We all know that cataracts and glaucoma can cause blindness in the eyes, but many people do not know that vision loss and blindness in the eyes may actually be caused by diabetes.
Ms. Li, 41, has had severe visual impairments for more than two years, even affecting her daily life. For example, she pours water into the cup, because she can't see clearly, she may spill the water outside; when waiting for the bus, because she can't see the bus clearly, she often misses it; more dangerously, when she goes down the stairs, she may step on the empty if she is not careful, and if the stairs do not have handrails, they can only move forward a little.
Ms. Li said that now her right eye has a slightly better vision, wearing glasses with 0.1, while the left eye only has manual vision, which means that when someone shakes her hand in front of her eyes, she can only distinguish that something is moving, but she can't see clearly.
The culprit responsible for Ms. Li's severe vision loss is diabetes. Diabetic retinopathy is a microvascular lesion caused by diabetes, referred to as "glyco-retinopathy".
12 million people with diabetes are at risk of blindness
Wei Wenbin, vice president of Beijing Tongren Hospital affiliated to Capital Medical University and director of the Department of Ophthalmology, introduced that there are about 100 million to 120 million diabetic patients in China, and one-third of them have problems with fundus, that is, diabetic retinopathy has emerged, that is, there should be 30 million to 40 million people with diabetic retinopathy in China. Once these people miss the opportunity to be treated, a third of them are at risk of blindness — and this group is also very large, about 12 million. In particular, it is the young people among them who deserve attention. Young people often feel that they are in good health, young, and the pillar of work and family, so this group of people often ignores their health. The first major cause of blindness among people aged 40-60 is diabetic retinopathy.
Why does diabetes affect the eyes?
Zhao Weigang, chief physician of the Department of Endocrinology of Peking Union Medical College Hospital, introduced that diabetes is unable to control blood sugar. Blood sugar is high and endocrine instability is gone. Histiocytes are in a high-sugar environment for a long time, the first thing that affects the blood vessels, long-term hyperglycemia will cause vascular abnormalities, vascular wall problems, tissue destruction and so on. Complications of diabetes include cardiovascular, cerebrovascular, diabetic foot peripheral large blood vessels and other large blood vessel diseases, there are also microangiopathy, including the eyes, kidneys and other microvascular diseases.
Diabetes is a chronic disease, fasting blood glucose exceeds 7, postprandial blood glucose exceeds 11 can be diagnosed as diabetes. The treatment of diabetes is to control blood sugar well and not to cause complications. As long as blood sugar is controlled, the harm of diabetes to the human body is minimal; if it is not controlled, it will lead to various complications.
Almost all eye diseases are associated with diabetes
Dean Wei Wenbin said that almost all eye diseases are related to diabetes.
Some people get up in the morning to feel eye pain and grinding, because the change in blood sugar in diabetic patients causes changes in the surface of the eyes and dry eye disease, and the proportion of dry eye disease in diabetic patients is very high. Diabetic patients do not have the secretion function of the eye surface, the cell function is not good, a little trauma, such as rubbing the eyes, or a little inattention, the corneal epithelium is peeled off. The supra corneal nerves are particularly abundant, so the patient will be very painful, and the eyes will not be opened.
Diabetic patients can also cause inflammation of the iris, and new blood vessels grow on the iris. After the growth of new blood vessels, blocking the corner of the room on the side will lead to high intraocular pressure, causing glaucoma.
The lens of the eye is equivalent to the lens of a camera, and if the lens is cloudy, it will cause cataracts. Diabetic patients with crystal clouding is particularly early, may be thirty or forty years old to get cataracts, which is called metabolic cataracts.
Diabetes can also cause vitreous bleeding and, in severe cases, blindness. Diabetes can also cause poor nerve function, the most common is abductor nerve paralysis, the appearance of seeing things and things double shadow, can not walk.
The eyes are not only windows to the mind, but also to the health of the whole body, and the blood vessels of the retina are part of our microvascular.
Long-term diabetes leads to significant changes in microangiovascular disease, which can cause a series of retinopathy.
According to the survey, about 40% of people have problems with the fundus of type 2 diabetes in 15 years; if the 25-year course of the disease, more than 70% of people have problems with the fundus. Therefore, diabetics can only delay eye diseases if they manage their blood sugar for life.
