Treatment of Diabetic Retinopathy
Good control of diabetic disease produces many benefits, including slowing down the development of retinal complications, kidney complications and foot neuropathy. Therefore, it is very important to control your diabetes. Complications of diabetic retinopathy are commonly treated with laser therapies, medication and eye surgery.
As demonstrated in the Diabetic Retinopathy Study (DRS) and The Early Treatment Diabetic Retinopathy Study (ETDRS), laser therapies can be extremely useful in reducing the rate of visual loss. Laser treatments for either macular swelling or new blood vessels are performed as an outpatient with topical anesthetic drops. Treatments may be divided into several sessions over a few weeks, depending on what needs to be treated. Although some patients may want a family member or friend to help them with transportation, most patients can handle the treatments easily and without pain.
Macular/focal laser for macular swelling. This treatment is applied to stop or reduce the leakage in the macula. The laser treatment is usually completed in one session, and depending on the patient’s response, additional macular laser may be applied several months later. Although laser treatment can slow the progression of diabetic retinopathy, its goal is to stabilize vision rather than to reverse any visual loss. Patients are often reminded that this is why we emphasize early detection followed by early treatment.
Panretinal/scatter laser for reverse blood vessel development. This treatment is applied to eyes and the goal is to shrink the new blood vessels. A total of 1,400 to 1,600 spots are applied and often the treatment is split into at least two sessions. As the vessels begin to shrink, small bleedings may occur from traction on the vessels, but without this laser treatment, severe bleedings often occur as part of the natural course of this disease. Increased macular leakage may also develop after scatter laser, but again, the benefit of the scatter laser treatment outweighs some of the laser-associated complications.
Drug Treatments (not FDA approved)
In recent years, many drug therapies have been evaluated for the management of diabetic retinopathy. The following two are the most commonly used intraocular injections used for diabetic retinopathy.
- Intravitreal Kenalog – Kenalog is a steroid and is injected directly inside the eye to reduce macular swelling. Unfortunately, it is associated with glaucoma (elevated intraocular pressure), increased cataract formation, infection, retinal detachment and intraocular bleeding. Most patients have found that the visual gain is only temporary (about 2 months), which requires them to get repeated injections.
- Intravitreal Avastin – Avastin is similar to Lucentis, the most common drug used for wet macular degeneration. As Lucentis is not approved for use for patients who do not have macular degeneration, many doctors have elected to treat some forms of diabetic retinopathy with intravitreal Avastin. Bear in mind that unlike Lucentis, Avastin is not FDA-approved for intraocular use. However in some cases of advanced proliferative disease, Avastin may be a reasonable supplement to scatter laser treatment.
Vitreous surgery for diabetic retinopathy
Vitreous surgery for diabetic retinopathy is surgery within the eye in order to remove blood, re-attach the retina, or both. The procedure is usually done under local anesthesia, similar to modern cataract surgery. Miniaturized instruments such as scissors, lasers, and other devices are introduced into tiny openings in the side of the eye. Thanks to new technology, with either 23-gauge or 25-gauge instrumentations, we are able to perform vitrectomies much faster than before.
May I use aspirin?
There are no ocular contraindications/restrictions on the use of aspirin when required for cardiovascular disease or other medical conditions. The Early Treatment Diabetic Retinopathy Study showed that aspirin had no effect on retinopathy – no harmful or beneficial effects.