Diabetic retinopathy is a common ocular complication of diabetes. Because diabetic retinopathy is progressing more hidden, they often have been overlooked in patients, but its development to severe may lead to blindness, so diabetics should adhere to at least one meeting per year fundus examination. In addition to diabetic retinopathy, fundus examination also found that chronic glaucoma, retinal degeneration, retinal tears and other eye diseases, but also reflects the kidney disease, hypertension, hyperlipidemia, arteriosclerosis, chronic high intracranial pressure, and many other systemic diseases.

It is understood that Chinese patients with diabetes has tripled in the last fifteen years, has reached 30 million to 40 million people, second only to India, ranked second in the world. Guangdong Province, up 3.5 percent prevalence of diabetes, glucose tolerance with low prevalence rate of nearly 6 percent reduction, both higher than the national average. Guangzhou, which is even more serious, and diabetes prevalence rate of more than 6 percent of female morbidity and a half times higher than men, especially the family of women, obese more.

Diabetic retinopathy as the main cause of blindness, risk of its occurrence rate of 25 times that of non-diabetic patients. Diabetic retinopathy after five years into a rate of two and a half after ten years up to Liu Cheng, fifteen years later Bacheng After two decades, suffered from diabetes for more than Jiucheng vision problems, such as decreased vision or metamorphopsia, flying mosquito disease until the blind.

In addition to blindness, diabetes, there is kidney failure, foot ulcers, severe disease complications, with higher death, disability. Because diabetes is the most effective treatment, “insulin” expensive, diabetic patients also a huge economic burden.

Experts point out that preventive care is the best way to treat diabetes. Should be eating sweets, high fat food, to establish a scientific diet, quit smoking, more physical exercise is very important. According to the Guangdong Provincial Health Department deputy director Lau Cheung Fung introduced starting from 1996, Guangdong Province, are carrying out the intervention of diabetes education and community-based prevention and treatment work, received wide support results are obvious.

Ocular complications of diabetes caused by, first, the treatment of diabetes, blood glucose control in a satisfactory level, it is the fundamental; further speaking, patients must comply with the five principles of diabetes treatment. That is, diet control; appropriate exercises; time and according to the amount of medication; increasing love of eye, eye care knowledge; improve self-protection, self-monitoring awareness. To do this five, a good control of blood glucose is possible, and difficult to retinal complications occurred. Worse glycemic control and the occurrence and development of ocular complications are directly related, but can not be absolutely avoided. Data show that oral hypoglycemic drugs in patients with diabetes, the incidence of retinopathy of 24%, more than 20 years, up to 60%; with insulin-treated patients, diabetic retinopathy, the incidence of 30%, more than 20 years, up to 84%. To this end, once again stressed the need to combine for eye treatment.

Experts say many patients that the medication on time, their blood sugar down than before, a lot of feel good about themselves. However, the detailed inquiry revealed that the patient is higher than in the past when the target blood glucose decreased, but still higher than normal blood glucose targets, their eye disease in a slow development. Patients can not be strictly to reduce blood sugar, for two main reasons: First, blood glucose monitoring index is unclear, or that is almost on the line; Second is the lack of understanding of the consequences of this state.

Diabetic retinopathy is a complication of microvascular disease in the human body endovascular sugar high, over time, the extension of the human eye will be a qualitative change in a variety of organizations within the blood vessel wall tissue is most evident in the early performance of small of hemangiomas, small bleeding points, then there is no vision loss in patients, nor to the hospital to be checked. With time, a major-related macular degeneration, exudative retinal hemorrhage, vitreous hemorrhage, proliferative and even retinal detachment, visual acuity decreased sharply until the blind. Then re-examination and treatment, has lost the best time of their treatment. Therefore, patients with diabetes from the disease, it should be on a regular basis to the eye hospital for examination, early treatment is necessary. All of the treatments, the most fundamental is to keep blood sugar in the normal target range, which is a diabetic fundus of the most basic treatment. Without this foundation, the other treatment will be futile.

In this, the experts advise diabetic patients should be routinely once a year, fundus examination and fundus photography to do to prepare for contrast. Fundus of the right has occurred, should be 3 months to six months, check again.

