Occupational Medicine & Health Affairs
Open Access

The term retinopathy describes an eye problem caused by an increase in pressure in the retina, a condition that leads to reduced vision and can lead to loss of sight and blindness. The pressure damages the eye's optical capacity, by and by causing sight loss [1]. Diabetic retinopathy is, on the other hand, a condition of increased pressure in the eye's retina, one that causes reduced vision and thus blindness and whose result is diabetes. Diabetes mellitus is a situational disease in which the body is unable to generate adequate insulin for glucoselevel regulation in the body or is unable to use secreted insulin. The objective of this research is to demonstrate how Diabetic Retinopathy; a complication of uncontrolled Diabetes Mellitus in African American in Washington D.C. Can be prevented, treated and managed.

Diabetes

Diabetes 1 and 2 are some of the most prevalent diseases among youths and children, especially, in the American population. A study covering 2001 through 2009 averagely 0.2 percent of the youths in America suffering from diabetes type 1 and about 0.03 percent suffering from type two diabetes showing that throughout the study period, type 1 diabetes is the most common [2]. This, again, shows the rate of exposure of economically viable age groups. Diabetes mellitus is a public health concern because it is affecting many people including children in an inactive American population where exercise is a rare practice and is a lead reason for adults becoming blind in America today. While diabetes mellitus is the number one cause of lost vision among the Americans, diabetic retinopathy is the leading subset of mellitus. As such, with diabetes mellitus remaining a rampant disease in America, chances of diabetic retinopathy declining are unimaginable. On the contrary, the number of Americans living with diabetes is still rising, with the number standing at 171 million Americans now; the number is estimated to reach 366 million people by 2030. Given that the retinopathy attacks majorly people within their prime, economic and socially productive age, it poses not only a social but also an economic threat to the people. Nationally, 8000 eye blindness occur annually due to diabetic retinopathy, with a total 5.4 million Americans living with the disorder today between the ages 25-74, with severity in Washington DC. [3]. According to Maxine & Stephen (2017), 35 percent of diabetic patients exhibit diabetic retinopathy with 20 percent of these being from patients with diabetes mellitus, hence the need to research further on the link between type two diabetes and retinopathy.

Diabetes and Diabetic Retinopathy in Washington DC

The Washington DC, under the authority of the city, is divided into wards, each with a population almost equal to the other. The district, constituted by a majority of African-Americans with 47% and 36% white population as in 2016, suffers a big challenge in containing diabetes. 9.1 percent of the district’s population live with diabetes, the 9th reason in rank for hospitalization, and number five in reasons for death. Obesity and non-activity are some of the leading factors for diabetes while in the district, 35 percent of the children are obese with 72 percent physically inactive. 23 percent of the adults are obese while 39 percent are already overweight. Directly linked with retinopathy, these statistics paint a district that lies with a high risk of diabetic retinopathy, one in which the challenge needs urgent attention [4].

Other Eye Problems Caused by Diabetes Mellitus

Another complication of diabetes mellitus is glaucoma. In a scholarly study, it was found that people with diabetes are 1.4 times risky to get glaucoma, a problem that occurs with increased eye pressure that leads to the damage of the optical nerve. Being the communication fiber-optic between the eye and the brain, the damage of the optical nerve, which construes millions of fibers, leads to reduced or total loss of sight [5]. Lastly, cataracts can result from diabetes mellitus. Cataract damage the lens by forming as proteins clamping together in the lens and reducing the clarity of the lens, thus light passage into the retina for brain signals (National Eye Institute, n.p). Reduced light means that objects will appear blurred and that the signals submitted to the brain through the optical nerve are not clear, causing blurred vision. It is commonly caused by diabetes mellitus and smoking. Patients experience blurred vision and color blindness, meaning they cannot differentiate between close or distant colors. They may also experience glares before normal sunlight or car lights. They will have reduced night vision, multiple vision or cloudy sight.

