 Hello everyone, today we are talking about diabetic retinopathy, which is diabetic eye disease. Today we will touch base the symptoms, the causes, the risk factors, diagnosis, treatment and complications. So, let's get started guys. I am Dr. Ahmed Ergin, I am an endocrinologist and a diabetes specialist. I treat patients with diabetes every day and I ask one single question every day. Have you seen your eye doctor? Extremely important, a lot of people end up going blind and the most common reason for blindness is diabetic retinopathy. So we are going to go over all these today and at the end of the video I am going to give you a bonus tip. So stay tuned and before we get started please hit the subscribe button and let's go. So guys before we jump to the topic I want to encourage you to take the quiz in the description below to win a chapter from my diabetes book. Let's move on. So I want to emphasize why understanding this horrible complication of diabetes is so important. Because think about this, 2 out of 5 of every diabetic has some sort of diabetic eye disease that includes everyone, controlled or uncontrolled. If you are not uncontrolled the chances of diabetic retinopathy is 90%. That's huge. Now if you already have underlying diabetic retinopathy and if you control your diabetes and your blood sugars you can reduce your risk by up to 54%. Now if you do not even have retinopathy at all but you just got diagnosed with diabetes you can reduce your risk of diabetic retinopathy or diabetic eye disease up to 75%. So let's talk about symptoms. The most common symptoms of diabetic retinopathy is blurry vision that comes and goes. It gets better and gets blurry again. You may have a change in the perception of the color so the colors may fade away. You may end up not seeing very well at night so it's called poor night vision. You may end up developing some floaters or dark spots in your eye that kind of increase in number gradually. So what are the real serious symptoms that you have to go see doctor today immediately? Is if you see a curtain coming down over your eyes that would be I think anyone can tell it's not good. If you start seeing flashing of lights all over your eyes, if you start seeing a tunnel vision where the peripheral vision is totally lost or you cannot really see your sides well. These are almost emergencies that you have to hit the emergency room or hit the doctors, the eye doctor's office today. So why does diabetic retinopathy develop to begin with? So how come the high blood sugar caused the diabetic retinopathy? Well, number one, when you have high blood sugars and we discussed about this before and your body cannot utilize the sugar. That sugar has to go somewhere, right? And then we call this alternative pathways. Like sorbitol pathway, protein kinase C, hexazamine pathway, et cetera, et cetera. Now what happens with these pathways is the body does not really know what to do with the blood sugar and trying to get rid of it. It's like, you know, you have a manager that knows what to do and then manager calls sick and you just assign one of the employees who has no idea what to do. But he has to be there because he had to be the manager and then, you know, that person does something or tries to do something but ends up messing a lot of things up, right? That's typically what happens when an inexperienced person takes on the job. So same thing when your body is trying to process the glucose in an alternative pathway, in different pathways, you end up creating a lot of cytokines, especially inflammatory cytokines and growth markers. So these are the things that lead to what we call endothelial damage, which is the blood vessel wall is called endothelium. When there is a damage in your endothelium, what happens is you start leaking fluid and sometimes the blood itself, the wall of the arteries, especially when they get thin, they start ballooning and we call them aneurysms. So the aneurysms typically end up bursting eventually as well. So that brings us to staging. So how do we really stage diabetic retinopathy? We divide into two. So one is nonproliferative. One is proliferative. So what does the proliferative? The blockage in those arteries induces the growth factors for other new vessels to develop, and the new vessels are not as good or strong. Now, this formation of that new blood vessels are called proliferation. So that's why we call them first nonproliferative, which means, you know, this is the initial stages of diabetic retinopathy where you're not really getting these new weak vessels yet or arteries yet, but you start seeing certain features in the eye. Now versus proliferative is more advanced stage where you start seeing these new weak arteries. So the first stage of nonproliferative retinopathy is the mild stage. That's pretty easy, right? In the mild stage, you know, the doctors can see the weakening of the blood vessels. There's some aneurysms, maybe there's some leakage, but typically there is no symptoms at this stage. Now when it becomes moderate, the larger areas of these blood vessels become more visible, leaky, etc. And then symptoms of proliferation may develop at that stage. Now, when it is severe, that is the beginning of the proliferation where your body is attempting to start making the new arteries in your retina. Now, of course, the next stage will be the proliferative diabetic retinopathy where you see a bunch of the bleeding, the exudates, fatty and fluid, exudates in your retina, and then the proliferation, which is the new vessels coming up, and then they actually start bleeding even more because they're weaker, and that's not going to