Treatment for Diabetic Retinopathy

How is diabetic retinopathy treated?

The best treatment is to prevent the development of retinopathy as much as possible. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss from diabetic retinopathy. If high blood pressure and kidney problems are present, they need to be treated.

Laser surgery:

Laser surgery is often recommended for people with macular edema, Proliferative Diabetic Retinopathy (PDR) and neovascular glaucoma.

For macular edema, the laser is focused on the damaged retina near the macula to decrease the fluid leakage. The main goal of treatment is to prevent further loss of vision. It is uncommon for people who have blurred vision from macular edema to recover normal vision, although some may experience partial improvement. A few people may see the laser  spots near the center of their vision following treatment. The spots usually fade with time, but may not disappear. See a short video on Laser Procedures for Macular Edema.

Laser spots can be seen throughout the retina. Abnormal blood vessel growth has resolved. Note small spot of blood in macula, lower left.

For PDR, the laser is focused on all parts of the retina except the macula. This panretinal photocoagulation treatment causes abnormal new vessels to shrink and often prevents them from growing in the future.

It also decreases the chance that vitreous bleeding or retinal distortion will occur. Multiple laser treatments over time are sometimes necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision.  See a short video on Laser Procedure for Proliferative Diabetic Retinopathy (PDR).

Vitrectomy:

In advanced PDR, the ophthalmologist may recommend a vitrectomy. During this microsurgical procedure, which is performed in the operating room, the blood-filled vitreous is removed and replaced with a clear solution. The ophthalmologist may wait for several months or up to a year to see if the blood clears on its own before performing a vitrectomy.

Vitrectomy often prevents further bleeding by removing the abnormal vessels that caused the bleeding. If the retina is detached, it can be repaired during the vitrectomy surgery. Surgery should usually be done early because macular distortion or traction retinal detachment will cause permanent visual loss. The longer the macula is distorted or out of place, the more serious the vision loss will be.  See a short video on Vitrectomy Surgery for Vitreous Hemorrhage.

Vision loss is largely preventable

If you have diabetes, it is important to know that today, with improved methods of diagnosis and treatment, only a small percentage of people who develop retinopathy have serious vision problems. Early detection of diabetic retinopathy is the best protection against loss of vision.

You can significantly lower your risk of vision loss by maintaining strict control of your blood sugar and visiting your ophthalmologist regularly.

When to schedule an examination

People with diabetes should schedule examinations at least once a year. More frequent medical eye examinations may be necessary after the diagnosis of diabetic retinopathy.

Pregnant women with diabetes should schedule an appointment in the first trimester because retinopathy can progress quickly during pregnancy.

If you need to be examined for glasses, it is important that your blood sugar be in constant control for several days when you see your ophthalmologist. Glasses that work well when the blood sugar is out of control will not work well when sugar is stable.

Rapid changes in blood sugar can cause fluctuating vision in both eyes even if retinopathy is not present.

You should have your eyes checked promptly if you have visual changes that:

• Affect only one eye
• Last more than a few days
• Are not associated with a change in blood sugar

When you are first diagnosed with diabetes, you should have your eyes checked:

• Within five years of the diagnosis if you are 30 years old or younger
• Within a few months of the diagnosis if you are older than 30 years