Treatment Options for Diabetic Retinopathy
Worldwide, it’s estimated over 30% of people with diabetes have diabetic retinopathy. Of these cases, 30% have diabetic retinopathy that’s severe enough to threaten vision loss. Thankfully, treatment options for diabetic retinopathy have come a long way over the last several years. The goal of diabetic retinopathy treatment is to generally slow the progression of the disease and stabilize vision, but with recent advances, sometimes vision can even be improved.
Understanding Diabetic Retinopathy
Diabetic retinopathy develops when high blood sugar levels damage the small blood vessels within the retina. These blood vessels begin to weaken and leak fluid and blood. As diabetic retinopathy progresses, the vessels can shrink, become blocked, and lose their ability to transport blood. Eventually, the body produces new blood vessels, but these tend to be fragile, causing them to bleed and leak fluid into the retina and the vitreous, the gel-like substance that fills the back of the eye. Scar tissue can develop as well, leading the retina to detach from its normal position, which can cause permanent vision loss.
Swelling may also occur in a portion of the retina known as the macula, the part of the eye responsible for sharp, central vision. This is called diabetic macular edema and it can cause blindness without proper treatment.
Treatment Options for Early Stage Diabetic Retinopathy
Diabetic retinopathy may not have any symptoms in the beginning, so if you have diabetes, it’s recommended to have yearly, dilated eye exams by an ophthalmologist. This allows your eye doctor to assess for any changes in your eyes before any significant damage occurs.
When early signs of diabetic retinopathy are detected, treatment consists of maintaining good control of your blood sugar through proper diet and medication or insulin management. Keeping your blood sugar in a healthy range can help prevent diabetic retinopathy from getting worse. Controlling high blood pressure and cholesterol have also been shown to lower the risk of vision loss from diabetes.
Treatment Options for Advanced Stage Diabetic Retinopathy
If new blood vessel growth is detected (also called proliferative diabetic retinopathy) or diabetic macular edema is present, your doctor may suggest one or more of the following treatments:
Laser surgery: A procedure called focal laser surgery treats blood vessels in the macula by sealing off leaking blood vessels and helping to reduce macular edema. Another type of laser procedure, called scatter laser surgery, treats abnormal vessels away from the macula, causing the vessels to shrink.
Anti-VEGF injections: These eye injections block a protein called vascular endothelial growth factor (VEGF) that stimulates new, abnormal blood vessels to grow. Examples include bevacizumab (Avastin), ranibizumab (Lucentis), and aflibercept (Eylea). They are usually given monthly for the first six months and then spread out over time. When effective, anti-VEGF injections can reverse diabetic macular edema and significantly improve vision.
Corticosteroids: Steroids may be injected or implanted into the eye, releasing a constant dose of medication to help reduce inflammation from diabetic macular edema. Dexamethasone (Orzudex) and fluocinolone acetonide (Iluvien) are two common implants. They pose a risk for increased pressure in the eye, so close monitoring is recommended.
Vitrectomy: When severe bleeding is present in the vitreous, this procedure may be performed to remove the vitreous gel through a small incision and replace it with a special salt water solution. Scar tissue and membranes may also be removed. A vitrectomy can help improve vision or prevent it from getting worse.
After treatment, it’s important to continue regular follow up with your doctor and ophthalmologist. Together, you can formulate a plan to manage your diabetes and monitor your diabetic retinopathy in an effort to prevent permanent vision loss.