Is responsible for this study come from the Sussex Eye Hospital’s Anthony G. Casswell. He explained that in diabetic patients with decreased visual acuity and retinal cell morphology changed, its ability to distinguish colors often will decline. However, the sensitivity of conventional color-blind detection methods are insufficient for the large-scale screening of patients.

Lionel Ripley told Reuters: “We have used this technology require the patient to sit in a chair, watch display, when the subjects identify the color bar on the screen after the click of a button. The whole testing process only take several minutes. and this method also has good reliability and repeatability, the main reason may be due to this testing is carried out on the computer, does not fatigue of error. In contrast, FM100 method in need of try to spend more time to do more to judge, but also the credibility of test results is relatively poor. ”

And test results with the slit-lamp examination results were compared. TCT using a computer-aided detection system and the cathode-ray tube to stimulate the individual generator. The results showed that there is no detection of retinopathy in patients with TCT values for 42.5, while the background retinal patients detect the TCT value is 41.7. There are 17 tested were found to suffer from the eye that may affect the eyesight of diabetic retinopathy (STDR), with STDR between test results with the TCT significant correlation (p <0.001). Such examination of the sensitivity was 94% and specificity of 95%. This detection method for proliferative retinopathy and macular degeneration detection sensitivity was 100%. 3 pre-proliferative diabetic retinopathy in patients with a mean value of TCT examination results 29.6,2 were proliferative diabetic retinopathy in patients with a mean value of TCT examination results were 21.7,12 patients suffering from macular degeneration TCT examination results of the average 24.0. TCT test results with patients suffering from diabetes, the length of time, or the latest between the level of glycosylated hemoglobin there is no correlation. Casswell and others believe that because of this TCT inspection methods can be directly visual function test subjects, so it will be able to early detection of disease, to prevent them from developing into more serious retinal diseases. Ripley concluded that: “The researchers hope that doctors will be able to recognize the health of the retina TCT detection reliability is better than slit-lamp examination. We have published many articles to show TCT can also be used to diagnose other diseases such as Parkinson’s disease, etc. . “He also pointed out:” At present, they use testing equipment also can not buy an estimated selling price in the future is about 15,000. but we are still studying a new type of color blindness test device, it is smaller, less expensive, but the test results is the same. “

Diabetic retinopathy is the leading cause of blindness caused by young people. This disease occurs in the retina, since the diabetes caused by oxygen so that the light-sensitive part of the damaged eye. Early lesions occur in the retina, most patients do not feel the eye, and when the eye noticeable symptoms, retinopathy have been more serious, often losing the best time of their treatment, leading to blindness. Thus, medical experts have always hoped for early detection of this disease in order to control the disease progresses, blindness prevention.

According to “Russian newspaper” report, the Russian medical experts found that risk of diabetic retinopathy in patients with diabetes, their blood will become very thick. In the early stages of diabetic retinopathy, and viscosity of blood is flowing through the blood vessels in the retina, so only an analysis of the retina’s blood can be an early diagnosis of diabetic patients suffering from a diabetic retinopathy. However, extracting the blood from the retina is both complex and dangerous, is not suitable for practical application.

The Russian researchers in the study to find ways to solve this problem. In their view, the eye in the blood of substances that promote blood coagulation components through capillary walls and penetrate into tears inside the cornea, the eye tears contain blood components that reflect the information, by analyzing the composition of tears of the ingredients can understand the eye changes in blood viscosity, which can be made early diagnosis of diabetic retinopathy.

Russian experts believe that as the tears of blood and other body fluids such as urine, containing a number of physiological response to the situation of information, by analyzing the composition of tears, you can understand people’s physical health.

Professor Jin Ming A: OK fundus fluorescein angiography is necessary. Once diagnosed with diabetic retinopathy, fundus microscope than the actual illness is often seen even more serious, is likely to have entered the proliferative phase, when required by fundus fluorescein angiography to detect lesions and to take laser or surgical treatment to control the progression of the disease.

Question 2 got diabetic retinopathy means blind, treatment has lost its meaning?

Professor Jin Ming A: The patient must be put right mentality, do not have too much psychological burden. Diabetic retinopathy could indeed lead to blindness, but as long as understanding of their clinical features, a good grasp of their own condition in which stage, they will not miss the best time of their treatment. Professor Jin Ming to remind patients: no obvious symptoms of early lesions, therefore, must be regularly checked fundus, once problems are detected well in controlling blood glucose, blood pressure and lipids, while taking the drug to expand blood vessels and improve microcirculation. At the same time, but also to the requirements of a doctor on a regular basis to review the hospital, once the disease continue to develop, to take timely and effective measures, if not treated promptly, blindness can be avoided.

