Diabetic Retinopathy

Background

Diabetes is a very serious disease that can cause many problems such as blindness, heart disease, kidney failure, and limb amputations. However, by taking good care of yourself through diet, exercise, and medications, you can control your diabetes.

Diabetic eye disease refers to a group of eye problems. All of which can cause severe vision loss or blindness. Since diabetic eye disease may be the first sign of diabetes and there are often no symptoms in the early stages, regular dilated eye exams are very important.

Diabetic eye disease includes:

  • Diabetic retinopathy: Damage to the blood vessels in the retina.
  • Cataract: Clouding of the lens of the eye.
  • Glaucoma: Increase pressure in the eye that leads to optic nerve damage and loss of vision.

Diabetic retinopathy is the leading cause of blindness among adult Americans. Diabetes affects the small blood vessels throughout the entire body, including the eye. Retinal blood vessels may leak fluid and abnormal new blood vessels may grow on the retina. These changes may result in vision loss or blindness.

Vision loss may occur when the macula (the central part of the retina that you focus with) swells due to leaking fluid. This condition is called macular edema. If new vessels have grown on the surface of the retina, they can bleed into the eye, blocking vision.

Early detection and treatment is key. Several decades of clinical research, the advent of medical lasers and multi-center clinical trials have paved the way for treatment strategies that are 90% effective in preventing severe vision loss. Diabetic eye disease is best treated before you lose vision. With use to the latest technology, such as the Optopmap retinal scanner, fluorescing angiography, OCT laser scanner, digital photography, and argon lasers, we can optimize our detection and treatment of diabetic retinopathy.

Laser Treatment

Laser treatment is often recommended for macular edema, proliferative retinopathy (PDR) and neovascular glaucoma.

Laser surgery is performed in our office with the use of an anesthetic eyedrop and an instrument called a slit-lamp microscope. A contact lens is placed on the eye to focus the laser light on the retina with pinpoint accuracy.

With laser surgery for macular edema, tiny laser burns are applied near the macula to reduce fluid leakage. The goal of laser treatment is to keep the level of vision you have and prevent further loss of vision loss. Although some may experience partial visual improvement, full visual recovery is uncommon.

In PDR, the laser is applied to the peripheral retina and not the macula. This is know as panretinal photocoagulation (PRP) which helps to shrink new blood vessels and often prevents them from growing in the future. PRP laser has proven to be very effective for preventing severe vision loss.

Multiple laser treatments over time may be necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision.

Injections

Steroids and anti-VEGF medications such as Avastin and Lucentis can also be used help treat diabetic retinopathy. Steroids help to reduce inflammation and anti-VEGF medicine blocks a substance known as vascular endothelial growth factor (VEGF) which contributes to abnormal blood vessel growth.

Once the eye is anesthetized with drops, the medication is injected into the eye with minimal discomfort. The injected medication reduces swelling, leakage, and growth of unwanted blood vessels, and helps to improve vision.

Medication injections may be given once or as a series of injections at regular intervals, usually around every four to six weeks or as determined by your doctor.

Vitrectomy

Vitrectomy is a procedure used to remove blood and scar tissue from within the eye and is performed in a hospital or ambulatory surgery center with either a local or general anesthetic.

Vitrectomy not only helps your ophthalmologist visualize the retina better, it helps prevent further vitreous hemorrhage by removing abnormal vessels that often bleed. Furthermore, removal of scar tissue helps return the retina to its normal anatomical location. Laser may also be applied during a vitrectomy.

In some instances, a gas or oil bubble may be placed in the eye and you may be told to keep your head in a certain positions while the bubble helps to heal the retina. It is important to follow your ophthalmologist’s instructions so your eye will heal properly.