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Diabetic Retinopathy

Diabetic Retinopathy diagram

Diabetes’ effect on the retina is the main threat to vision in patients under the age of people under the age of 60 in the United States. Diabetes damages the retina circulatory system in the back of the eye. The capillaries in the retina weaken and may leak fluid into the retina, resulting in complications of diabetes in the eye: diabetic macular edema, abnormal blood vessel growth and retinal neovascularization. Diabetes is a chronic disorder requiring regular examinations with your primary care physician and your retina specialist

If diabetic macular edema extends close to the center of the macula, significant vision loss may result. New retinal blood vessels may hemorrhage easily allowing blood to leak into the vitreous, causing decreased vision and floaters. 

Treatment for diabetic retinopathy is determined by the stage of the disease and the complications involved.  There are two categories of diabetic retinopathy:  non-proliferative and proliferative diabetic retinopathy. 

Diabetic Retinopathy as seen with Fluorescein angiography

During your examination, your retina specialist may request several tests to gather the information needed to plan the best course for your individualized need for treatment.  Our goal for each patient is to prevent, arrest or reverse this sight threatening disorder.

Treatment for diabetic retinopathy is based on the severity of the disease. 

Mild diabetic retinopathy may not require treatment and your physician my monitor your condition before determining your treatment. 

Moderate diabetic retinopathy may be treated with focal laser. The focal laser is used to treat the growth of new blood vessels in the back of the eye. If diabetic macular edema is present, you may also be treated with anti-VEGF injections to decrease the edema. 

Proliferative diabetic retinopathy is the most advanced and severe form diabetic eye disease. As a result of poor blood flow to the retina, new blood vessels begin to grow. This is called neovascularization. These fragile new blood vessels grown in the wrong places and can bleed into the eye and causing new floaters or completely block the vision. The new blood vessels can also form scar tissue as they grow. This scar tissue can cause severe problems from traction or pulling on the retina and can result in a retinal detachment. 

Treatment options for proliferative diabetic retinopathy depend upon the severity of the disease. You may have more severe disease in one eye which may require more aggressive treatment than the eye with less significant retinopathy.  

Treatments for proliferative diabetic retinopathy may include one, or a combination of the following treatments: 

Laser Photocoagulation. Laser photocoagulation is used to seal the leaking blood vessels in the eye. This procedure is performed in the office setting and does not require a trip to the surgery center, or hospital to be performed. Laser may need to be repeated more than once and it is possible other treatments may be used in combination with laser. 

Anti- VEGF. Anti- VEGF medications given in the eye to reduce the leakage and bleeding of blood vessels in the eye and decrease swelling of the macula. Anti – VEGF mediations can result in slowing vision loss and may improve vision.  These injections may need to be repeated over time, each person is and eye is different and the response to injections varies. Your retina specialist will discuss and create an individualized treatment plan based on your needs and severity of retinopathy. 

Steroids. Steroids can also be injected in the eye to reduce swelling and macular edema. Steroid injections can be given in the office and may need to be repeated over time to decrease the swelling and macular edema.  

Vitrectomy Surgery .If you have advanced proliferative diabetic retinopathy with bleeding, scar tissue, or a retinal detachment, your retina specialist may recommend a surgery called a vitrectomy. This surgery is performed in the surgical suite, or in the hospital. During this surgery ,the vitreous gel with any blood is removed from the inside of your eye. At the time of  surgery, your retina specialist may also perform laser treatment. Scar tissue may also need to be removed or a retinal detachment may need to be repaired. As with all of the treatments for diabetic retinopathy, your retina specialist will discuss the best treatment plan for you during your examination.

It is important for patients to be aware, diabetic retinopathy may not cause symptoms and you may not notice a change in your vision, which is why regular eye exams are necessary for patients who are diagnosed with diabetes. Diabetic retinopathy usually affects both eyes, and one eye may be worse than the other. Unstable blood sugar levels may also affect your vision. 

Possible symptoms of diabetic retinopathy:

  • New or increasing floaters
  • Blurry vision 
  • Fluctuating vision – sometime blurry, sometime clear 
  • Dark or blank areas in you field of vision
  • Decreased night vision 
  • Decreased clarity of images or colors 

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