Early Stages of Diabetic Retinopathy
In the early stages of diabetic retinopathy you may have a few scattered hemorrhages and blood serum deposits. At this stage, you will probably not need any treatment but will need to be closely monitored for any progression.
Advanced Stages of Diabetic Retinopathy
Advanced stages of non-proliferative or background diabetic retinopathy is characterized by blood and edema especially in the macula (part of retina that provides clear central vision). This can lead to significant central vision loss if not treated.
Proliferative Diabetic Retinopathy
Proliferative diabetic retinopathy is characterized by the presence of abnormal new blood vessels growing inside the eye in the retina, from the optic nerve, and into the vitreous. These are fragile and bleed leading to scarring with the possibility of retinal detachment. This can lead to severe vision loss or blindness.
Treatment for Advanced Stages of Diabetic Retinopathy
Focal Laser Treatment
Focal laser treatment (photocoagulation) is used when there are isolated areas of leaking blood vessels that are causing damage to the retina. This damage will lead to vision loss and is usually done in the doctor’s office. This laser treatment does not take very long. The laser is used to close or shrink the abnormal leaking vessels. Your vision may be blurred from the laser treatment for a few days but usually will return. The amount of edema and damage to the retina will determine how much vision will eventually return from treating the edema in the retina.
Panretinal Laser Treatment (photocoagulation) or PRP
Panretinal laser treatment consists of applying the laser treatment to the retina outside of the macular area. This laser treatment is usually done in the doctor’s office and may take more than one treatment session. This treatment is done for proliferative diabetic retinopathy. The treatment causes the abnormal new blood vessels to shrink or disappear. You may have blurred vision for a few days after the treatment. You also may notice loss of peripheral and night vision after the treatment.
Vitrectomy is a procedure used to remove the vitreous which may contain blood, remove scar tissue from the surface of the retina that can cause a traction retinal detachment, and laser treatment can be applied as well during the vitrectomy. Small incisions are made in the white portion of the eye that usually do not need sutures. Fine delicate instruments are inserted into the eye and are used to remove the vitreous and replace it with a balanced salt solution. The instruments can also remove scar tissue from the eye. A gas bubble may be placed inside the eye to help with the surgery. You will have to keep your head down for several days until the eye has healed sufficiently and the gas bubble is resolving.
Lucentis and Avastin are being studied for use in treating diabetic retinopathy and at this point have been shown to be useful.
Prednisone injections are also being used in certain circumstances.
Prevention of Diabetic Retinopathy
Follow closely your diabetic diet and maintain strict control of your blood glucose. Blood pressure and cholesterol control is important. Do not smoke if you have diabetes. Exercise and maintain healthy lifestyle. Once you have been diagnosed with diabetes it is important that you have a dilated eye exam yearly to monitor your retina.