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Treatment of Diabetic Retinopathy

With over two decades of experience in medicine, Melissa Flagg writes patient education articles, keeping you informed about your health.

A Healthy Retina

The treatment of diabetic retinopathy is a constant battle for both patient and doctor. The patient is locked in a constant battle with their blood sugar in an effort to keep it within normal limits. The doctor is constantly trying to stay ahead of the damage caused by the diabetes in an effort to save the patient’s vision.

Unfortunately, there are only a few treatments available for diabetic retinopathy:

  • Laser therapy (focal and panretinal)
  • Anti-VEGF injections

To understand how and when these treatments are used, we need to understand a little bit about the disease.

Types of Diabetic Retinopathy

There are two main types of diabetic retinopathy. There are complications that can be caused by both types and subsequent treatments for those complications. But it all starts with the two main types of retinopathy:

  • Background (also called nonproliferative) diabetic retinopathy
  • Proliferative diabetic retinopathy

Background diabetic retinopathy is the first stage of this disease. It is characterized by tiny hemorrhages, called microaneurysms, and the weakening of the walls of the retinal vessels. Swelling of the macula can also be a problem.

Proliferative diabetic retinopathy is the second stage and is characterized by new blood vessels growing into the retina, called neovascularization. These new blood vessels are just as weak, if not weaker, than the parent blood vessels and hemorrhage very easily. Some of these vessels can grow into the vitreous and hemorrhage leading to a sudden loss of vision.

A Retina with Diabetic Retinopathy

This is what a retina with diabetic retinopathy looks like.

This is what a retina with diabetic retinopathy looks like.

Treatments For Diabetic Retinopathy

Laser Treatment

The most common treatment for retinopathy is laser therapy. This treatment uses the heat of a laser beam to seal blood vessels that are leaking, or may leak in the near future. There are two different types of laser treatments:

  • Focal laser photocoagulation
  • Panretinal photocoagulation

Focal laser photocoagulation is generally used for neovascularization of the macula because it is a finely focused laser beam. It is meant to treat a very small blood vessel without damaging the surrounding tissue. This treatment is also used in cases of macular edema to seal blood vessels that are leaking underneath the macula.

Panretinal photocoagulation is used when a large area of the retina needs to be treated for neovascularization. This treatment is typically only used in the periphery of the retina because it damages the retinal tissue surrounding the blood vessels being treated. It is most commonly used in severe proliferative retinopathy.

Anti-VEGF Treatments

This is a fairly new treatment option and is typically used in patients with wet macular degeneration. However, it has proved to be very effective in the treatment of neovascularization as well. Anti-VEGF, or anti-vascular endothelial growth factor treatments, are designed to prevent new blood vessels from forming, and to shrink the new blood vessels that have started to grow in to the retina. Unfortunately, these treatments need to be repeated frequently, most commonly on a monthly basis.

These treatments have been shown to drastically improve vision in patients with severe proliferative retinopathy. They were originally FDA approved for colon cancer and are used off-label for the purposes of treating macular degeneration and diabetic retinopathy. However, the FDA is investigating their efficacy and the treatments should be approved in the near future.

Treatment for Macular Edema

Treatment for Vitreous Hemorrhage

Treatments for Complications of Diabetic Retinopathy

Cystoid Macular Edema

Cystoid macular edema is a very common complication of diabetic retinopathy. It is caused by lipoid exudates, or fat cells, that leak from blood vessels under the macula. The lipoid exudates can cause fluid to build up under the macula (edema) causing blurry vision.

The most effective treatment is Kenalog injections. Kenalog is a corticosteroid, which is a class of medications that prevent and alleviate inflammation. Results are usually seen within the first week; however, the injections need to be repeated about every three to six months.

Vitreous Hemorrhage

Vitreous hemorrhages occur when neovascular blood vessels grow into the vitreous, the gel-like fluid in the back of the eye. Depending on the severity of the hemorrhage, vision can be slightly or completely obstructed.

Most doctors prefer to wait a few weeks or months to see if the body will absorb the blood on its own. However, nine times out of ten, a vitrectomy needs to be performed. This is an invasive procedure that involves removing the vitreous gel and replacing it with a silicon-based oil. Healing time is lengthy. It can take up to a year before the eye is completely healed and useful vision is restored.