Question 3 Fundus why bleeding?

Ophthalmology, director of People’s Liberation Army General Hospital, Dr. Yao Yi A: Fundus hemorrhage is not an independent eye, but many eye diseases and certain systemic diseases, shared characteristics. Is common in hypertensive retinopathy, diabetes and kidney disease caused by retinal lesions. Peri-retinal vein, retinal vein occlusion, optic disc vasculitis, as well as blood disease caused by retinopathy, ocular fundus traumatic bleeding. Diabetic retinal hemorrhage was mainly caused by microcirculatory disturbances caused by diabetes, blood vessel blockage, resulting in unreasonable blood flow caused by ischemia, which led to secondary bleeding. Microvascular tumor, hard exudation, retinal neovascularization and so can cause bleeding, at the same time, retinal infarction will lead to exudative retinal cotton wool spots occur.

Early diabetic retinopathy caused no symptoms until vision loss again when the treatment was already too late. About 20% of diabetes patients have been diagnosed when retinal bleeding, and, therefore, when diagnosed with diabetes should be done in the early eye screening.

Question 4 eye surgery can improve vision?

China-Japan Friendship Hospital, Ministry of Health, Dr. Chen, director of eye surgery A: In clinical practice, patients with diabetes are doing a lot of eye surgery, a doctor would ask such a question, “my vision after the operation can go to a few points”?

In fact, commonly used in vitrectomy eye more often to create the conditions for the completion of laser treatment, stable and new blood vessels, control of the disease. To improve visual acuity is not the goal of surgery, as the possibility of surgery to improve visual acuity, retinopathy depends on the specific circumstances to determine, and is closely related to the severity of the disease. Surgical indications include: vitreous hemorrhage, traction retinal detachment, dense macular hemorrhage, as well as pre-angle glaucoma caused by neovascularization.

Question 5 aspirin will increase the fundus bleeding risk?

Professor Yao Yi A: We all know that low-dose aspirin can improve blood viscosity, but some patients worry that aspirin can cause retinal bleeding, and therefore did not dare take. In fact, the United States has an on aspirin (2000 cases of samples) clinical trial results showed: aspirin does not cause retinal bleeding, the drug does not increase the risk of retinal bleeding, the patient can be assured to take.
6 cataract and glaucoma problems should pay attention to?

Professor Jin Ming A: Diabetic retinopathy is the most common and more about eye disease, but it does not therefore consider that cataract and glaucoma should be taken seriously.

Rate of occurrence of cataract patients with diabetes than the normal 4 ~ 6 times higher, while cataracts can also cover retinopathy, delayed treatment of diabetic eye disease. The maintenance of normal eyes and normal eyes, the shape and function, need to constantly produce aqueous humor, you can clean the eyes, taking harmful substances, and then discharged through the channel from the eye. When people with diabetes fundus lesions is that when they began to grow from the back of the eye “bad blood vessels”, the Ministry of spread slowly forward, thereby blocking aqueous drainage channels, so that aqueous humor can not be discharged, causing elevation of intraocular pressure, triggering glaucoma.

In clinical work, JIN Ming Professor encountered such a patient, the patient felt his eyes and blurred vision, and went to an optical shop for optometry, the scene clearly a lot of time to try them on, went so far as the eye can return home without ambiguity , and with glasses are even more blurred. It turned out that he was not aware of because of the sudden increased blood sugar, leading to crystal expansion, the distance between objects near and far to see a change, depending on the material naturally blurred together, while also lowering blood sugar after with glasses, crystal expansion situation improved, so look at things become clear again. Professor Jin Ming suggested that patients with diabetes, as the object if they do not suddenly become clear to the eye must be examined to make it clear whether there was ocular complications. In addition, if we find a place within the eye symptoms such as oblique, or oblique view, the exclusion of other factors to consider with diabetes or hypertension, should be as soon as possible to the eye examination to determine the cause, symptomatic treatment.

Question 7 What is diabetic nephropathy and diabetic eye disease related?

