To the ophthalmologist for diabetes Specialist in diabetic retinopathy
With more than 7 million diabetics in Germany, diabetes is already a widespread disease. The longer the disease lasts, the greater the risk of diabetic retinopathy. Early detection through regular check-ups is crucial in order to treat a diabetic eye in good time and to avoid irreparable damage.
Specialized ophthalmologists for diabetic retinopathy and diabetic macular edema
- Diabetes mellitus increases the risk of changes in the eye and damage to the retina. Our ophthalmological practice, in the heart of Düsseldorf, has specialized in the detection and treatment of these co-morbidities.
- We take a lot of time for our patients and offer special preventive examinations for high-risk patients.
- In the case of diabetic retinopathy, we carry out therapy with intra-vitreal injections or laser after detailed consultation, depending on the findings.
Diabetes-related eye diseases
Important questions and answers
What eye problems can be caused by diabetes?
In diabetes, the eye can be affected as follows:
- Diabetic retinopathy
- Diabetic macula edema
- Lens opacity (cataract)
What is diabetic retinopathy?
Diabetic retinal disease or diabetic retinopathy is the most common microvascular complication of diabetes mellitus and continues to be the most common cause of blindness in working age in the western world. It is caused by increasing damage to the small blood vessels (microangiopathy), which initially damages the retina unnoticed.
How does diabetic retinopathy develop?
In the course of the disease, high blood sugar levels lead to changes in the blood vessels. This leads to damage to the small capillaries in the eye. The vascular walls thicken and become brittle and vascular dilatations (microaneurysms) form. This can cause the vessels to leak, causing fluid and blood to enter the retina. When fluid enters the central retina, it is called diabetic macular edema.
In addition, pronounced hardening of the arteries can occur. This makes the blood flow more difficult, causing a lack of oxygen in the eye, called microangiopathy.
Who belongs to the risk group for diabetic retinopathy?
The main risk factor for the development of diabetic retinopathy is a poor blood sugar level over a long period of time. Arterial hypertension (high blood pressure) and smoking are further risk factors. Diabetic retinopathy can also worsen during puberty and pregnancy.
Forms of diabetic retinopathy
Diabetic retinopathy, also known as diabetic retinal disease, can be divided into the following forms.
Non-proliferative diabetic retinopathy (NPDR)
Most diabetics have non-proliferative retinopathy. This stage of the disease can be from mild to severe. Vascular dilatation (microaneurysms), retinal bleeding, fat deposits (hard exudates), capillary fluctuations and infarcts of the nerve fiber layer (so-called cotton wool spots) can occur.
In the initial stage, the disease does not require any eye therapy, apart from optimal blood sugar control, and only needs to be checked. Close controls are required depending on the stage. If the pathological findings increase, a laser treatment of the retina may be indicated.
In the initial stages, most patients have no symptoms for a long time. Damage to the retina occurs without the patient noticing. Therefore, annual checkups are extremely important. With timely treatment, the progression of the disease can be stopped.
Proliferative diabetic retinopathy
Proliferative diabetic retinopathy is more common in adolescents with type 1 diabetes than in type 2 diabetes. As a result of the lack of oxygen in the retina (retinal ischemia), new vessels form (neovascularization). However, due to their changed wall structure, they are leaky, bleed easily and allow fluid into the retina. Sudden bleeding into the vitreous space can occur, with the consequence of a sudden severe visual impairment, up to and including blindness. In some cases, scar membranes can form on the retina, contracting the retina and causing retinal detachment.
In some untreated cases, new vessels can also form on the iris and in the corner of the eye (the structure where the eye fluid drains away). As a result, the intraocular pressure can rise sharply.
The stage of proliferative diabetic retinopathy is in urgent need of treatment. Treatment consists primarily of panretinal laser coagulation (laser treatment of the entire peripheral retina). Lately, based on current study results, this treatment can also be carried out with intravitreal injections as the sole therapy or, depending on the findings, in combination with laser therapy.
In case of macular edema, therapy can be combined with intravitreal administration of medication into the eye. If vitreous hemorrhage occurs without resorption or if strong traction membranes are present, with the risk of retinal detachment, an operation may be necessary. Close treatments and controls are essential at this stage.
Our ophthalmological practice specializes in the treatment of diabetic retinopathy and has state-of-the-art diagnostic and therapeutic equipment. If required, we also perform retinal lasers and intravitreal injections.
Diabetic maculopathy and diabetic macular edema
If the diabetic retinal changes affect the macula, the point of sharpest vision, one speaks of diabetic maculopathy. Often, a leakage of fluid from the small vessels leads to a swelling at the center of the retina (macular edema). Macular edema impairs the visual function and, without treatment, can lead to permanent damage to the central retina with a permanent loss of the function of the eye.
Therefore, timely treatment at this stage is very important!
The treatment of diabetic macular edema consists of performing repeated intravitreal injections, which we can perform on our own.
Risk factors for diabetes-related eye diseases
What are the risk factors for developing diabetic retinopathy?
There are several factors that pave the way for diabetic retinopathy.
