A COMPLICATION OF NONCOMPLIANCE IN DIABETICS
Diabetic retinopathy is becoming a common problem in patients with type 1 diabetic patients. 80% to 90% of such patients may suffer from diabetic retinopathy after 10 to 15 years of diagnosis of diabetes type 1. It is very rare in the type 2 diabetes patients. Collectively both types of diabetics are 25 times more at risk for blindness than the general population. Diabetes mellitus generally is a major cause of blindness in the United States alone and in working-aged Americans it is the leading cause of new blindness that account for at least 12% of new cases each year.
The incidence of its complications, namely proliferative diabetic retinopathy and diabetic macular edema, are on the rise. Annually it is 65,000 and 75,000 cases of these problems respectively. The patients with type 1 diabetes may develop these complications in their lifetime with the prevalence rates of 70% for proliferative diabetic retinopathy and 40% for macular edema. As soon as the person with diabetes type 1 feels any problems in vision regardless of how minor it is, the patient should immediately have an examination of the eyes. If untreated, it frequently leads to serious visual loss and disability.
The main cause of this complication that all agree upon is uncontrolled hyperglycemia. This is generally due to the patient's noncompliance and unwillingness to take medications.Persistent high levels of blood glucose along with an elevated blood pressure (as both are simultaneously present in diabetics) tend to damage the small blood vessels in the retina thereby preventing an adequate supply of blood to the retinal tissues. The severity varies in both the eyes, and in many cases it is present in one eye only. Many a times the fluid leakage from these capillaries worsens the conditions and may lead to loss of vision.It is also related to a long duration of development of diabetes and the age of patient. At some stages in life, for instance puberty and pregnancy the blood glucose level is out of control and there is a greater chance of developing this complication.
Principles and recommendations for Patient Education:
The patients should be informed about the threats on sight of this complication which can result in total blindness. The diabetics should themselves be aware and report the changes in their vision and its symptoms since they are of the diabetic origin. Macular edema for instance is indicated by Blurred vision while reading. Other symptoms such as the presence of floaters may indicate hemorrhage, and flashing lights may indicate retinal detachment. The risk of the complication resulting in an ultimate loss of vision is greatly reduced by an early detection and treatment appropriate for the symptoms. An early and timely laser photocoagulation therapy also reduces the risk of visual loss. There are higher risks of cataract formation, open- angle glaucoma, and neovascular glaucoma if these symptoms go untreated in diabetics.The patients should also know about.The relationship between glycemic control and its ocular complications,the association between hypertension, diabetes and diabetic retinopathy,The importance of an early diagnosis.
High cholesterol intake as well as the consumption of snuff and alcohol should be avoided.
There is evidence that smoking prevents the retina reach the required amounts of oxygen.
It is also observed that smoking prevents the amount of oxygen required by the retina. Thus smoking should be avoided. On a regular basis the patients should have eye checkups along with a healthy visual hygiene. For example Use glasses if necessary,Use of appropriate sunscreen, Wear protective filters when working with computer,Eye protection to avoid burns or wounds,No self-medication with eye drops should be taken, except by prescription,Never to overstress visual or reading,Work with optimal light conditions.
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