The most advanced treatments (laser, drugs and surgery) can reduce the proliferation of the vessels causing the major problems in the nerve membrane of the eye
A key reason why it screening for diabetic retinopathy is helpful and sacrosanct is that they exist effective therapies to manage it. Today it is possible to save sight, if the diagnosis arrives in time and you undergo treatment: as underlined by Stela Vujosevic, head of the MultiMedica Group Medical Retina Service in Milan, «where screening for diabetic retinopathy existsas in the United Kingdom or in some Northern European countries, lhe prevalence and incidence of the disease have decreased and diabetic retinopathy is no longer the leading cause of blindness in the working-age population». Given that the best strategy remains prevention, trying to keep blood sugar stable and checking the conditions of the retina at regular intervals, which what can be done when the disease occurs?
Photocoagulation
“Today the possibilities are different. It is still in use and very useful for example the laser photocoagulation, which until twenty years ago was the only possibility of intervention», answers Vujosevich. “The laser is used to prevent blood vessels in the retina from bleeding, reducing vision, and also to reduce the retina’s need for oxygen, which triggers the production of abnormal blood vessels which then impair vision. The laser can Like this slow down the loss of vision and today there are also “mild” ones, suitable for treating the central part of the retina in case of edema, that is, when liquid leaking from the vessels collects:
until recently it was possible to intervene with photocoagulation only in peripheral areas, today even the central one can be treated with “light” lasers, although this option is not the first choice
».
The laser, by eliminating areas of retinal tissue that is diseased and suffering from oxygen deficiency, prevents the signals from being sent to form new blood vessels and that the retinopathy progresses.
Antibodies
However, today it is also possible to intervene with specific drugs which prevent the abnormal proliferation of vessels. “It’s about the anti-VEGF monoclonal antibodies (Vascular Endothelial Growth Factor, i.e. the vascular growth factor which is directly responsible for stimulating the formation of new vessels, ndr), also already used for age-related macular degeneration,” notes Vujosevic. «They are drugs in use for years, sure and well known, which may be helpful in some cases of proliferative diabetic retinopathy and when there is macular oedema, because they reduce the growth and permeability of the retinal vessels. These drugs come injected into the vitreous ocular, in sterile clinics or surgical rooms, therefore in total safety
; the injections must be repeated according to cycles that provide for precise timing, but the results are very good and in some cases it is also possible to have a visual improvement. Furthermore, diabetic retinopathy is a complex pathology in which the levels of various inflammatory molecules also increase: for this reason in some patients it is necessary to use
broad spectrum steroidal anti-inflammatory drugs».
Vitrectomia
In the most serious casesqWhen the disease progresses and there is consistent bleeding or edema that makes the vitreous opaquemay become appropriate
vitrectomy, i.e. surgery to remove the vitreous body inside the eye. Finally, in some patients, diabetic retinopathy can cause a retinal detachment that can be treated with laserwhich creates a kind of scar to weld the degenerated tissue to prevent the lesion from spreading, oror with an actual microsurgical intervention to repair the retina or ensure that it can reattach itself.
Future therapies
In the future it will perhaps be possible to intervene with even earlier therapies for diabetic retinopathy, to prevent its progression: studies conducted on mice promise it and published onAmerican Journal of Pathology, according to which the key is to act on local inflammation due to hyperglycemia. “Inflammation causes nerve degeneration and microvascular abnormalities, but nerve damage precedes more visible damage to blood vessels,” explains Hyung Jin Choi of Seoul University in South Korea, author of the investigations. “Therefore, a therapy with an anti-inflammatory and neuroprotective effect could be a successful strategy in the period between the diagnosis of type 2 diabetes and the clinical appearance of retinopathy.”
Contact lenses with LED light
Choi focused on a GLP-1 receptor agonist already used for diabetes therapy: the drug demonstrated a neuroprotective and anti-inflammatory effect independent of its action on blood sugar, because mice treated with insulin were not equally protected from retinal damage. «Retinal cells begin to die long before the microscopic bleeding typical of diabetic retinopathy occurs: protecting them by reducing neuroinflammation can be a winning strategy» says Choi. Something similar could happen with le contact lenses with LED light developed by researchers at the South Korean University of Pohang: the lenses, designed for patients with early-stage retinopathy, they deliver a weak infrared light that appears to be protective for the retina. «Mice that wore the lenses for 15 minutes three times a week for two months did not develop the disease. as those to which they have not been applied,” conclude the authors.
November 14, 2022 (change November 14, 2022 | 10:51 am)
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