Risk Factors for Diabetic Retinopathy

There are several risk factors for diabetic retinopathy, broadly classified as modifiable or non-modifiable. The modifiable factors include hypertension, hyperglycemia, obesity and hyperlipidemia. These are modifiable in that the person can control the level of risk of each condition by seeking medical or lifestyle solutions. The nonmodifiable risk factors are mainly three. These are; the duration one has been suffering from diabetes, pregnancy and puberty [6]. These are non-modifiable in that one cannot control the time length they have had the diabetes problem or skip puberty or bypass the real state of pregnancy. Once pregnant, the individual assumes the state of pregnant women. Hypertension, which is more prevalent in people with type two diabetes, mellitus, being the most correlated with diabetic retinopathy, double the risk of retinopathy when combined with diabetes mellitus. Hyperglycemia and hyperlipidemia are both concerned with the health status of the individual. More of lifestyle diseases, hyperglycemia is having excess glucose in the blood, hyperlipidemia is the presence of excess lipids or fats in the blood [7].

Symptoms of Diabetic Retinopathy

The symptoms of diabetic retinopathy are hard to trace or track during the early development of the disease [8]. This threatens scientific or medical research in an effort to counter retinopathy as early as possible. At first, the victim may not realize that they have any changes in the eye until the blood vessels are affected. The national eye institute confirms that the problem is first manifested as floating or delocalized spots that appear to be on the retina surface. These may or may not disappear without intervention but are a clear indication of the necessity to check for diabetic retinopathy. Further on, blood vessels of people with the disease begin to swell and often leak some fluid into the eye, causing blurred vision or reduced focal ability of the retina. In others, the retina starts to develop some abnormal blood vessels by its surface, a situation that leads to reduced vision or vision loss [9]. This is due to the retina being the light-sensitive eye component whose health is directly proportional to sight. The retinopathy affects both eyes at the same time.

Detection of Diabetic Retinopathy

For detection, there are four main methods of testing for and detecting diabetic retinopathy. First, one can use visual acuity tests to test to see whether or no they have retinopathy. This is the capacity of the eye to see objects from several lengths or different distances, which helps to test for diabetic retinopathy. Second, the person can use optical coherence tomography. OCT is an ultra-energy signal system for capturing tissues in the body and helps to study the eye for detection of abnormal spots or blood vessels. A third method is the pupil dilation technique. In this method, the investigator will check for the retina and the optic nerve by using drops into the eye, which widen the retina giving optical access to the nerves. Lastly, the investigator can use tonometry, the measurement of the eye pressure which confirms or denies the presence of diabetic retinopathy [10].

The need for mediation Without mediation, the number of people suffering and living with diabetic retinopathy will continue to rise in America and especially, in Washington dc, being one of the most populated cities in the world and the capital of the US. This, behind the backdrop of public education and classic eye checkup, treatment and advice by health groups and that calls for improved efforts to inform the public on blood sugar level management practices (National Eye Institute, n.p.). In my estimation, should the challenge not be countered proactively, that is, if nothing is done in terms of awareness for diabetes mellitus and diabetic retinopathy, the 8000 annual additions to patients with the retinopathy will keep rising.

Management and Solutions

In managing the problem of diabetes mellitus and diabetic retinopathy, prevention is better than cure. The public, through the government, should be taught on healthy lifestyles that encourage optimal or normal insulin production. Insulin, when destroyed by the body's immune system, leaves the body prone to hyperglycemia. Diabetes results from unbalanced sugar levels. Exercise, for instance, will ensure that the person has optimal immunity and sound insulin levels so that the blood sugar is well regulated. This will help curb the leading cause of retinopathy, cataracts and macula. Secondly, the people should be educated to avoid risk factors such as smoking, heavy drinking and eating too fatty foods or excessively processed foods, factors that give room to diabetes one and two [11].

