes Mellitus in 60% at 20 years of diabetes.

The first risk factor for the appearance of this ocular problem that can lead to blindness is to suffer from Diabetes Mellitus in a prolonged way over time. The second risk factor is poor metabolic control, very important for the development and progression of this pathology. The worse control the more severe the diabetic retinopathy will be.

The patient notices loss of vision generally when this pathology has already advanced so it is mandatory and important, the diabetic fundus eye is checked periodically and before the loss of vision begins.

Therefore, the patient may have diabetic retinopathy and not be aware of it for not presenting symptoms. As the progression of the problem occurs, patients may perceive any of the following symptoms:

• Vision loss
• Blurry or fluctuating vision (goes from clear to blurred).
• Bad night vision
• Difficulty perceiving colors.
• Stains in the visual field or dark areas (main symptom of retinal detachment).

When the diabetic retinopathy is suspected, the ophthalmologist will perform a study of the fundus with fluorescein angiography, which will allow him to know the characteristics of the alterations of the blood vessels of the retina, and with OCT (Optical Coherence Tomography), which offers information of size, location, volume of exudation (waterlogging) and affected layers of the retina. This test is also very important to study the possible edema of the macula (the macula is the central part of the retina).

The patient must have strict control of glycemia (glycosylated hemoglobin less than 7%).

In the case of patients diagnosed with type 2 diabetes, it is necessary to perform an eye fundus study as soon as possible. In those who suffer from type 1 diabetes, the test should be performed 5 years after diagnosis. Subsequent revisions should be carried out annually if the fundus is normal or if there is mild diabetic retinopathy. If the diabetic retinopathy is moderate, the revisions will be carried out every six months and every four months if a risk of the proliferative form is suspected.

Treatment

The basic treatment of diabetic retinopathy is laser photocoagulation in one or several sessions after checking the state of the blood vessels through a fluorescein angiography. This photocoagulation with a laser can be associated with intravitreal injections of anti-angiogenic medication in some forms with neovessels (newly formed blood vessels). To treat macular edema (build-up of fluid in the macula), intravitreal injections of anti-angiogenic medication will be applied with or without the laser. Corticosteroids can also be used as a treatment inside the eyeball. The possible complications will be treated with surgery (vitrectomy that consists of the extraction of the vitreous humor through different procedures).