Diabetes medicine to prevent eye complications

Currently, there are no specific drugs approved globally for the prevention of diabetic eye complications. If diabetic patients want to prevent and control eye diseases, the core is to stabilize their metabolic indicators with basic medications that lower blood sugar, lower blood pressure, and regulate lipids. Some high-risk groups can use auxiliary drugs that improve microcirculation and antioxidants under the guidance of doctors to slow down the progression of the disease. No medicine can 100% prevent the occurrence of diabetic eye disease. Regular fundus screening is much higher priority than taking "eye protection medicine" in advance.”。

Last week when I went out to the clinic, I met a typical old diabetes patient, Uncle Zhang. He is 58 years old and has type 2 diabetes for 11 years. His normal fasting blood sugar ranges between 8-10mmol/L. He has never checked the fundus of his eyes. Recently, he has been seeing small flying shadows when looking at things. He clutched his mobile phone and asked me if I had any "eye-protecting medicine specially for diabetes patients." I poured cold water on him at that time: There is no such magic pill. The damage to blood vessels under the eyes caused by high blood sugar is cumulative, just like water pipes soaked in corrosive water for a long time, they will slowly leak and become clogged. If you don’t fundamentally change the "corrosive water quality", just painting the water pipes will be useless.

The sugar-controlling, blood-pressure-controlling, and lipid-lowering drugs you usually take are actually the most effective "basic eye protection drugs." Commonly used hypoglycemic drugs such as metformin, GLP-1 receptor agonists, and SGLT2 inhibitors, or insulin administered as directed by your doctor, should stabilize fasting blood sugar at 4.4-7.0mmol/L and do not exceed 1 two hours after a meal. 0mmol/L, coupled with Sartan/Puri antihypertensive drugs and statin lipid-lowering drugs to lower blood pressure and blood lipids to the target value, fundamentally reducing the erosion of microvessels caused by high sugar, high blood pressure, and hyperlipidemia, it is more effective than any specialized eye protection drug. In the past two years, many studies have also found that new anti-diabetic drugs such as GLP-1 and SGLT2 have additional microvascular benefits. However, "prevention of diabetic eye disease" is not currently included in the indications. Don't put the cart before the horse and take them as eye protection drugs.

Of course, this does not mean that all eye-protection-related drugs are IQ-taxed, but clinical differences on "whether to use auxiliary drugs in advance" are actually quite obvious: some doctors think that as long as the fundus of the eyes is completely normal, there is no need to take additional drugs even if the patient is 10 years old. After all, the drug is three-part poison.； Some doctors also think that people who have had diabetes for more than 5 years can eat some to protect their capillaries. There are only a few commonly used auxiliary drugs at present. There is no saying that anyone is more effective than anyone else. Just choose the one that suits you:

The most widely used calcium dobesilate is mainly used to reduce the permeability of retinal capillaries and reduce the risk of exudation and bleeding. I have an old patient with a sugar age of 8 years. Three years ago, he had three microaneurysms under his eyes. There was no bleeding or leakage, and his blood sugar control was fairly stable. I prescribed this medicine for him to take regularly. Last year, there was no increase in microaneurysms and no new lesions. Of course, there are patients who have been taking it for two or three years and still progress when they should. After all, its function is to delay rather than block, and individual differences are quite large. There are also bilberry extract-based lutein, which improves microvascular circulation, and the latter which protects the macular area. Many people like to spend hundreds of dollars on imported eye care products. In fact, the medicinal products that cost a few yuan a bottle are not bad. This type is more suitable for elderly people with diabetes who usually watch mobile phones a lot and are at risk of age-related macular degeneration. Young people with diabetes in their 20s and 30s who have no problems with their eyes really don’t need to blindly supplement. Pancreatic kallikrein is also a commonly used drug to improve microcirculation. However, people with bleeding tendencies such as cerebral hemorrhage and gastrointestinal bleeding should not take it. A few people will feel dizzy and develop rashes after taking it, which will disappear after stopping.

The most common misunderstanding is that many people think "I can just take eye-protecting medicine and sit back and relax." Last year, I met a patient who was 15 years old and was taking calcium dobesilate every day. He felt that he would definitely not get eye disease. He didn't have a fundus check for 10 years. When he came, his vision had dropped to 0.2. The test showed that he had proliferative retinopathy, which had new blood vessels. He had to have laser treatment and intraocular injections. He even asked me very aggrievedly, "I have been taking eye protection drugs for so many years. How can I still be like this?" To be honest, medicines are only auxiliary. If you spend more than ten yuan a year to take fundus photography, problems can be detected and dealt with early, which is 10 times more effective than taking medicines worth thousands of yuan a year.

There is still a controversial direction in academic circles: Can the anti-VEGF intraocular injections used to treat diabetic macular edema and proliferative lesions be used to prevent high-risk patients in advance? A small sample study shows that for patients who have developed moderate non-proliferative lesions, early anti-VEGF administration can reduce the risk of later blindness. However, most clinical experts still do not recommend routine use for prevention - after all, it is an intraocular injection, and even if the risk is low, there is still the possibility of infection. One injection costs thousands, and the cost-effectiveness is too low. There is really no need to insert a needle into the eye when there is no illness.

The advice I usually give to patients is also very practical: if you are less than 3 years old, your blood sugar, blood pressure, and blood lipids are all within the target value, and your fundus examination every year is clean, you don’t need to take any auxiliary drugs, stay up late and turn off the lights less often and use your mobile phone, this is better than anything else.； If you have had diabetes for more than 5 years, or you already have mild microaneurysms, just ask a doctor to prescribe an auxiliary drug. Don't listen to what the Internet says about this and that. Buying several at once and taking them on top of each other will put a heavy burden on the liver and kidneys, and they will not be effective twice as much. ； The most important thing is, whether you take medicine or not, you should have your fundus checked at least once a year. If there are early lesions, you need to check your eyes every three months to six months.

To be honest, there is really no shortcut to prevent diabetic eye diseases. Don’t believe the propaganda of “special eye protection medicine”. If you control the basic indicators stably and conduct regular screening, you can already prevent more than 90% of serious eye diseases.