How is Diabetic Retinopathy Treated?
Treatment for diabetic retinopathy depends on the type of diabetic retinopathy you have, its severity and how well it may respond to specific treatments.
- Early diabetic retinopathy
If you have nonproliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your retina to determine if you need laser treatment. - Advanced diabetic retinopathy
If you have proliferative diabetic retinopathy, you will need prompt surgical treatment. Sometimes surgery is recommended for severe nonproliferative diabetic retinopathy, too.
On the other hand, how specific treatment will be determined by your physician(s) based on:
- your age, overall health, and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
According to the National Eye Institute, part of the National Institutes of Health, even people with advance retinopathy have a 90 percent chance of keeping their vision when they seek treatment before the retina becomes severely damaged.
Treatment options for diabetic retinopathy include:
- Focal laser treatment. This laser treatment is also known as photocoagulation. It can stop the leakage of blood and fluid in the eye. It is good in treating macular edema. During the surgery, your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed.
A patient may need focal laser surgery more than once to control the leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart.
Focal laser treatment stabilizes vision. In fact, focal laser treatment reduces the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it can be improved.
- Scatter laser treatment. This laser treatment, also known as panretinal photocoagulation, can shrink the abnormal blood vessels. It’s also done in your doctor’s office or eye clinic. During the procedure, your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink.
Scatter laser treatment is usually done in two or more sessions. Your vision will be blurry for about a day after the procedure. Some loss of peripheral vision or night vision after the procedure is possible.
- Vitrectomy. Instead of laser surgery, you may need an eye operation called a vitrectomy to restore your sight. A vitrectomy is performed if the retina bleeds into the vitreous. It involves removing the cloudy vitreous and replacing it with a normal saline solution. Vitrectomy often prevents further bleeding by removing neovascularization (abnormal blood vessel growth) that caused the bleeding. If the retina is detached, it can be repaired during vitrectomy surgery.
Studies show that people who have a vitrectomy soon after a large hemorrhage are more likely to protect their vision than those who wait to have the operation. Early vitrectomy is especially effective in people with insulin-dependent diabetes, who may be at greater risk of blindness from a hemorrhage into the vitreous.
Vitrectomy is often done under local anesthesia. This means that you will be awake during the operation. The doctor makes a tiny incision in the sclera, or white of the eye. Next, a small instrument is placed into the eye. It removes the vitreous and replaces it with a saline solution in the eye.
You may be able to return home soon after the vitrectomy. Or, you may be asked to stay in the hospital overnight. Your eye will be red and sensitive. After the operation, you will need to wear an eyepatch for a few days or weeks to protect the eye. You will also need to use eye drops to protect against infection and inflammation.
- Intraocular Steroid Injection. It is a newly emerging treatment for diabetic macular edema. This therapy uses steroid injection into the eye to help reduce the amount of fluid leaking into the retina, resulting in visual improvement. Due to the chronic nature of diabetic eye disease, this treatment may need to be repeated or combined with laser therapy to obtain maximal or lasting effect.
- Cryotherapy (freezing). This treatment is helpful in treating diabetic retinopathy. If the vitreous is clouded by blood, laser surgery cannot be used until the blood settles or clears. In this case, cryotherapy (freezing of the retina) may help shrink the abnormal blood vessels.
Although laser surgery and vitrectomy are very successful, they do not cure diabetic retinopathy. Once you have proliferative retinopathy, you will always be at risk for new bleeding. This means you may need treatment more than once to protect your sight.
