What are the medicines for preventing eye disease in diabetes

Currently, there are no specific preventive drugs for diabetic eye lesions. Clinically, drugs that can reduce the risk of diabetic retinopathy are mainly divided into two categories - core drugs to control basic diseases, and auxiliary drugs to improve microcirculation. The effect of the former is much higher than that of the latter, so don't reverse the priorities.

A while ago, I met two old diabetic patients in the outpatient clinic who had been diagnosed with diabetes for almost 10 years. Uncle Zhang has been keeping his glycated hemoglobin within 6.5%. In addition to regular metformin and antihypertensive valsartan, last year because of occasional visual fatigue, the doctor gave him calcium dobesilate, which he took for more than half a year. After a review this year, his eyes were still clean. Another uncle, Li, always felt that "it's the medicine that is three-thirds of the poison." He took the antidiabetic medicine only after he remembered it. The glycation level was often above 8%. He also bought a bunch of imported lutein eye-protection tablets and took them. As a result, microaneurysms had grown in the fundus of his eyes this year. If he came back half a year later, there might be leakage that would affect his vision.

In fact, the reason is very simple. The capillaries in our eyes are like thin rubber tubes soaked in body fluids. High sugar, high blood pressure, and high blood lipids are corrosive liquids. Sooner or later, the tubes will harden, leak, or even rupture if they are soaked for a long time. If you don’t remove these corrosive factors first, just spraying a protective layer on the outside of the tubes will not have any fundamental effect. New anti-diabetic drugs such as commonly used GLP-1 receptor agonists and SGLT2 inhibitors, as well as sartan anti-hypertensive drugs and statin anti-lipid drugs, essentially help you lower the concentration of these "corrosive fluids" and fundamentally reduce the possibility of fundus blood vessel damage. Many large-scale clinical studies have confirmed that long-term stable control of glycation below 7% can reduce the risk of diabetes by more than 70%. This effect is more reliable than any eye protection drug.

As for the commonly asked questions about drugs such as calcium dobesilate, pancreatic kallikreinogenase, and doxamine, there are indeed studies showing that they can improve the permeability of microvessels and reduce the risk of early progression of glycosylation. However, the academic community currently has different opinions on their preventive effects. Some doctors suggest that the disease duration is more than 5 years, and blood sugar fluctuates greatly, or Patients who already have mild blurred vision and a very small amount of microaneurysm in the fundus can take it as needed to reduce the risk of progression; some doctors believe that if the basic indicators are very stable and the fundus examination is completely normal every year, there is no need to take additional such drugs. After all, long-term medication will also increase the metabolic burden on the liver and kidneys, which is not worth the gain.

I would also like to mention that eye health products such as lutein and blueberry, which many people with diabetes are superstitious about, can only help relieve visual fatigue at most. There is no clear evidence-based medical evidence for the prevention of diabetes. Don’t spend a lot of money to buy useless products, which will delay the control of underlying diseases. To put it bluntly, diabetes prevention is really not something that can be solved by taking medicine. I have met a 32-year-old young man with diabetes before who has had diabetes for only 4 years. His sugar control is relatively stable and he has been taking calcium dobesilate, so he felt that there would be no problem. He did not check his fundus for 3 years. However, this year’s physical examination found that there was yellowish white oozing under his eyes. Fortunately, he was discovered early and could intervene. If it were delayed for another two years, he might have to undergo laser surgery. Therefore, fundus screening at least once a year is the most cost-effective "prevention method", which is more effective than taking any number of medicines.