National Eye Care Day | Yu Jinguo: Analysis of common misunderstandings in the prevention and treatment of diabetic retinopathy

Editor's Note: June 6, 2024 is the 29th National Eye Care Day. This year's theme is "Pay attention to general eye health", focusing on two key groups: children, adolescents and the elderly. In order to further publicize the importance of eye health for all age groups and throughout the life cycle, this magazine will launch a manuscript solicitation and solicitation activity on the occasion of National Eye Care Day, and select excellent articles for readers.
Yu Jinguo Diabetes is a common chronic metabolic disease in our daily life characterized by high blood sugar. The typical symptoms are polydipsia, polyuria, polyphagia and weight loss, namely "three mores and one less". Diabetes can cause diabetic retinopathy, which can lead to vision loss or loss. It has become the leading cause of blindness among people of working age and should attract the attention of patients and friends. The following is an analysis of the four common misunderstandings about the prevention and treatment of diabetic retinopathy in clinical practice to improve awareness, eliminate misunderstandings and treat them early.

Misconception 1: If you have diabetes and your eyesight is good, it means there is no retinal disease and you don’t need to go to the hospital for a check-up.

Diabetic retinopathy caused by diabetes develops gradually, progressing from mild to severe, and this process may take 5 to 10 years. Of course, this process can be shortened if blood sugar is not well controlled. In the early stages of diabetic retinopathy, if the lesion does not involve the macular area, or if the lesion is mild, vision can be normal. For the treatment of diabetic retinopathy, if it is discovered early, preventive treatment can be carried out and vision will be maintained very well; if treatment is not carried out until the lesion is very serious, it is too late, and even surgery will only restore vision to a very limited extent. Therefore, if diabetes is diagnosed, regardless of whether there is a decrease in vision, you should go to the hospital for a professional eye examination and follow the doctor's advice for regular checkups.

Myth 2: As long as blood sugar is well controlled, you will not get diabetic retinopathy.

Controlling blood sugar is the key to preventing and treating diabetic retinopathy, but it does not mean that controlling blood sugar will prevent diabetic retinopathy. The occurrence and development of diabetic retinopathy are closely related to the duration of diabetes and blood sugar control. Generally, the incidence of diabetic retinopathy is 25% after 5 years of diabetes, which increases to 60% after 10 years and can be as high as 75% to 80% after 15 years. In addition, poor blood sugar control, hypertension and hyperlipidemia, as well as smoking and drinking are all risk factors for the occurrence and development of diabetic retinopathy. Those with good blood sugar control have mild lesions, while those with poor control have severe lesions.

Myth 3: If you have diabetic retinopathy, the disease will heal once your blood sugar level is stabilized.

If diabetic retinopathy is clearly diagnosed, controlling blood sugar does not mean that the disease will improve on its own, but it does not mean that controlling blood sugar is meaningless at this time. Stable blood sugar control can slow the progression of retinopathy and is also the basis for further treatment, such as retinal laser photocoagulation treatment, intraocular injection of anti-vascular endothelial growth factor (VEGF) drug treatment, and vitrectomy surgery, all of which require stable blood sugar control as a prerequisite.

Myth 4: If you have diabetic retinopathy, your vision can be restored to normal after surgery.

Diabetic retinopathy can cause vitreous hemorrhage, tractional retinal detachment, etc. The most fundamental causes of these lesions are vascular occlusion, retinal ischemia, neovascularization, etc. caused by diabetes. Vitrectomy can remove vitreous hemorrhage, relieve vitreous traction, and reposition the detached retina, but the most fundamental lesions such as vascular occlusion and retinal ischemia are not completely improved. The retina after surgery is still a lesion. Therefore, it is impossible for vision to return to normal after surgery, and vision recovery is related to the severity of the lesion. Early diagnosis and early treatment are the most critical factors for vision recovery.

(Author: Yu Jinguo, Department of Ophthalmology, Tianjin Medical University General Hospital)