小心因糖尿病喪失視力

糖尿病是已發展地區其中一個主要的健康問題。糖尿病會影響身體血管的結構及導致多種器官受損, 而其中一個可因糖尿病受嚴重影響的器官是眼睛。糖尿病可影響眼睛不同部分, 引致白內障、青光眼、黃斑點水腫和視網膜病變。當中糖尿視網膜病變最常導致視力下降, 亦是世界工作人口中頭數個致盲眼疾之一,一般泛稱的 “糖尿上眼” 大多是指糖尿視網膜病變。糖尿病怎樣造成 “糖尿上眼”? “糖尿上眼”的病徵是甚麼? 懷疑 “糖尿上眼” 應該接受甚麼檢查? 怎樣治療及預防 “糖尿上眼”? 現在就樣我們一起來了解一下 “糖尿上眼” 這個糖尿病人不可不防的眼疾。

糖尿病怎樣造成 “糖尿上眼”?

糖尿病人的血糖水平較高, 血糖偏高會破壞身體的微細血管, 而眼睛的視網膜則有複雜的微細血管網絡。受高血糖破壞的微細血管會滲出液體和血液, 又或者會導致阻塞使之無法運送氧氣和養份給視網膜細胞。如果微細血管滲漏在黃斑點附近發生, 黃斑點就會出現水腫, 視力亦會出現變形。到了 “糖尿上眼”晚期, 視網膜會有不正常的血管增生。這些增生的血管結構不良, 容易出血。視網膜出血後會結痂, 而痂塊及後會收縮及拉扯視網膜 – 最終導致致盲的視網膜脫落。除了視網膜, 眼睛的虹膜亦可出現血管增成, 引發致盲青光眼。

“糖尿上眼”的機率及風險因素

在已發展地區中大多數的糖尿病人都是二型糖尿病。根據統計, 有35%的糖尿病人有 “糖尿上眼”, 而 “糖尿上眼”的風險與患上糖尿病的年期有關。文獻顯示患上二型糖尿病達10年以上的病人有20%出現 “糖尿上眼”; 患上二型糖尿病14年以上者機率升至40%; 而患病16年以上者機率會達至60%。其他風險因素還包括高血糖、高血壓和高膽固醇。

S“糖尿上眼”的病徵

既是慶幸又是不幸地, “糖尿上眼”的早期大致沒有任何病徵。由於病人沒有留意到自己有 “糖尿上眼”, 他們沒有意識需要接受檢查, 往往導致病情惡化而這時病人會可能覺得飛蚊增加、視力模糊和視力變形。在晚期 “糖尿上眼”時, 可以出現突發性永久失明。其他 “糖尿上眼”的病徵還有視網膜滲血和滲水、視網膜血管外觀改變, 視神經缺氧、黃斑點水腫、不正常血管增生和視網膜結痂。

以下的圖片模擬中度及晚期 “糖尿上眼”的視力徵狀:

中度 “糖尿上眼”的視力徵狀。圖片來源:
https://www.aao.org/eye-health/diseases/non-proliferative-diabetic-retinopathy-vision-simu-2


晚期”糖尿上眼”的視力徵狀。圖片來源:
https://www.aao.org/eye-health/diseases/proliferative-diabetic-retinopathy-vision-simulato


圖左是視力正常的人看見的影像; 圖右是晚期 “糖尿上眼”病人看見的同一個影像。圖片來源: https://nei.nih.gov/health/diabetic/retinopathy

“糖尿上眼”的病情變化

“糖尿上眼”的病情變化視乎 “糖尿上眼”的階段而定。晚期的 “糖尿上眼”定義為視網膜出現不正常血管增生, 可出現突發性大量出血及失明。對於輕度 “糖尿上眼”患者, 如果他們沒有適當跟進病情, 他們當中有5%可於一年內惡化至晚期 “糖尿上眼”。對於中度 “糖尿上眼”而又沒有跟進的患者, 一年內惡化至晚期的機率有27%。如果病人的 “糖尿上眼”已達嚴重, 一年內惡化至晚期的機會有50%。

治療及預防糖尿上眼

控制血糖和血壓

要延遲和控制 “糖尿上眼”, 最佳的方法是控制血糖和血壓。糖尿病患者應控制他們的HbA1c血糖指數至6-7%水平, 降低1% HbA1c指數可減低 “糖尿上眼” 風險約30%。另外如糖尿病患者同時患有高血壓, 糖尿上眼的風險亦會增加約10%。

激光和藥物治療

除了控制血糖和血壓, 在某些階段的 “糖尿上眼”可以接受治療減輕病徵。輕度 “糖尿上眼”患者由於視力大多沒有受損, 因此眼睛不需要額外治療。中度 “糖尿上眼”患者的視力會因為黃斑點水腫而出現模糊和變形, 他們可以接受激光治療堵塞血管滲透以改善視力。晚期患者會出現不正常血管增生, 他們可以接受藥物治療, 將抑制血管增生的藥物打進眼球內, 藥物效果在視力表檢查中可改善兩行視力, 不過他們可能要每月或每數月接受一次治療。某些 “糖尿上眼”個案需要以激光大範圍破壞周邊視網膜, 犧牲周邊的視野以降低視網膜的氧氣需要, 保住中間視力。

“糖尿上眼”的覆診時間

一般糖尿病及患有輕度 “糖尿上眼”人士, 他們應最少每年一次接受眼科視光師或眼科醫生的全面眼睛檢查, 全面眼睛檢查即除了度數檢查外, 還包括放大瞳孔檢查眼底。而中度 “糖尿上眼”患者, 應該每6個月做一次全面眼睛檢查, 嚴重 “糖尿上眼”患者則要每2-3個月全面檢查眼睛一次, 以儘快跟進可能出現的眼睛變化。

就如糖尿病一樣, “糖尿上眼”無法完全根治, 不過 “糖尿上眼”病情是能夠控制和預防的。超過90%因 “糖尿上眼”導致失明的個案, 其實只要及早發現和治療就可避免。所以糖尿病患者除了定時覆診取藥外, 也記得按時預約您的眼科視光師接受全面眼晴檢查。

註冊眼科視光師(第一部份) 鄧光佑


以上護眼資訊由瑞士寶視光中心提供

地址 : 香港新界荃灣海盛路11號 One Midtown 23樓全層

查詢/預約電話 : +852 2751 8491

綢址: www.swisscoat.com.hk


參考資料:

  1. Bhavsar A. (2017). Diabetic Retinopathy. Medscape. Retrieved from http://emedicine.medscape.com/article/1225122-overview#a1
  2. Diabetic Retinopathy. American Optometric Association. Retrieved from https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/diabetic-retinopathy?sso=y.
  3. Facts About Diabetic Eye Disease. (2015). The National Eye Institute . Retrieved from https://nei.nih.gov/health/diabetic/retinopathy.
  4. Yau JWY, Rogers SL, Kawasaki R, et al. Global Prevalence and Major Risk Factors of Diabetic Retinopathy. Diabetes Care. 2012;35(3):556-564. doi:10.2337/dc11-1909.
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