Caderno Especial Congresso de Oftalmologia - O POVO

FIGHT AGAINST RETINOPATHY

Diabetic retinopathy can be diagnosed early, increasing the effectiveness of the treatment

Sabryna Esmeraldo

"Due to progress in the clinical management of diabetes and increased longevity of the diabetic patient, it is inevitable that most diabetics will suffer some degree of visual loss in the decades following the onset of the disease." The statement is by Leiria de Andrade Neto, ophthalmologist and professor at the Department of Surgery at the Health Sciences Center at the Faculty of Medicine at the Federal University of Ceará (UFC).

According to data from research carried out by the physician at the retina and vitreous service at Hospital de Olhos Leiria de Andrade, Diabetes Mellitus is the main cause of blindness in the United States and the major cause of new cases of visual loss in the population aged 20 to 64 years.

According to estimated data indicated in the survey, 9% of the Brazilian population has diabetes, and may present ocular manifestations such as corneal abnormalities, glaucoma, iris neovascularization, cataracts, abnormalities in the optic nerve and, mainly, retinopathy. "Approximately 25% of all diabetics have some form of retinopathy", evaluates Andrade.

Diagnosis

The main determinants of the incidence of diabetic retinopathy are the duration of diabetes, the age of the patient and the type of diabetes (Type II - insulin dependent or Type II - non-insulin dependent). Leiria de Andrade points out that early diagnosis and treatment can slow the progress of the disease and help prevent blindness caused by vitreous hemorrhage or retinal detachment.

By causing obstruction and abnormal permeability of vessels, retinopathy causes so-called macular edema, which can affect vision. The diagnosis of clinically significant macular edema that requires treatment is made through a thorough ophthalmological examination. “It is better to diagnose macular edema when it is clinically significant before it affects vision, as the treatment is much more effective at this stage”, warns the ophthalmologist, emphasizing the importance of periodic consultations between the patient and the doctor.

Who needs it

In order to bring the most modern ophthalmology to the neediest population, the ophthalmology service of the Irmandade da Santa Casa da Misericórdia in Fortaleza was modernized.

The Service operates in all subspecialties of the area. The emphasis is on the Retina Service, with a primary focus on treating patients with diabetic retinopathy.

“After years working in the public and private sector, our group noticed the enormous difficulty for certain groups of our population to have access to modern treatments for diabetic retinopathy”, explains Javier Montero, specialist in ophthalmology and head of the Retina Service at the of Ophthalmology at Santa Casa.

Currently, the service offers high-tech complementary exams for the diagnosis and follow-up of diabetic retinopathy; in addition to laser for photocoagulation and powerful anti-angiogenic drugs for treatment. “To perform surgeries, we rely on modern microscopes and the latest equipment to perform vitreoretinal surgeries”, says the doctor. The service is open to the entire population of Ceará and partnerships are being created with public and private bodies to further facilitate access.

Understanding Diabetic Retinopathy

What is it?

Background (or non-proliferative) diabetic retinopathy is primarily a disease in which the blood vessels of the retina are mainly affected by two processes:

- Vascular occlusion (obstruction): impairs the delivery of oxygen and other nutrients to each retinal area and the return of carbon dioxide and other blood wastes

- Abnormal vascular permeability: Water, blood cells, proteins, fats, and other large molecules accumulate, which can cause macular edema if this fluid goes to the central region of the retina (the macula).

How to prevent

The disease can be diagnosed early through periodic examinations by the ophthalmologist. With a detailed examination of the retina and adequate treatment of retinopathy, early visual loss is prevented.

Treatment

Made mainly through laser, the treatment of macular edema can take from days to months to have its effects (decrease of edema and improvement of vision) felt by the patient.