When already affected, the individual should seek early medical attention with the eye clinics. The doctors will advise on whether a surgery or drugs are the ideal solutions (National Eye Institute, n.p.). Meanwhile, such individuals should also resist idle lifestyles, unhealthy foods and unbalanced meals. They should exercise more and keep a close attention to the physician's prescriptions all they until they recover [12]. If beyond recovery, the patients should ensure to follow the clinician's program for diabetes and retinopathy management. The public and especially patients should be taught on when and why to seek medical assistance and such services made affordable. [13]. The public can also be encouraged to use mobile apps such as Glucosio, MySugr and BG Monitor, apps that help the person to understand the contributions of different foods and diets to diabetes and uses fed-in data to monitor the person's diabetes status. This awareness, as explained in the Hawthorne effect, will help to fashion the people towards a diabetes avoidance lifestyle. They will also ensure they visit doctors to have their eyes examined from time to time. This could reduce diabetes and retinopathy by 10 percent and 15 percent each, given that the former is a risk factor for the latter. In this effort, the district’s authority should sponsor non-commercial public education both offline, online and onscreen to ensure thorough awareness on health living, screening and managing diabetes.

Treatment of Diabetic Retinopathy

Treatment of diabetic retinopathy calls for meticulous processes to omit the fluid leaked into the eye, restore the clarity of the retinal surface and remove the unnecessary growth of blood vessels. It also needs the lowering of the blood pressure in the eye. In lowering the blood pressure and the pressure of the eye, the process must be controlled as a precipitous lowering could lead to optic disc infarction. This would lead to a higher problem than the one being treated [14].

For retinal clarity, surgical means can be used and this includes optical laser and non-laser surgery. Laser treatment is one of the most common methods of treating diabetic retinopathy. Once the examination shows that the patient has retinal capillary disorders due to their sugar level, they will need an intervention either to destroy, stagnate or remove the extra unnecessary blood vessels. These are some of the elements that cause reduced vision. The laser therapy, like any other therapy, aims at restoring normality by stabilizing one's eye changes caused by diabetes. The patients have their scheduled clinical laser visits in which their eyes are dilated using eye drops and then, laser surgery carried out. For people with proliferative retinopathy, the patient will have to undergo peripheral scatter laser photocoagulation, a process that involves larger and more concentrated laser beams onto the retina to destabilize the developing proliferations and restore the eye to normal structures. This treatment may have its side effects, including reduced night vision, a reduction in peripheral vision or reduced blind spot vision, macula, a disorder that autocorrects but reduces vision for a short span of time, and jelly bleeding, a condition in which the jelly seems to have many floaters that may need a close medical attention. Nevertheless, laser treatment is by far the most assured for those with advanced diabetic retinopathy.

If the macula has swollen, the patient will be subjected to one or a combination of therapies. The first is anti-GEGF injection therapy which involves the insertion of drugs that inhibit or block the development or growth of the protein Vascular Endothelial Growth Factor and which leads to the growth of and bleeding of abnormal blood capillaries on the retina. As seen above, this is one of the leading causes of reduced vision and floating spots in the eye's vitreous gel. This is called proliferative retinopathy and the person should see the as soon as the vitreous hemorrhage is detected. The gel is supposed to be clear to allow for vision. However, with the spots and the capillaries about the retina, vision is minimized and often lost. A second method involves the laser welding of leaking vessels around the macula area which reduces swelling in the retina, restoring the focal acuity. Alternatively, a patient can sign for corticosteroids, lens worn in the eye and which are biodegradable and leak into the eye suppressing macula swelling. Corticosteroid drugs, on the other hand, are as well injected for a similar function.

Conclusion

Diabetic Retinopathy is a complication of irregular glucose levels in the body that causes diabetes mellitus, leading to eye problems such as cataracts, glaucoma and retinopathy. Diabetic retinopathy can be avoided by reducing or managing the risk factors which include diabetes mellitus, blood pressure, lipid and sugar level in the blood, pregnancy and puberty. For treatment, the person can take either surgical or nonsurgical therapy. Laser therapy is the most approved surgical means. For non-surgical treatment, one can have corticosteroids injected into the eye to inhibit the growth of abnormal blood vessels or worn as a lens to biodegrade into the eye for remedy. Exercise and active lifestyle with avoidance of excessively fatty and sugary foods help to manage the risk of diabetes mellitus and thus, its retinopathy

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