Professor Yao Yi A: Because diabetic eye disease and diabetic nephropathy belong to microangiopathy, therefore, the two diseases coexist. In clinical work, found that 80% of albuminuria in patients with diabetes mellitus are associated with varying degrees of retinopathy; but the combined patients with retinal disease, only 1 / 3 of the patients had proteinuria. Thus, Yao Zhuren suggested to identify patients with diabetic nephropathy fundus screening should be done.

Question 8 eye can prevent diabetes and eye disease?

Professor Jin Ming A: The reference to eye, many people automatically think of doing eye-up exercises and taking cassia seed, chrysanthemum tea and other goods, but these precautions can really do eyesight?

Eye setting-up exercises can improve people’s awareness of eye care, eye and head to adjust the blood circulation, regulate muscle, improve eye fatigue, especially for primary and secondary students benefit. Setting-up exercises right eye by eye around the acupuncture point massage to smooth eyes of qi and blood and improve neurological nutrition, in order to achieve the elimination of ciliary muscle tension or spasm of the purpose, serve to protect eyesight, the role of prevention and treatment of myopia. The ocular complications of diabetes is an internal change, not due to fatigue caused by eye. Therefore, JIN Ming Professor, eye-up exercises to protect eyesight, as a health campaigns to alleviate eye fatigue, but no indication of their diabetic eye disease have any effect. Others, such as taking cassia seed, chrysanthemum tea and other tea products, mostly from the perspective of ease eye fatigue, eye protection, for diabetic eye disease do not have much to prevention.

Professor Jin Ming reminded of diabetic patients with diabetic eye disease prevention there is no shortcut to the most basic is the most important thing is sticking to the regulations to control blood sugar, in the absence of disease, when every one years to do a dilated eye examination, if we find disease, we must follow the doctor’s prescription medication, more active control of blood sugar, according to the requirements of a doctor to the hospital for review. From the long-term perspective, it may not be easy to avoid the complications of diabetes, the eye, but if given enough attention, can make early detection and control, delayed lesion growth rate, slow down the pace of the blind, or have some significance.

Question 9 Why should attach importance to referral in patients with eye disease, and followed up?

Professor Yao Yi A: Because the patient’s health awareness, as treatment of disease, patients have the opposite attitude. Some sufferers that he is sick, it was very great importance, and even to go to four or five hospital for treatment, some sufferers are left unchecked, indifference, and sometimes doctors refer patients for a month after the referral, the patient does not follow doctor’s orders. Like to remind the sufferers, as we choose to see regular doctors, allow doctors to fully understand and grasp the patient’s condition, but also to reduce unnecessary spending, nor a waste of patient time and effort. Please patients must follow doctor’s orders, on time and referral, so as not to miss the best time of their treatment.

Diabetic retinopathy is the pathological basis of microvascular disease. My fundus scientists will be divided into the background diabetic retinopathy and proliferative type 2 type, each type is divided into three phases. From I to III phase of the development period of relatively slow speed in general, the patient may be asymptomatic wide, visual acuity is not affected. To the IV, then, easily lead to intraocular hemorrhage and other serious complications, vision loss and even blindness. At this point even if the blood sugar under control, body condition has improved, do not make eye reversal of the pathological process must match the local treatment, in order to make a stable lesion.

Diabetic retinopathy prevention is the most important element, from the risk of diabetes will begin to make regular inspections fundus, at least once a year to check the retina for early detection of disease and treatment. Treatment methods include:

Strict control of blood sugar can prevent further damage to retinal blood vessels.

Control of blood pressure, high blood pressure can increase retinal vascular lesions, with a significant increase in the possibility of retinal hemorrhage. Patients with blood pressure control must be below 130/85mmHg.

Drug therapy: use of anti-platelet aggregation drugs, such as aspirin, dipyridamole. There fundus bleeding, can be an envelope of blood, rutin, Clofibrate iodine, etc.. Can also be used Chinese medicine Qi Yin, promoting blood circulation Huayu to treat.

Laser treatment: for proliferative diabetic retinopathy. Timely laser treatment can protect the visual acuity.

Surgical treatment: when the ocular vitreous hemorrhage and traction retinal detachment, viable vitrectomy to remove blood clots in the eye, will pull the retina lysis reset.

