Date: February 6, 2023.
Whether it’s enjoying cool ice creams in scorching summers or savoring hot gajar ka halwa in chilly winters or simply relishing delightful sweets and flavorful kheers… my grandma never missed a treat! Even with diabetes, she never compromised her sweet tooth. After insulin shots, she would enjoy her sugary glees and manage her condition. Sounds pretty easy right?
Well, life isn’t always simple for people suffering from diabetes. It takes its toll on their physical as well as mental health. Some very common complications according to CDC that the majority of patients suffer from are- heart disease, chronic kidney disease, nerve damage, and other problems with feet, oral health, vision, hearing, and mental health. In today’s blog, I shall shed light upon the condition that takes away light from diabetics; diabetic retinopathy.
First, let us understand what happens in diabetic retinopathy?
Diabetic retinopathy is difficult to diagnose due to the lack of symptoms at the beginning, but as it worsens, you will begin to notice it. In a nutshell, it goes like this:
Stage 1: Mild NPDR (Non proliferative diabetic retinopathy)
In this stage, capillaries in the retina (light-sensitive nerve cells at the back of the eye that transmit images through the optic nerve to the brain) develop micro aneurysms (abnormal bulges in the wall of a blood vessel). They appear as tiny red dots scattered on the back of the retina.
Stage 2: Moderate NPDR
They are characterized by cotton wool spots and dot hemorrhages (bleeding because of broken blood vessels).
Stage 3: Severe NPDR
At this stage, four quadrants in the eye have intra-retinal hemorrhages, two quadrants have venous beading (expansion of the retinal vein) and one quadrant has intra-retinal microvascular abnormalities (IRMAs). Vision will be blurry in NPDR.
Stage 4: Proliferative Diabetic Retinopathy (PDR)
The retina begins to grow new blood vessels at this stage, known as neovascularization. These blood vessels are fragile and start bleeding into the vitreous chamber (located behind the lens and in front of the optic nerve). The appearance of floaters (spots) can be caused by a little bleeding, but a lot of bleeding can cause vision loss.
Let us now dive into what causes diabetic retinopathy.
To put it simply, high blood sugar levels (hyperglycemia) cause damage to the blood vessels in the retina and cause diabetic retinopathy.
Pericytes (cells present at intervals along the walls of capillaries and are important for maintaining the blood-retinal barrier) and endothelial cells (blood vessel cells) are the two main cellular constituents of the retinal microvasculature. During hyperglycemia, pericytes are lost, which results in the development of micro aneurysms. Additionally, endothelial cells are lost and the basement membrane thickens, which contribute to the impairment of the blood-retinal barrier, subsequently resulting in retinal edema (swelling).
Furthermore, the apoptosis (cell death) of pericytes and endothelial cells causes capillary occlusion and retinal ischemia (inadequate blood supply and lack of oxygen). To compensate for this, the levels of VEGF (vascular endothelial growth factor; an angiogenic factor that promotes the formation of new blood vessels) increase. VEGF produces new blood vessels i.e. neovascularization. However, these blood vessels are abnormal (intra retinal microvascular abnormalities) and can rupture and cause bleeding.
Thus, there is a potential loss of vision in diabetic patients. As mentioned previously, it is difficult to diagnose diabetic retinopathy due to the lack of symptoms in the initial stages. However, once it enters the proliferative stage (PDR), the chances of vision loss increase. This is why it is vital for diabetic patients to get their eyes regularly examined.
Now strikes the real question, Can sugar control in diabetics prevent the onset of retinopathy?
YES IT CAN!
Research says managing diabetes by minimizing sugar intake, consuming a healthy diet, exercising regularly and getting an annual comprehensive dilated eye exam can prevent or significantly lower the risk of developing diabetic retinopathy.
There’s a lot of buzz going on around AI these days… can it help with diabetic retinopathy?
You guessed it… OF COURSE!
In the medical industry, AI and deep learning algorithms are predicted to have a growing presence over the coming decade. Ophthalmology has already adopted AI for the diagnosis of diabetic retinopathy (DR) from color fundus photographs. Studies have proven AI systems to be highly accurate in DR detection and two US FDA-approved AI systems, IDx-DR (first FDA approved AI algorithm for the detection of DR which can be used by non-ophthalmic healthcare professionals) and EyeArt (the first FDA cleared AI technology for autonomous detection of diabetic retinopathy) are currently in clinical use. Additionally, SELENA+ (Singapore Eye Lesions Analyzer- uses deep learning system) has received approval from Singapore’s HSA, European CE mark, Malaysia MDA, Indonesian regulatory certification and ANVISA in Brazil. A recent economic report reveals that incorporating AI into large-scale DR screening programs could mean significant savings. However, there are still obstacles, such as legal responsibility for diagnosing other illnesses. SELENA+, for instance, detects DR as well as two other major eye diseases, age-related macular degeneration (AMD) and glaucoma, whereas IDx-DR only detects DR. Furthermore, low-quality images can reduce the accuracy of AI algorithms, though most commercial systems now have automated image quality assessments. Furthermore, AI algorithms have a range of potential uses for DR screening, such as the detection of diabetic macular edema (DME) from color fundus photos (CFPs) and improving accuracy in retinal layer segmentation and quantifying the amount of fluid present in affected areas, which could be very beneficial in terms of disease prediction and guiding treatment decisions.
In recent years, progress has been made to reduce the amount of visual impairment and blindness caused by diabetic retinopathy (DR). As the clinical and research landscapes continue to evolve, more steps will be taken to decrease its impact. However, you must realize that your nutritional choices can have a significant effect on your health.
Cutting on sugary bites can save your sight and lead you to a brighter life!
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