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 GENERAL INFORMATION
The diabetic retinopatía (maculopatía or glassy hemorrhage) is the most frequent cause of blindness between the 30 and 64 years in England and Wales. This form of blindness can get ready and it is a work of the doctor to realize a review oftalmológica annual to all the patients with diabeteses mellitus insulin-dependent (DMID) with 5 years or more of evolution and from the moment of the diagnosis, to all the not insulin-dependent diabetics (DMNID). It brings in inside the responsibilities of the Sanitary Authorities offering the necessary facility to carry out this prevention.
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The chronological age at the moment of appearance of the diabetes mellitus (DM) and the duration of the same one have pronounced effect on the moment of appearance of the retinopatía and, after 20 years of DM, almost all the patients prove to be some type of retinopatía. In the youngest diabetics the average interval between the diagnosis of DM and the development of retinopatía is 13 years, while in those that DM develops after 60 years, the interval is 5 years; in fact, 5 % of DMNID has a retinopatía established at the moment of the diagnosis.
Fortunately, a retinopatía of considerable grade can exist without decrease of the visual keenness, and the prognosis can be optimistic. Nevertheless, in close to 15 %, the retinopatía is so serious that, if it does not talk each other, there will appear an important decrease of the visual keenness.
The patients need to be informed about the possibility of developing a diabetic retinopatía and of the importance of the strict metabolic control for his prevention. They must inform about any new visual symptom that it should appear. The importance of the review must stand out oftalmológica annual.
EVALUATION OF THE DIABETIC RETINOPATÍA
- Oftalmoscopia (exploration of the eye by means of an issuing device of light that allows to observe the retina) annual, realized with the extensive pupil.
- Angiografía fluoresceínica (method by means of which there interferes a contrast that allows to see the trajectory of the small arteries and veins that circulate along the interior of the eye. This exploration is more sensitive and it allows to quantify the benefits of the treatment.
Fruitless efforts have been done to predict the course of the diabetic retinopatía.
FACTORS OF RISK
The most important risk factor is the duration of the DM, especially for the retinopatía proliferativa.
The metabolic control for years also seems to be important and, in general, the predominance of retinopatía diabetic in the diabetic population increases as we are descending for the categories of good, moderate and bad control.
Nevertheless, some cases with good control develop a retinopatía quickly, while others with a bad control escape from her. Other determinant factors must exist, therefore, this factor can be genetic.
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