Diabetes-prone retinopathy

Zhongshan Ophthalmic Center, Sun Yat-sen, deputy director of China Institute of Ophthalmology, deputy head of the fundus Studies Professor Tang Shibo introduction, diabetic retinopathy is a serious eye disease that can cause blindness, but also a major complication of diabetes. At present, China 10-15 years with diabetes, the incidence of retinopathy was 25%; more than 20 years with diabetes, the incidence of retinopathy as high as 90%!

Professor Tang Shibo points out that diabetes patients with retinopathy, the first blurred vision, and then there shadow, vision loss and other disease, can lead to serious retinal detachment, eventually leading to blindness. “Early treat diabetic retinopathy, if blinding is not reversible by.”

“Sea election” to find “resistance genes”

Why are there diabetic retinopathy? Through research scientists have found that the incidence of diabetic retinopathy with the body’s immune response and vascular endothelial growth factor relevant. But why have some diabetic retinopathy soon after they fell sick, and some patients have arrived late, or even appear?

It turned out that some of the human body exist in a number of “resistance genes”, it will work with vascular endothelial growth factor to a negative adjustment to avoid the appearance of diabetic retinopathy.

In 2005, TANG Shibo led research team began the search for “resistance gene” research, the subject was the National Natural Science Fund. They will not suffer from a group of diabetic retinopathy in patients with a group of diabetic retinopathy in patients with genetic comparison, the success of “sea election” out of a part of the “resistance genes”, the demonstration of the ongoing animal models, have not yet entered clinical trials , while the research results will be the core of journals published in China. “This research ideas can be used to search for other complications of diabetes, the ‘resistance genes’, as well as the tumors ‘resistance genes’, so far-reaching significance.”

In fact, diabetes is not terrible, terrible complications of diabetes.

Complications of diabetes can be divided into two major categories of acute and chronic. Acute complications severity of the treatment can be life-threatening bad deal with good luck can be overcome, but essentially without leaving any traces. And chronic complications is more is more hidden, can occur unconsciously, early can still be reversed, late units must suffer.

Diabetic chronic complications, including blood vessels and nerves two categories, in particular, mainly in the following areas:

(1) eye. Easily lead to cataracts, retinopathy, there is the risk of blindness.

(2) kidney. Will lead to renal failure; the body a lot of waste can not be discharged, and so they easily lead to uremia.

(3) nerves. Mainly nerve palsy, it can lead hands and feet numbness, diarrhea, constipation, impotence and other young male patients, but also may affect the heart, gastrointestinal function, sensory-motor and so on.

(4) blood vessels. Because of high blood sugar in the blood will lead to arteriosclerosis, prone to cerebral thrombosis, stroke, cerebral infarction, angina, coronary heart disease and so on, causing paralysis, hemiplegia risk. In addition, lower extremity vascular disease, could easily lead to cold feet, intermittent claudication. If the wound generation, wound healing is not easy, easy to cause muscle necrosis while the risk of amputation. Lower extremity vascular disease and generally have neuropathy, they do not feel sensitive, slow, feet do not feel pain Tangde blistering, and some are rotten to the bones of the feeling of hurt.

In addition, urinary system diseases will occur, such as the complicated pyelonephritis, cystitis, skin lesions, such as from furuncle and carbuncle, athlete’s foot, genital itching and so on.

Therefore, the fight against chronic complications of diabetes has become our main task. I would like to present, as well as blood glucose increased in diabetic patients say: “To guard against complications of diabetes, with complications of diabetes fight!” It is very necessary.

But how can the risk of diabetic complications to minimize it?

Control of blood glucose is essential

Generally speaking, the normal range of blood glucose, fasting blood glucose should be 60 ~ 100 mg / liter. Can be the best within the normal range, but the age of 70 to 80-year-old, does not require his blood sugar completely in the normal range, it can be slightly higher than normal. If the elderly hypoglycemia, low blood sugar will affect the heart, brain function. 2 hours after meal blood sugar is not more than 140 milligrams.

Diabetes is a metabolic disorder of sugar-based diseases. Therefore, good blood glucose control is to prevent diabetes and its complications lies. In the living habits and diet, the better not to smoke, not drink, eat low-salt, low fat, low sugar food, to enhance physical exercise, while also on a regular basis to the hospital for examination, adjustment of treatment.

So majority of people with diabetes should not be too disappointed, in fact, diabetes itself is not terrible, as long as stable controlling blood sugar, high quality of life can still go on.