Diabetic Retinopathy encompasses the diabetic eye diseases affecting the retina, the thin lining at the back of the eye, which allows images to transmit to the brain. These eye conditions include nonproliferative retinopathy, macular edema, macular ischemia, and proliferative retinopathy.
When diabetes is not controlled through medication, diet, and exercise, hyperglycemia occurs, allowing glucose to accumulate in the blood vessels. This accumulation damages the small blood vessels that nourish the retina and can cause leakage, swelling, blockage, or the development of new abnormal blood vessels in the retina, ultimately affecting your vision.
The early or mild stage, NPDR, occurs when damaged blood vessels within the retina leak blood or fluid, causing the retina to swell or form fatty deposits called “exudates”.
When the swelling affects the macula, the area at the center of the retina that provides your pinpoint vision, it is called Diabetic macular edema (DME).
When the blood vessels of the retina become damaged or blocked in the stages of NPDR, your eye responds with neovascularization. Neovascularization is the growth of new abnormal blood vessels and scar tissue on the surface of the retina, prompted by your body’s natural growth hormone, and can cause you to see floating spots in your vision. This advanced stage of the disease is proliferative diabetic retinopathy (PDR) and can lead to serious conditions, such as retinal detachment and severe vision loss.
These new abnormal blood vessels are weak and can cause a vitreous hemorrhage, bleeding into the clear, gel-like substance inside the eye. Small amounts of bleeding can cause you to see dark floaters; significant bleeding can block all vision. When bleeding occurs in the center of the eye, scar tissue can form, pull on the retina, and cause a retinal detachment. If the blood vessels grow on the iris, they can clog the drainage system of the eye and lead to neovascular glaucoma.
Intravitreal Injections for Diabetic Retinopathy
Intravitreal injections are an in-office treatment for macular edema. Steroid or “Anti-VEGF” medications are injected into the eye to reduce the swelling of the macula.
Vascular endothelial growth factor (VEGF) is a chemical in the body that stimulates the growth of new blood vessels. While VEGF is needed in our bodies, when triggered by the effects of diabetic retinopathy, it can be vision-threatening because it creates abnormal blood vessels behind the retina, which leak blood and fluid into the retinal layers.
Anti-VEGF drugs are currently the most common and effective treatment for age-related macular degeneration (AMD). Studies have shown that these AMD drugs have also proven beneficial in reducing diabetic macular edema. With this treatment, an anti-VEGF drug is injected into the eye with a very fine needle. The drug inhibits the development or leakage of the abnormal blood vessels, slowing vision loss. These ongoing treatments have proven to reduce DME from diabetic retinopathy and preserve your vision.
Laser Treatment for Diabetic Retinopathy
Laser treatment is an in-office treatment for macular edema. With this procedure, a laser focuses on damaged areas of the retina to reduce fluid leakage and swelling caused by the abnormal blood vessels. The main purpose of this treatment is to prevent further vision loss. It is not possible to gain vision that has already been lost due to diabetic eye disease.
Pan-Retinal Photocoagulation (PRP) for Diabetic Retinopathy
Pan-Retinal Photocoagulation (PR) is an in-office laser treatment for PDR. A laser focuses on all parts of the retina, except the macula, causing abnormal new blood vessels to shrink. This treatment also helps prevent future growth and decreases the chance that bleeding and retinal distortion will occur. Multiple treatments are indicated. PRP does not cure PDR but can help prevent further vision loss.
