Doctor Maria Isabel López Gálvez, specialist in the Retina and Vitreous Unit of the Fernández-Vega Ophthalmological Institute, emphasizes that diabetic retinopathy "should not be addressed as an isolated eye problem, but as a manifestation of a systemic disease that can have repercussions in different organs and tissues."
As she specifies, "its evolution is related to factors such as the duration of diabetes, control of glucose levels, and the presence of other vascular alterations," and for this reason she considers it "important" to integrate visual health "within the overall monitoring of people with diabetes," while also promoting "that there is coordination between the professionals involved in their care."
Coinciding with World Diabetes Day, which is observed on November 14, López Gálvez recalls that diabetic retinopathy is one of the most common eye complications of this condition and is among the leading causes of vision loss in adults. It stems from the damage that high blood glucose levels cause to the small blood vessels of the retina and, among its greatest challenges, she highlights that it can progress without clear symptoms in the initial stages.
Given this situation, she explains that "in recent years, research has expanded knowledge of this condition and is exploring new ways to identify its first manifestations, understand the mechanisms involved in its development, and improve treatment options," with the aim of moving "toward a more precise evaluation of the disease, which makes it possible to better understand its progression, identify the needs of each patient, and adapt clinical decisions to the characteristics of each case."
In this vein, she details that "traditionally, diabetic retinopathy has been studied as a disease that affects mainly the small blood vessels of the retina." "However, research is expanding this perspective to study its neurovascular nature as well and the interaction between the different components of this tissue, including neurons and glial cells, which play essential roles in its functioning and maintenance."
New imaging techniques and support from artificial intelligence
López Gálvez indicates that advanced imaging diagnostic tools are being incorporated, including optical coherence tomography (OCT) and OCT angiography, which make it possible to analyze with great detail the structural and vascular changes linked to diabetes. To these technologies is added artificial intelligence (AI), whose use can speed up screening, help in the classification of lesions, and detect the people who require assessment by the specialist.
"The retina is an especially complex structure, and studying it allows us to obtain very valuable information about what is happening in its different layers and in its vascular network," the expert points out, emphasizing that the combination of different imaging techniques "helps to better characterize the alterations and to understand that not all patients present the same pattern of involvement." "The challenge is to interpret all that information from a clinical perspective, because knowing with greater precision the state of the retina is essential to decide what follow-up is most appropriate in each case," she underlines.
As she details, advances in knowledge of this ocular complication are expanding the options for intervention at the various stages of the disease. In the earliest phases, periodic ophthalmological control and rigorous management of the factors associated with diabetes, especially blood glucose levels, are essential. When complications arise such as diabetic macular edema or proliferative retinopathy, specific treatments may be required, such as intravitreal injections, laser photocoagulation, or vitreoretinal surgery.
Looking ahead, she explains that the objective is to move toward Precision Medicine, identifying the mediators involved in the development of each patient’s ocular complications, both in diabetic retinopathy and in macular edema, even through tear analysis, so that early detection and a truly personalized approach are feasible.
Finally, emphasize that work is also being done to improve control of systemic disease in type 1 and type 2 diabetes. In any case, remember that "the main objective of ophthalmic care is to preserve the vision and quality of life of people with diabetes" and that, "to achieve this, it is important not to wait for visual alterations to appear to pay attention to eye health, but to maintain adequate follow-up and periodically assess the status of the retina".