Blindness in diabetic patients

Vision-threatening retinopathy is usually due mainly to neovascularisation in Type 1 diabetes and maculopathy in Type 2 diabetes. In North America, 3-6% of patients with Type 1 diabetes and 1-6% of patients with Type 2 diabetes are legally blind. In England and Wales about 1000 diabetic patients are registered as blind or partially sighted each year, with diabetic retinopathy being the commonest cause of blindness in the working population.

Vitreous haemorrhage occurs suddenly and painlessly. The blood usually clears over the following weeks, but the underlying proliferative retinopathy causes repeated haemorrhages and progressive visual loss in most cases if it is not treated. Retinal detachment resulting from contracting fibrous bonds sometimes causes blindness.

Maculopathy. Macular disease has three causes in diabetic patients—exudative maculopathy, retinal oedema, and ischaemia. Deterioration of vision in these situations is often insidious, it can to some extent be prevented by appropriate laser treatment, but once vision has been lost it cannot be restored. Ischaemic maculopathy due to loss of perifoveal capillaries may cause severe visual loss and is very difficult to treat.

Cataract. Lens opacities or cataract develop earlier in diabetic patients and often progress more rapidly.

Primary open-angle glaucoma has an increased prevalence in diabetic patients compared with the general population.

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