How does glucoaromyuna develop step by step?
Diabetic retinopathy from mild to severe, divided into 6 stages, the risk of blindness at different stages is also different, stages 1-3 are relatively light, can be examined by fundus photography.
Stage 1 has a few small red dots above, these red dots are microhemangiomas, not paying attention is not visible, there are no symptoms at this stage, and it does not affect vision.
After entering phase 2, there are some yellow oozing outs. This is the blood vessel is not good, the composition of the blood is exposed, the blood lipids, fats in the blood can be exposed through the blood vessels, turning yellow.
After this yellow spot comes out, it is a stage 2 lesion, but the macula center is OK, so at this time, the vision is not much affected, or basically normal.
The reason why many diabetic patients have lost the opportunity for early diagnosis and early treatment is because there are no symptoms at the beginning, and patients do not feel it. Therefore, it is necessary to remind diabetics that diabetic disease is almost asymptomatic at the beginning, and as long as diabetes is diagnosed, the fundus should be examined.
By stage 3, there is more bleeding and a lot of oozing, which has an impact on vision at this time, and there is some blur in looking at things, and even sometimes looking at things is a little deformed.
In stages 1 and 2 of diabetic retinopathy require systemic treatment, the most important thing is to control blood sugar; after entering stage 3, special intervention is needed for the eyes; and entering stages 4, 5, and 6 has progressed to diabetic retinopathy, the proliferative phase of the lesion, is also a stage of rapid development, it is likely to be blind in a few days.
By the 4th period, from the external naked eye observation, it may not be possible to see, if not controlled, there will be visual impairment, at this time pay attention to control, to avoid entering the 4th, 5th, 6th stage.
Stages 5 to 6 are mainly new blood vessels that grow in the vitreous, and then there is serious bleeding; stage 6 causes severe retinal detachment. Therefore, whether it is stage 5 or stage 6, it is the most serious state of diabetic retinopathy, which requires surgery to intervene at this time, and the treatment effect is already very poor. No matter what kind of treatment is done, the final vision results are not particularly ideal. Therefore, diabetic retinopathy must be controlled in the first three stages.
It's hard for people with early diabetic disease to detect how to monitor their eyes?
To detect diabetic retinopathy, screening must be prompt. People with type 2 diabetes, once diabetes is diagnosed, should have a fundus examination. If the fundus is normal, it can be checked once a year; if the first screening of the fundus has problems, such as lesions that have entered stage 2 and stage 3, then the interval between screenings should be shortened, and it may be necessary to check every six months.
Patients with type 1 diabetes should also have a check-up after the diagnosis of diabetes, and then do a fundus examination every six months. For most people over the age of 40, if it is a healthy state, blood sugar control is also particularly good, and it is okay to check it once a year or once a year or once every two years.
Hyperglycemia, hyperlipidemia, and hypertension accelerate the development of glycopathy. The first is high blood sugar. Hyperglycemia is the most important cause of gluco-omyopathy. Controlling blood sugar or completely controlling blood sugar in the normal range, at least close to normal, is the basis for ensuring the prevention of sugar nets. In addition to hyperglycemia, in the process of controlling blood sugar, hypoglycemia can not be produced, hypoglycemia is easy to aggravate neuropathy, but also pay attention to the progression of mentopathy, in addition, blood glucose fluctuations can also cause damage to blood vessels.
The second risk factor for accelerated gluco-retinopathy is hyperlipidemia, including cholesterol and triglycerides. High cholesterol, causing great damage to the vascular endothelium, the appearance of intravascular plaque, blood vessel stenosis. High triglycerides can lead to insensitivity to insulin, which is medically called insulin resistance, and the overall blood sugar will also be high. So, cholesterol affects blood vessels, and triglycerides affect blood sugar.
The third risk factor is hypertension. Hypertension can cause changes in blood vessels, hardening of blood vessels and changes in the permeability of blood vessels, and also easily cause retinal lesions, such as retinal vascular obstruction, fundus hemorrhage, etc. Therefore, diabetic patients have high blood pressure, which is particularly prone to fundus lesions. (Content source "Workplace Health Class")