Diabetic retinopathy - cause, symptoms and treatment
What is diabetes?
Diabetes is a disease in which the pancreas or pancreas does not work properly. As a result, insufficient insulin is produced, leaving sugar (glucose) in the bloodstream. These elevated levels of sugar affect the microscopic blood vessels in the eyes, kidneys and limbs. Diabetes can be divided into type 1 and type 2. Of course, very strict monitoring of the disease is necessary. This follow-up should be done by your family doctor or diabetologist. In addition to a strict diet, drug treatment is often necessary.
What is diabetic retinopathy?
Diabetic retinopathy is an eye disease that results from long-term diabetes and can lead to severe vision problems or even blindness. High blood sugar levels gradually damage the tiny blood vessels in the retina, the light-sensitive part of the eye. This can cause bleeding, swelling and new, fragile blood vessels that interfere with the normal functioning of the retina.
The condition has several stages: from nonproliferative diabetic retinopathy (NPDR), in which small leaks and swelling occur, to proliferative diabetic retinopathy (PDR), in which abnormal blood vessels grow and can cause serious complications such as vitreous hemorrhage and retinal detachment.
Early detection is crucial. Regular eye checkups help detect and treat damage in time. Depending on severity, treatments such as laser therapy, injections or a vitrectomy may be needed to prevent further vision deterioration. Stable blood sugar levels and a healthy lifestyle significantly reduce the risk of diabetic retinopathy.
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The different forms of diabetic retinopathy
The deterioration of the retina due to diabetes is called diabetic retinopathy and is divided into several stages:
no diabetic retinopathy
This is the stage where no abnormalities can yet be seen at the level of the retina. Many diabetics have no problem with diabetic retinopathy for the first five years. If the patient can control sugar levels well through their diet or medication, it can sometimes take 20 years for the first signs to appear.
Nonproliferative retinopathy
The walls of the microscopic blood vessels break down, causing them to leak. The leaked substance consists of blood, fat or fluid. Depending on the degree of deterioration, this stage can be divided into mild, moderate or severe. From the severe stage, a fluo-angiographic examination will be required to determine whether laser treatment is necessary.
Pre-proliferative retinopathy
The walls of the microscopic blood vessels break down, causing them to leak. The leaked substance consists of blood, fat or fluid. Depending on the degree of deterioration, this stage can be divided into mild, moderate or severe. From the severe stage, a fluo-angiographic examination will be required to determine whether laser treatment is necessary.
Proliferative retinopathy
Because of the retina's increasing lack of oxygen due to the destruction of microscopic blood vessels, the retina will try to compensate for the lack of oxygen. To do this, the retina will create new blood vessels. However, these new blood vessels (neovascularization) are of poor quality and often cause bleeding in the vitreous, resulting in scarring of the retina. Comprehensive and rapid treatment is needed to prevent this scarring of the retina because it is not always reversible. Treatment consists of laser of the retina. If this laser remains insufficient, vitrectomy surgery is required to remove these new blood vessels. Extensive laser treatment will also be performed during the vitrectomy.
Diabetic maculopathy
This occurs when microscopic blood vessels are affected in the center the retina. This center is the macula (see construction of the eye). At this stage, a leakage will occur at the level of the macula. This leakage consists of fluid, fat or blood. Since the macula is so important for vision, this will cause a sharp decrease in vision. Treatment consists of laser treatment or intravitreal injection of medication.
What is a vitrectomy
A vitrectomy is a surgical procedure performed to treat conditions in the vitreous and retina of the eye. The vitreous, a clear gel-like substance that fills the inside of the eye, is partially or completely removed during the procedure. This space is then filled with a special liquid, gas or silicone oil, depending on the type of treatment.
Vitrectomy is used for a variety of eye problems, including retinal detachment, macular surgery (such as an epiretinal membrane or macular hole), severe vitreous hemorrhage or infection, and complications of diabetes of the retina. Removing the vitreous allows the ophthalmologist better access to the retina to repair it or perform other treatments.
The procedure is usually performed under local anesthesia and takes an average of 20 to 60 minutes, depending on the complexity of the problem. Some recovery time may be required after surgery, depending on the filler used and the type of procedure. Vitrectomy is a safe and effective procedure that often leads to significantly improved vision or preservation of vision.
Treatment of diabetic retinopathy: vitrectomy
Vitrectomy is indicated when laser treatment is inadequate. This is the case with vitreous hemorrhage because the blood makes laser treatment impossible.
Retinal surgeon: Dr. Bart Pion
Dr. Bart Pion, specialist in vitreoretinal surgery, is a leading retinal surgeon with years of experience in complex retinal surgery. He graduated magna cum laude from the Free University of Brussels in 2002, after which he specialized in retinal detachment, macular surgery and other advanced vitreoretinal procedures. Through continuous continuing education and participation in international conferences, he always stays abreast of the latest innovations in retinal surgery.
From 2010 to 2023, Dr. Pion was head of ophthalmic surgery at St. Peter's Hospital Brussels, where he spent 13 years performing the most complex eye surgeries and leading a team of more than 20 ophthalmic surgeons. During this time, he built a strong reputation in retinal surgery, cataract surgery and refractive treatments.
Here he performs vitrectomies, laser treatments and other innovative techniques to restore and protect his patients' vision. Focus Eye Clinic is the only extramural center in Belgium where retinal surgery is performed in an outpatient setting, offering patients fast and efficient treatment without hospitalization. His commitment to precision, innovation and the highest quality care makes him an authority in retinal surgery and vitreoretinal disorders.
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