The incidence of diabetes mellitus in Spain affects 13.8% and is expected to increase significantly in the coming years, according to the World Health Organization (WHO). Follow-up guidelines generally involve an annual check-up by the ophthalmologist.
Diabetic retinopathy is one of the most frequent complications associated with diabetes and a major cause of blindness in the population between the ages of 25 and 65. Vision loss can be prevented with proper treatment. Forty-five percent of the adult population with diabetes also has diabetic retinopathy and an increased risk of developing cataracts at an early age. One of the medical goals of Dr. Ruiz Lapuente’s team is to optimize the management of diabetes-related eye problems.
In order to obtain the most appropriate treatment, it is essential to get a good diagnosis. Our center incorporates high resolution optical coherence tomography OCT, electroretinography with multifocal visual evoked potentials and MAIA microperimetry. With this diagnostic platform we can know the structure of the retina in a non-invasive way. We profile the functioning of the different subzones and plan the treatment.
The new diagnostic tools allow us to address the assessment of diabetic retina and macular degeneration AMD without pupillary dilation in most cases if required. The retina can microscopically hide early stages of diseases whose early approach will offer better treatment prospects. OCT takes only a few seconds to reproduce a virtual 3D image of all retinal layers. We complement the study with MAIA microperimetry which allows us to know the exact point of visual fixation according to visual treatments and to incorporate visual rehabilitation modalities. Multifocal electrophysiology provides objective information by sectors of the electrical activity of the different layers of the retina and the optic nerve and also of the tolerance of some rheumatology treatments.
It is recognized that one of the basic pillars of having managed to eliminate diabetes as the first cause of blindness in our environment is the laser. Our center is a pioneer with the Pascal Yellow Laser in pattern with the threshold treatment modality. It radically reduces the discomfort of the treatment and respects the layers of the retina.
Why is the yellow laser less bothersome?
Ultrashort lasers do not give enough time to generate the discomfort of the conventional (green) laser; neither do they allow temperature elevation while respecting the necessary retinal layers. Corticosteroid (Ozurdex®), anti-VEGF (Lucentis®) and VEGF trap (Eylea®) infiltrations are performed when necessary.
The most common intervention in diabetics is cataract surgery. There are cases of special complexity in which patients benefit from the removal of small membranes through the posterior minimal incision vitrectomy technique, performed on an outpatient basis.
In diabetic patients, cataract presents earlier. For cataract surgery, the new calculation technology will not be enough to dispense with glasses as much as possible; it will be necessary to ensure the stability of retinal health. In some cases, diabetic retinopathy should be treated first, followed by cataract surgery.