Diabetes and the Eyes: Diabetic Retinopathy Basics

[What is diabetes?]

Glucose in the blood (blood sugar) is known to be harmful to blood vessels.

When blood sugar rises after a meal, the pancreas, located behind the stomach, immediately releases insulin to bring it down.
If this mechanism stops working well and blood sugar stays high, blood vessels are damaged from the inside.
When this continues for a long time, diabetic complications first appear in the tissues with the finest blood vessels in the body: the kidneys, peripheral nerves, and the retina.

[Eye complication: diabetic retinopathy]

When blood vessels stop working properly, blood no longer reaches the nerve tissue at the back of the eye (the retina) (ischemia).
An ischemic retina is the root of the trouble.
Retinal cells become inflamed, various proteins (cytokines) accumulate in the eye, and they further damage the retinal blood vessels.

・Increased retinal vascular permeability: vessel walls weaken and fluid leaks out
　→ it collects in the center of the retina (the macula) and vision drops

・Retinal neovascularization: in response to oxygen shortage, new fragile vessels form
　→ bleeding inside the eye (vitreous hemorrhage)

・Others: retinal detachment (tractional retinal detachment), secondary glaucoma, and more

This vicious cycle inside the eye makes diabetic retinopathy progress.

» Oxygen shortage makes blood vessels grow onto the cornea (corneal pannus)

There are no noticeable symptoms in the eye until the disease is quite advanced.
If you have been diagnosed with diabetes, it is important to have regular eye examinations.

» Preventive ophthalmology: care tailored to the community (update)

[Examination and diagnosis]

Added August 29, 2021: the following can now be used.
» Advances in retinal imaging: ultra-widefield fundus imaging

We examine the fundus to judge the presence of retinopathy and the degree of ischemia, and advise when you should come back next.

» Dilated (pupil-widening) examination and fundus examination: an introductory video

As needed, we use fundus photography, optical coherence tomography, OCT angiography, and static visual field testing, and explain all results with images.

[Treatment]

Retinal photocoagulation (laser treatment)
: by shutting down the function of the ischemic retina, it slows the progression of the disease.

Posterior sub-Tenon steroid injection
: a suspension steroid (triamcinolone acetonide) is injected outside the eyeball to calm inflammation inside the eye.

Intravitreal anti-VEGF injection
: by suppressing VEGF (vascular endothelial growth factor), one of the cytokines in the eye, it slows the progression of the disease.

» Why we use laser on the fundus and injections into the eye

Vitreous surgery
: its main purpose is to remove cytokines that have accumulated in the eye. It is also used for markedly advanced diabetic retinopathy, for example to remove proliferative membranes, apply endolaser, or repair retinal detachment.

Thanks to recent advances in ophthalmology, vision loss can be prevented if the disease is dealt with early.

After grasping the condition and judging the best timing, we provide optimal treatment in cooperation with partner hospitals. Thank you for your trust.