Diabetes prevalence has risen so fast in recent years that it has been declared an epidemic in some countries such as Mexico. Among its many complications, visual impairment and blindness are some of the most devastating as they create disability in adults and more so because these tragedies can be easily prevented. This study recognizes that diabetes does not discriminate between nationality, gender or age and thus it can potentially affect anyone. More alarming is the rate of type 2 increment especially in industrialized countries due to sedentary lifestyles that damage insulin receptors and disable the blood sugar control mechanism of the body. Ocular complications do not discriminate between type 1 and type 2 diabetics, and they are much harder to fix in type 2 cases as per the findings of this review.
Significant risk factors that increase the risk of developing diabetic retinopathy (DR) and subsequently blindness have been identified as obesity and inflammation. They cause the release of cytokines and growth factor such as Vascular Endothelial Growth Factor (VEGF) which cause increases permeability of vessels increasing leakage and the development of rogue capillaries in the retina respectively. Hypertension increases the risk of DR by creating a strain on blood vessels when the blood pressure gets high which causes them to break and leak. This means that for people with diabetes who are obese, have high blood pressure or both, the risk of developing diabetic retinopathy as compared to other diabetic populations is greater. Previous studies have identified the duration of sickness as a leading risk factor for the progression of ocular complications, and few have looked at obesity and inflammation as significant factors.
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Late presentation of the disease also reduces the reversibility of DR because the more a patient stays with the condition, the further the damage that occurs to the retina. Since the retina is a very sensitive organ interventions meant to fix DR such as laser photocoagulation can damage it further. Most procedures used to treat DR do not guarantee an improvement in visual acuity, so it is better to prevent the progression of DR than to attempt to reverse it. Diabetic women who are pregnant have a higher risk of developing retinopathy, and this can be attributed to the unstable blood pressure recorded during pregnancy and how quickly they get stresses due to hormonal imbalance. Although kidney disease or nephropathy is also identified as a risk factor, it is not clear why and further investigation into this is required.
This review identified several interventions that can be used to stop the progression of diabetic retinopathy. The most commonly used despite being potentially harmful is Laser photocoagulation. It involves using a focused laser beam to close off leakages in retinal vessels. Anti-VEGF medication is a relatively new field in practice, but it has shown success in several cases. These injectable drugs react by inhibiting VEGF production and thus the development of additional blood vessels. This method is especially effective when used together with photocoagulation. This combination also decreases the cost of treatment because it reduces the frequency of anti-VEGF administration. However, not all people respond to anti-VEGF due to genetic variation and possible mutation of the growth factor which means that these people need to seek other interventions. This review highlights the use of intravitreal steroids to treat DR. However, even in other medical instances, steroids are known to have unexpected side effects. This method seems dangerous and has more disadvantages than advantages as it may lead to the development of cataracts and glaucoma which are ocular complications on their own.
Recommendations
As per the findings of this review, the following recommendations are made regarding this topic. The medical community can conduct further research on the effect of inhibiting the signal transducer and activator of transcription (Stat3) by conducting human trials. The study done on rats who had suffered vision loss caused by DR for 16 weeks recorded an improvement of vision. So many diabetics are screened with DR when it is too late to fix it and success in this field can help save them from permanent disability. This is the only option that was recorded to not only stop DR progression but also improve vision and may have significant implications if the results can be replicated in humans.
Prevention is always better than cure, and this applies to the prevention of DR caused visual impairment. Tight metabolic control has recorded positive outcomes in both type 1 and 2 diabetics. Even though the results were significantly better for type 1 diabetics, more can be done to improve the situation for type 2s as well. Patients, as well as healthcare providers, should adopt practices and policies that promote metabolic control. This includes close monitoring of insulin deficiency and availability of insulin injections for people with type 1 diabetes despite their economic status. Governments can incentivize the production of insulin and make it available to diabetes patients through primary care organizations. Patients with type 2 diabetes can be educated on how to identify abnormal blood sugar levels and ways to keep it balanced.
Focus on the overall wellness of diabetic patients is also recommended for prevention of visual loss. As identified by this review, factors such as poor nutrition leading to obesity and stress which can cause high blood pressure are harmful to diabetic patients. Healthcare providers should, therefore, incorporate wellness programs into diabetes treatment.
Diabetes patients are advised to go for regular eye checkups at least once a year. This ensures that symptoms associated with the development of retinopathy are identified early enough, and treatment is begun. This increases the chances of controlling the progression of DR. the review identified changes in retinal oxygen metabolism that can help ophthalmologists in detecting possible DR in its early stages as this occurs well before the physical changes appear. Although this was recorded in a study involving rats, replication in a human sample with similar outcomes would revolutionize the screening of DR even before it begins to affect vision.
The purpose of this review was to identify areas of interest regarding the prevalence and progression of diabetic retinopathy. Its findings and recommendations can be used to formulate a comprehensive program that caters to diabetic patients of all ages to reduce the progression of retinopathy to blindness. From this information, awareness creation exercises can be formulated based on reliable data to make life better for diabetes patients. Possible new interventions described by this report suggest new strides in the fight against DR and blindness that may reduce the predicted tripled prevalence by 2050. Although the further investigation into these new interventions is required to propagate progress, this report provides a starting point for future research into the prevention of DR.
