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Diabetic retinopathy treatment

Diabetic retinopathy: Illustration showing how vision is affected.

Diabetic retinopathy treatment can help prevent or delay eye damage and vision loss from diabetes. Treatment may not be needed in early stages of the disease, when your eyesight is normal.

There are three common treatment methods for diabetic retinopathy: laser treatment, vitrectomy surgery and medication. An ophthalmologist, likely a retina specialist, can evaluate your needs and determine the best treatment options for you.

SEE RELATED: Other forms of retinopathy

Laser treatment

There are two types of laser treatment for diabetic retinopathy:

Focal or grid laser photocoagulation

This type of laser energy is aimed directly at the affected area or applied in a contained, grid-like pattern to destroy damaged eye tissue and clear away scars that contribute to blind spots and vision loss. This method of laser treatment generally targets specific, individual blood vessels in the retina that have been damaged by diabetes.

Scatter (pan-retinal) laser photocoagulation

With this method, laser energy is applied to more than 1,000 tiny spots in the periphery of the retina, leaving the central macula untouched.

Though this type of laser treatment destroys some functional cells in the peripheral retina, it improves blood supply to the more essential central portion of the retina to maintain eyesight.

Also, the peripheral retina is thought to be involved in formation of vascular endothelial growth factor (VEGF), responsible for abnormal blood vessel formation. When cells in the peripheral retina are destroyed by laser treatment, the amount of VEGF is reduced, along with the potential to produce abnormal retinal blood vessels that can leak and cause additional vision loss.

After laser treatment of the peripheral retina, some blood flow bypasses this region and instead provides extra nourishment to the central portion of the retina. The resulting boost of nutrients and oxygen to the central retina helps maintain the health of the macula, which is essential for visual acuity and color vision. However, some peripheral vision may be lost due to this treatment.

While laser treatment for diabetic retinopathy usually does not improve vision, the therapy is designed to prevent or halt further vision loss from diabetes.

Laser treatments can often be performed at your eye doctor’s office. You might feel minor discomfort, but the numbing medication will make the procedure less uncomfortable.

Your vision might be blurry for a day or two, so you’ll need someone to drive you home. Depending on your individual condition, you may need to have additional laser procedures in the future.

SEE RELATED: Diabetic eye problems and symptoms

Vitrectomy

In advanced diabetic retinopathy, blood from damaged or fragile new blood vessels in the retina can leak into the clear fluid (vitreous) that fills the back of the eye. When this occurs, the blood clouds the vitreous and prevents light from reaching the retina, obscuring vision.

Expandable

If you have a diabetic vitreous hemorrhage, you may require a vitrectomy to remove the clear, gel-like substance in your eye's interior.

The cloudy vitreous also prevents your eye doctor from getting a clear view of the retina to treat the leaking blood vessels.

A vitrectomy is a procedure performed by an eye surgeon to remove the cloudy vitreous and replace it with a clear gel or fluid. This restores vision and allows the surgeon a better view of the retina to treat the leaking blood vessels.

Vitrectomies are usually performed at a hospital or surgical facility. Your eye will be numbed, or you may be put under general anesthesia. When both eyes need a vitrectomy, only one surgery will be performed at a time.

Full recovery can take several weeks, and you will need to avoid certain activities during that time. Your doctor will give you medication to help with any discomfort.

Injections of medication

Diabetic retinopathy is associated with a protein called VEGF in the retina. VEGF stimulates the production of new blood vessels in the retina to bring more oxygen to the tissue because retinal blood circulation is inadequate due to diabetes.

Unfortunately, these tiny new blood vessels that form in the retina in response to VEGF are fragile and leak easily — resulting in bleeding, swelling (edema) and scarring in the retina that causes progressive vision loss.

Injections of anti-VEGF medication can help stop VEGF from triggering new growth and reduce macular swelling. Corticosteroid injections can also be used to reduce VEGF production and reduce macular inflammation.

Anti-VEGFs and corticosteroids can help improve your vision and slow vision loss. They can be injected directly into the eye or released slowly through a tiny device implanted inside the eye.

In the United States, the more common anti-VEGF drugs and drug-releasing implants include:

  • Eylea (Regeneron)

  • Lucentis (Genentech)

  • Iluvien (Alimera Sciences)

  • Ozurdex (Allergan)

  • Retisert (Bausch + Lomb)

Diabetic retinopathy injections are usually done in an ophthalmologist’s office. You may need someone to drive you home, but you’ll probably be able to resume regular activities shortly after.

Visit your eye doctor

Source: National Eye Institute (NIH)

If you’re at risk of diabetes or are over age 60, see an eye doctor near you annually for a comprehensive eye exam to rule out early signs of the disease in your eyes.

If you have diabetes, you can minimize your chances of vision loss by scheduling frequent diabetic eye exams with your eye doctor. 

In addition to closely examining the back of your eye (fundoscopy), your doctor may perform additional tests or refer you to a specialist to monitor the health of your retinal blood vessels and other aspects of your eyes that may be affected by the disease.

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Gary Heiting, OD

Gary Heiting, OD, is a former senior editor of AllAboutVision.com. Dr. Heiting has more than 30 years of experience as an eye care provider, health educator and consultant to the eyewear ... Read more