Diabetic Retinopathy (Eye Damage)
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If nonproliferative retinopathy has led to macular edema (swelling of the retina), laser photocoagulation, a type of surgery that uses an intense beam of light, is used to burn and seal the leaking blood vessels and decrease tissue swelling, thereby decreasing the likelihood of further vision deterioration.
For proliferative retinopathy, laser surgery known as panretinal photocoagulation, which uses a scattered laser, is used to stop the growth of new blood vessels, thereby decreasing the likelihood of serious side effects including vitreous hemorrhage and retinal detachment.
Vitrectomy is a surgical treatment that can help restore vision by removing a vitreous hemorrhage or repairing retinal detachment.
Several new treatments are also being evaluated to determine if they curb progression of retinopathy or decrease vision loss associated with it. These treatments include oral medications for nonproliferative disease and intraocular injections of anti-inflammatory medications (steroids) for macular edema.
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Blurry vision. Floating spots. Distorted images. If excess glucose (high blood sugar) damages the blood vessels that feed your retina, you may develop an eye problem called diabetic retinopathy. Diabetic retinopathy often starts with no symptoms, but over time, can destroy your eyesight and cause vision loss. In fact, diabetes is the leading cause of blindness in adults between the ages of 20 and 74. To prevent retinopathy, watch your blood sugar levels closely and see an eye doctor once a year for a complete eye exam.
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While laser is frequently effective in treating diabetic retinopathy -- an eye disease caused by damage to blood vessels of the retina (the innermost layer of the eye) -- it doesn't help every patient. In these cases, your doctor may recommend other options.
Because vascular endothelial growth factor contributes to diabetic retinopathy, anti-VEGF (vascular endothelial growth factor) drugs are now being tested in clinical trials to evaluate whether they will help people with diabetic macular edema or advanced proliferative retinopathy. For instance, one early study found that ranibizumab (Lucentis) could improve vision in people with diabetic macular edema; a follow-up study is under way. Similarly, two preliminary studies have suggested that bevacizumab (Avastin) might be helpful in treating proliferative diabetic retinopathy.
Steroid injections have also been used to treat advanced diabetic retinopathy. Steroids can reduce retinal swelling and often improve vision, at least for a limited time. However, one large study found that the benefits of steroid injections often disappear after one to two years. And the long-term risks of steroid use, which include an increased risk of developing cataract or glaucoma, are concerning. But research continues on ways to increase the duration of effectiveness and minimize side effects.
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Focal photocoagulation, a laser treatment for diabetic retinopathy, enables an ophthalmologist to identify individual blood vessels and seal them off with the laser. This method is often used to treat macular edema (blurring of central vision). The doctor uses a laser to make 20 to 50 tiny burns to seal the leaking blood vessels, which slows the leakage and promotes fluid resorption -- effectively reducing the amount of fluid in the retina (the innermost layer of the eye). Local anesthetics prevent any discomfort during the procedure, and the surgery is usually completed in a single session. If macular edema affects both eyes, only one is operated on at a time. A second session -- usually a week or so later -- will be needed for the second eye. The procedure can cut the risk of further vision loss in half, and in a small number of people, it actually restores vision.
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So far, there is no cure for diabetic retinopathy -- an eye disease caused by damage to blood vessels of the retina (the innermost layer of the eye). But you can take steps to prevent vision loss -- or at least to slow its progression. The type of treatment recommended will depend on the type and extent of your disorder.
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As diabetic retinopathy -- an eye disease caused by damage to blood vessels of the retina (the innermost layer of the eye) -- progresses to its later stage, proliferative retinopathy, symptoms become more dramatic. You might notice spots that are really specks of blood floating in your vision. Although sometimes the specks will clear without treatment, hemorrhaging can occur repeatedly, often during sleep. Seek treatment immediately from an eye care professional if you notice specks obscuring your vision. Otherwise, bleeding may become more severe, and vision loss and blindness can occur. The sooner you get help, the better, as earlier treatment is more likely to be effective.
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One of the best ways to protect your vision if you have diabetes is to control your blood glucose levels carefully. Studies found that people with diabetes who keep their blood sugar at near-normal levels cut their risk of developing eye diseases and macular edema by 75%. If you have diabetes, also pay careful attention to your blood pressure and cholesterol levels. Levels above normal increase the likelihood that diabetic retinopathy will occur and that it will significantly affect your vision.
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The following are guidelines for dilated eye exams if you have diabetes:
- If you are between 10 and 29 years old and have had diabetes for at least 5 years, you should have an annual dilated eye exam.
- If you are 30 or older, you should have an annual dilated eye exam, no matter how short a time you have had diabetes. More frequent exams may be needed if you have eye disease.
- If you have any changes in your vision.
- You should have a dilated eye exam if you are pregnant or planning to get pregnant.
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If you have diabetes, see your eye care professional if:
- Your vision becomes blurry
- You have trouble reading signs or books
- You see double
- One or both of your eyes hurt
- Your eyes get red and stay that way
- You feel pressure in your eye
- You see spots or floaters
- Straight lines do not look straight
- You can't see things at the side as you used to
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In photocoagulation (used in the treatment of diabetic retinopathy) the eye care professional makes tiny burns on the retina with a special laser. These burns seal the blood vessels and stop them from growing and leaking.
In scatter photocoagulation (also called panretinal photocoagulation), the eye care professional makes hundreds of burns in a polka-dot pattern on two or more occasions. Scatter photocoagulation reduces the risk of blindness from vitreous hemorrhage or detachment of the retina, but it only works before bleeding or detachment has progressed very far. This treatment is also used for some kinds of glaucoma. Side effects of scatter photocoagulation are usually minor. They include several days of blurred vision after each treatment and possible loss of side (peripheral) vision.
In focal photocoagulation, the eye care professional aims the laser precisely at leaking blood vessels in the macula. This procedure does not cure blurry vision caused by macular edema. But it does keep it from getting worse.