Type 1 diabetes
Type 1 diabetes is a general risk factor for developing diabetic retinopathy. If you are diagnosed with diabetes, visit your ophthalmologist every year for a check-up.
Type 2 diabetes
A diagnosis of type 2 diabetes is also a general risk factor for developing diabetic retinopathy. We recommend regular check-ups by an ophthalmologist.
Duration of illness
The risk of a diabetes-related retinal change increases with the duration of the illness.
Blood sugar levels
Persistent poor blood sugar levels are a risk factor for developing diabetic retinopathy. Good blood sugar control is crucial.
High blood pressure
Too high blood pressure for many years damages the blood vessels and is a risk factor for diabetic retinopathy. Medical supervision and regulation is important.
Smoking also damages the vessels in the eye. Try to become or remain a non-smoker.
Excessive consumption of alcohol has negative effects on blood vessels and therefore also on the health of the eyes. Try to avoid alcohol.
Puberty and pregnancy
Diabetic retinopathy can get worse during puberty or pregnancy.
Examination of the eyes for diabetics
Eye problems in diabetes often go unnoticed in the early stages because the patient has hardly any noticeable symptoms or signs of a diabetic eye. This is why regular visits to the ophthalmologist are so important for diabetics. This is the only way to ensure timely therapy that can avoid irreparable damage.
Regular checks of the retina for diabetics by the ophthalmologist
We recommend diabetics to undergo regular ophthalmological examinations. In our ophthalmological practice, we can use the most modern technology to diagnose diabetic retinal changes from the preventive examination to the advanced stage, follow their course and, if necessary, treat them.
Our ophthalmological practice is equipped with the latest technology. Depending on the stage of the disease, the following examinations can be carried out to detect a diabetic retinal change:
OCT - Optical Coherence Tomography
Optical coherence tomography is a non-contact and non-invasive examination method for displaying the individual central layers of the retina. With this examination, the ophthalmologist can identify detailed findings that cannot otherwise be seen with conventional methods. For example, macular edema and the extent of the edema can be precisely displayed and the course of the disease can be exactly followed. This way we can also determine the need for further treatment.
OCT angiography is a modern, non-invasive method for visualizing the small retinal vessels in the area of the macula and in the adjacent area of the retina. In the case of diabetic retinal changes, it enables us to visualize the small vascular sacs (so-called microaneurysms), the pathological new vascular formations and vascular-free areas (with so-called ischemic maculopathy). The examination is carried out without the use of dye injection. This examination method is also very well suited to carry out follow-up controls of diabetic retinal diseases.
FLA Fluorescence Angiography
Fluorescence angiography is an examination that is carried out when a detailed statement about the blood flow to the retina is necessary. This examination is useful, for example in the stage of proliferative diabetic retinopathy, both for diagnosis and later follow-up. During this examination, a well-tolerated yellow dye (fluorescein) is injected into the arm vein. This is distributed throughout the body including the fundus vessels. The vessels can then be photographed over time with a special camera. Many pathological changes, such as new vessel formation in proliferative diabetic retinopathy, can be represented in this way.
Fundus photography and wide-angle images of the retina
The wide-angle view of the retina is done using a special camera. In some cases, the image can also be taken without dilating the pupil. Many pathological changes, such as bleeding, can also be precisely documented. The recordings can be very helpful later as a follow-up.
Therapy for the treatment of diabetic retinopathy
The therapy of diabetic retinopathy depends on the changes. In the initial stages, such as mild to moderate non-proliferative diabetic retinopathies, therapy is usually not necessary. However, good control of the findings is essential. Good blood sugar control and blood pressure control are extremely important here and often determine the further course of the disease.
Severe non-proliferative diabetic retinopathy and proliferative diabetic retinopathy always require laser treatment. Diabetic macular edema, with impaired vision, must also be treated with intravitreal injections.
Our ophthalmological practice uses the latest technologies to treat diabetes-related eye diseases.
Treatment of diabetic retinopathy at the ophthalmologist
We treat diabetic retinopathy with the following methods, depending on the patient’s findings:
Laser therapy for diabetic retinopathy
Laser treatment is often necessary for proliferative changes (new blood vessels). However, some other pathological changes can also afford targeted and gentle laser treatment.
Therapy with intravitreal injections
Intravitreal injection (IVOM) therapy is required for clinically significant diabetic macular edema. The prognosis is better with early therapy. Therefore, patients with incipient diabetic vascular changes should be examined regularly in order to be able to start any therapy in good time.
Further information on diabetes and the eye
Don't be afraid of the ophthalmologist!
Our ophthalmological practice specializes in the detection and treatment of diabetes-related eye diseases. We use the latest technologies in ophthalmology, work very sensitively, absolutely sterile and particularly precisely, so that examinations and treatment can be experienced quickly and painlessly.
PD Dr. Klaus Dieter Lemmen
Many years of experience as senior physician and chief physician in specific eye clinics. Focus: Age-related macular degeneration, retinal diseases and diabetes-induced retina diseasesLearn more
Dr. Katarina Vahdat
Focus: general ophthalmology and pediatric ophthalmology. Treatment of various macula diseases, diabetic retinopathy and diabetic maculopathyLearn more