total mass. At this stage, the doctors intervene and move you to the treatment stage. So, what are the risk factors actually for diabetic retinopathy? Well, number one is your genes. So some people are, unfortunately, more prone to have diabetic complications, and that is very difficult to estimate who's going to be prone to until they get it. So, don't just assume or just try to be positive and say, oh, I think I probably have good genes. Well, that may be too late by the time you figure out that you do not. So, I would suggest definitely try to do everything you can do to get your blood sugars under control. Now, unfortunately, if you're African American, Hispanic or Native American, the chances of diabetic retinopathy is more. If you're a smoker, definitely the diabetic retinopathy is risk is more because the smoking also weakens your arteries. When you're pregnant, you have to be watching that out more carefully. It really gets worse during pregnancy. So if you already have retinopathy and you're pregnant, you better see your doctor way more often than normal. And if you have high blood pressure and high cholesterol and people ignore that, people get hung up on your blood sugars. But I tell them all the time, you know, your blood pressure is as important, your cholesterol is as important. Because again, this is all about the blood vessels and your blood vessels are going to be damaged with the high blood pressure and high cholesterol as well. Studies indicate that actually, if you control your blood pressure in addition to your blood sugar, remember we talked about up to 75% risk reduction with controlling the blood sugars. You can get another 35-40% risk reduction on top of that if you control your blood pressure as well. Now remember, we have how to control blood pressure naturally videos. You can find it right here. Or you can just search on YouTube and watch the video. It's actually important for you to understand the blood pressure control. Now, what are other conditions that are actually not necessarily diabetic retinopathy or bleeding or anything like that, but you still associate with diabetes? Well, number one, cataract. Cataract is very common, but it's super common in diabetes. What else? Glaucoma. They're going to be like, how the hell glaucoma is associated with the diabetes? Well, the glaucoma is all about your eyes draining the fluid in your eye. When your eye is not able to drain the water, then you end up having a lot of pressure in your eye, which is not good. It starts pushing on the nerves and causes damage. Now, when you have proliferation in the areas where your eyes are trying to drain that water, it creates the blockages. And that also leads to glaucoma as well, which leads to if untreated, especially to blindness. The macular edema is also common. It happens to non-diabetics as well. But since the edema happens from the leakage of the damaged blood vessels, you are more likely to have macular edema, which definitely is a very high-risk disease for blindness. Now, what do you do to diagnose that big retinopathy? Well, see your eye doctor. So typically, we recommend seeing the eye doctor once a year. And if everything is okay, your diabetes is under perfect control. It's okay to stretch it up to two every two years. But if you already have some retinopathy going on, at least every year. And in some cases, doctors may want to see you every six or even three months for your eye examinations. So what are the treatment options? Well, your eye doctor will do a few things. Most commonly nowadays, they use something called VGEF, which is a VGF inhibitors. They are basically injecting a substance to your eye to inhibit the proliferation of the new vessels we talked about. They will sometimes do a laser photocoagulation, which is basically burning the leakage points and making sure that your blood vessels are not leaking anymore. Sometimes they will do a pen photocoagulation, which basically does decrease the proliferation in your entire retina. And finally, they sometimes will do something called retrectomy. And that is a procedure where they go in and remove all the blood from your uterus area. The uterus area is a liquidy watery area behind your eye. And sometimes acute bleeding happens and you may have a temporary vision loss. And that will definitely need intervention. Another scary thing that happens to some diabetics is retinal detachment. So that's basically because of the scar tissue. And remember, when your body is trying to heal something, it creates a scar. And when there is a scar in your retina, it starts pulling the retina off of your wall of your eye. And when that happens, that's definitely the reason for blindness. So they can reattach it, but you may not be always very lucky. So don't wait until you have retinal detachment. So I hope guys, this helped you so far. If it did, please subscribe and remember to take the quiz at the end of this video. And remember, do not wait until the complications develop. We have a lot of antioxidants in the foods or in the supplements that can help you. But the most importantly, you will have to understand the importance of diabetes control. There's so many ways to do it. The diet, the exercise, the supplements, the medications, whatever you have to do. You have to get these blood sugars under control today to prevent the complications later. So I hope guys, this helped. Again, subscribe, like, share. And we will see you in the next video. Hey guys, I hope you're enjoying this channel so far. And I hope you subscribed already. If you didn't, do it. And if you did, watch this video right there. I think that will help you too.