The retina and blood sugar (3D)
About this app
Diabetic retinopathy on the fundus of a right eye in 3D: a time slider over 25 years shows, with persistently high or well-controlled blood sugar, microaneurysms, haemorrhages, hard exudates, cotton wool spots, venous beading, new vessels, macular oedema and vitreous haemorrhage. Stages by the international classification (4-2-1 rule), the simulated vision of the person and a schematic section through the retinal layers.
With explain mode: an AI tutor walks you through the app, points out what matters in the scene and answers your questions.
The medicine
Diabetic retinopathy is a disease of the small retinal vessels in diabetes. Blood sugar that is too high for years damages the capillary walls. They bulge into microaneurysms, leak and close. Haemorrhages, hard exudates of fat and protein and cotton wool spots follow. When the retina runs short of oxygen it releases the growth factor VEGF, and fragile new vessels grow into the vitreous: proliferative retinopathy. Macular oedema, a swelling of the centre of the retina, can occur at any stage and blurs sharp vision.
What you see
The fundus of a right eye as a 3D shell, as the eye doctor sees it through the pupil: macula, optic disc and vascular arcades. A time slider runs over 25 years, either with persistently high blood sugar (HbA1c about 9 %) or well-controlled blood sugar (about 7 %). A findings panel gives the stage by the international classification with the 4-2-1 rule and counts the changes. Next to it a simplified simulation shows what the person sees, and a schematic section shows in which retinal layer each change lies.
Things to try
Let the years run with high blood sugar and watch the vision: up to severe non-proliferative retinopathy it stays sharp, although many haemorrhages are already present. Only macular oedema blurs the centre, and a vitreous haemorrhage puts dark spots into the image. Switch on the section to see the fluid in the retinal layers. Then compare the same 20 years with well-controlled blood sugar: it stays at mild retinopathy.
Frequently asked questions
- What is diabetic retinopathy?
- Damage to the small blood vessels of the retina caused by long-term high blood sugar. It starts with microaneurysms and haemorrhages (non-proliferative form) and can lead to new, fragile vessels (proliferative form). Macular oedema can come on top. It is one of the most common causes of vision loss in working-age adults worldwide.
- Why do you not notice diabetic retinopathy for a long time?
- The first changes usually lie outside the macula, the place of sharp vision. Microaneurysms, haemorrhages and exudates in the rest of the retina hardly disturb vision. Symptoms only appear when the macula swells or blood reaches the vitreous. That is why early retinopathy can only be detected by examining the back of the eye.
- How often should people with diabetes have their eyes examined?
- The German National Care Guideline recommends regular eye examinations of the fundus. Without retinal changes the interval is one or two years depending on risk; with known changes it is shorter. The exact interval is set by the eye doctor.
- What can I adjust in the app “The retina and blood sugar”?
- You choose the years with diabetes (0 to 25) and a blood sugar course, persistently high or well controlled. A findings panel gives the stage and the changes, a vision panel shows what the person sees. A schematic section through the retinal layers and labels can be switched on. The time courses are examples and do not replace an examination.
Subject: Biology & neuroscience
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