Obesity leads to insulin resistance, then to type 2 diabetes, and in parallel to elevated blood pressure and elevated fats. The so-called metabolic syndrome occurs. Very often arterial hypertension and diabetes are discovered accidentally. Thus, obese people and those with a hereditary predisposition to such disorders must be actively “searched” – pressure must be regularly measured, laboratory analyses, lipid status and blood sugar must be performed.
While people are young, even in middle age, elastic blood vessels resist high blood pressure. However, with age, changes in blood vessels become more pronounced.
In parallel, the process of arteriosclerosis – narrowing of the lumen as a result of aging, as well as atherosclerosis – the formation of atherosclerotic plaques due to the presence of elevated fats and sugar in the blood, with the influence of hypertension, takes place.
On the fundus, the changes due to hypertension on the small fine blood vessels of the retina can be seen extremely well. Thus, in the first stage of hypertensive retinopathy, we see the narrowing of the arteries, as well as the dilation of the veins, where the veins become tortuous. This is followed by a pronounced narrowing of the arteries with an increased reflex known as the “silver wire phenomenon”, when the arteries cut the veins and signs of crossing appear. There is gradual clogging of the capillaries, accompanied by increased leakage and bleeding, and finally, with the relaxation of the damaged blood vessels, there is a decrease in vision due to the appearance of edema of the macular and papilla of the optic nerve.
We find these extreme situations in patients with kidney failure, as well as in women in eclampsia with the development of malignant hypertension.
In addition to retinopathy, which manifests itself gradually on the blood vessels of the retina, there are o complications that occur suddenly and are accompanied by a sudden decrease in vision.
An example is the occlusion of the central retinal artery, when circulation is blocked in the only artery that feeds the internal structures of the eye, and vision drops to the sensation of light or even it is absent. Vision loss is usually permanent.
Thrombosis of the central retinal vein or its branches is much more common. These occlusions also occur suddenly and there is a loss of vision in the whole or part of the field of vision, if the occlusion involved a branch of the vein. The patients are most often hypertensive and very often unregulated, who do not go for regular check-ups with an internist and who very often dose the therapy themselves.
At the point where the arteries and veins are cut, there is a blockage in the circulation and an outpouring of plasma (exudation) and blood elements that soak the retina. Swelling in the area of the yellow spot leads to vision loss. Spontaneous recovery can occur in younger people, but it usually takes a long time and it is necessary to intervene in order to avoid permanent visual impairment.
In elderly patients, recovery is slow, and immediate action must be taken because there is a greater risk of ischemic complications. Of course, with ophthalmic therapy, the patient must immediately consult an internist for internal/cardiology and possibly hematological analyses.
These vascular incidents indicate the poor general condition of the patient, that is, they speak about the condition of the blood vessels in terms of increased risk for the occurrence of occlusive and ischemic incidents not only in the eye but also in the brain, heart, and kidneys. The risk is represented by: elevated blood pressure, elevated blood fats, disorders of coagulation factors, unregulated diabetes, heart rhythm disorders…
The treatment is urgent and patients should be referred to an ophthalmologist-retinologist without delay, as well as for systemic/internal examinations, carotid Doppler, echocardiogram, EKG, cardiological work-up to prevent further systemic and ophthalmic vascular complications.
In the development of diabetic changes in the blood vessels of the fundus, the changes are pathophysiologically similar – in the initial phase, the changes that occur due to the increased permeability of the capillaries that are damaged by long-term elevated sugar or its large oscillations dominate. There is a swelling in the yellow spot and a drop in visual acuity along with distortion of the image.
In the later phase, blood vessel occlusions dominate, followed by inadequate tissue nutrition, and as a result, we have the creation of new pathological blood vessels. Those blood vessels are not helpful to us, but quite the opposite – they cause a big problem, they burst and produce bleeding on the retina and inside the eye with vision loss that is sometimes difficult to recover from.
In both phases, effective treatment is a combination of injecting antibodies to vascular endothelial growth factor into the eye, as well as laser photocoagulation (the specialist will inform you in detail about the treatment in person). Rarely, in exceptional cases, surgery is needed. However, no therapy is effective if there is no patient understanding and active participation in the matter of the general state of health.
For all questions, examinations, opinions and treatment, see us at the ophthalmology office “dr. Sandra Jovanović” on Bulevar Patrijarh Pavla 1a. Appointments can be made by calling 066 403 174 and 021 403174.