“Of the nearly 4 million Italians with diabetes, about 1.2 million – or 30% – live with diabetic retinopathy. Of these, 6-7% lose their vision due to the disease. Fundamental preventions and periodic checks because the diabetic patient has perfect eyesight, but suddenly he no longer sees from one day to the next because the retinopathy has progressed slowly in the meantime. However, compared to 10 years ago, if we intervene in time we can prevent visual loss, but we must intercept the pathology before symptoms appear, otherwise we can stop the disease but what we have lost is impossible to recover “. Edoardo Midena explains, general secretary of the Italian Society of the Retina, on the occasion of the Sir National Congress which took place in Venice from 1 to 2 July. Objective of the two days: to take stock of screening, risk factors, differential diagnoses, surgical techniques and new drugs for pathologies affecting the retina.
Unlike macular degeneration, another pathology of the retina that affects anyone aged 65 and over, the subjects most at risk of diabetic retinopathy are precisely people with diabetes and arterial hypertension. “The real candidates, from a statistical point of view, also have ocular involvement – says Midena – The new screening techniques are fundamental, which in fact consist in photographing the retina (the back of the eye) and which allow us to see if there is retinopathy, how should we treat it and when to re-check the patient. with the pandemic, screening has stopped. Diabetic subjects no longer went to the doctor, there was very little approach to hospital facilities, general practitioners were so overwhelmed by the problems related to Covid that they did not have time to take care of these patients too. Many have taken care of and monitored themselves. This last year and a half has been a dark period, from a clinical point of view eye diseases have not been considered important “.
Not all patients with diabetic retinopathy risk not seeing anymore, “however 6-7% of them – underlines Midena, who is also director of the School of Specialization in Ophthalmology of the University of Padua – have a disabling visual loss, up to blindness. Fortunately, thanks to the new intravitreal drugs we can better manage and control the disease, without too many limitations for our patients “.
Ten years ago, “when we started using them – recalls the general secretary of SIR – we had to administer them into the eye with one injection a month. And since in most cases diabetic retinopathy is bilateral, the patient was forced to undergo this treatment every 15 days. Today this is no longer the case: these drugs can also be injected once a month for the first 3-5 months, then once every 2-3 months. The times are lengthening, for the patient it is a therapy that is easier to follow, as well as effective and safe. In some cases it is even possible to use drugs with injection times every 4 months “.
The last SIR Congress, which has just ended, was an opportunity to talk about the most important news in the diagnostic and therapeutic field. “Among these – recalls Midena – there is certainly the evolution of Oct technology (optical coherent light tomography), a non-invasive diagnostic test that allows us to obtain very accurate scans of the retina. performed a further examination, retinal angiography with fluorescein (or fluorangiography). In this case a dye is injected into the arm, photographs are taken, the retina is studied. Thanks to the evolution of the Oct (Oct angiography) we can see the the same things without the need to inject any dye, and it is an absolutely non-invasive method. Not surprisingly, many young researchers and associates of SIR have presented several studies dedicated to the application of this innovative technique “.
According to Midena, the diabetologist or general practitioner must be “very careful and refer the patient to a specialist, in this case the ophthalmologist – he warns – because a diabetic subject who has retinopathy is as if he had had a heart attack, is a highly vasculopathic subject. If the diabetic patient has had a heart attack, for him having a diabetic retinopathy is equivalent to having a second heart attack because the presence of damage to the retina is the signal of a disease of the small vessels of the whole organism, not only of the eyes, then the brain (cerebral ischemia), myocardial infarction, kidney diseases, neuropathies of the limbs. For these reasons it is important to visit the eyes, as well as not to lose sight “.