Neovascular Glaucoma

When new blood vessels grow into the retina, they can also grow around the iris and block the drainage system that keeps the pressure in the eye stable. When this happens, the pressure rises and causes damage to the optic nerve, which is permanent. This type of glaucoma can also be very painful because the pressure can rise very quickly.

Treatment for neovascular glaucoma involves anti-VEGF treatments, and laser therapy. Anti-VEGF treatments help prevent further growth of the neovascular blood vessels and laser therapy reopens the drainage system. This isn’t always effective, however. In these cases, trabeculectomy surgery may be necessary. This surgery involves creating a new “drain” that allows the fluid in the eye to escape called a bleb. Like a vitrectomy, this procedure is very invasive, and there is a risk of the bleb becoming infected even after the eye has healed.

Were You Paying Attention?

For each question, choose the best answer. The answer key is below.

  1. What is neovascularization?
    • The leaking of blood from hemorrhaging vessels
    • The growth of new blood vessels into the retina
    • Swelling of the macula
  2. What is proliferative diabetic retinopathy?
    • The second stage of the disease when the retina starts to neovascularize
    • The first stage of the disease when microaneurysms appear
    • When a blood vessel hemorrhages into the vitreous
  3. What causes cystoid macular edema?
    • Neovascularization of the macula
    • The leakage of lipoid exudates under the macula
    • Microaneurysms
  4. True or False: A vitreous hemorrhage will normally resolve on its own; it won't need surgery.
    • True
    • False
  5. True or False: Focal laser photocoagulation is used to treat neovascular blood vessels in the periphery of the retina.
    • True
    • False
  6. True or False: The most common treatment for diabetic retinopathy is laser photocoagulation.
    • True
    • False

Answer Key

  1. The growth of new blood vessels into the retina
  2. The second stage of the disease when the retina starts to neovascularize
  3. The leakage of lipoid exudates under the macula
  4. False
  5. False
  6. True

Alternative Treatments

The only alternative treatment for diabetic retinopathy is prevention. It is imperative to keep the blood sugar levels under control. “Spikes” in blood sugar wreak havoc on the body, and they also affect the vision.

High blood sugar levels result in a more myopic, or nearsighted eye, which causes blurry vision.A diabetic's vision can change several times a day depending on their blood sugar levels.

Keeping blood sugar under control isn’t easy. The simplest way to maintain a stable level is to change the diet. Adding vegetables and whole grains and abstaining from processed sugars and fattening foods is a good start.

Exercise is extremely important because not only does it burn calories, but it facilitates the proper use of insulin, allowing the body to burn excess sugar instead of storing it as fat. Even exercising just three times a week for 30 minutes is enough to make a difference.

Taking vitamins is another way to regulate blood sugar levels. For example, vitamin C is very beneficial to diabetics because it helps regulate insulin levels and facilitates the metabolism of glucose.

Diabetic retinopathy can’t be completely prevented, however. Even the most meticulous diabetics will eventually have some signs of the disease, but the damage to their retina will be minimal, which will prevent loss of vision.

If you believe you have an eye problem, or notice a sudden loss of vision contact your ophthalmologist right away. If you’re diabetic, make sure you see your ophthalmologist at least every six months in order to catch diabetic retinopathy before it becomes a problem.


This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Comments

Melissa Flagg COA OSC (author) from Rural Central Florida on September 07, 2012:

@kittythedreamer, Thank you! Diabetes is such an interesting disease, isn't it? It's amazing to me how one little hormone can completely offset the body's balance, and it does so much damage when it's not under control! I have a couple more ideas for diabetic retinopathy, so hopefully they'll help you at school as well lol :D

Melissa Flagg COA OSC (author) from Rural Central Florida on September 07, 2012:

Thank you Robin!!! When I first started writing, I was trying to get away from ophthalmology, but since I started the apprenticeship, I've found that writing about the eye and educating patients is such a pleasure (it was my favorite part of the job too!).

Kitty Fields from Summerland on September 06, 2012:

Very well written and relates to my unit in school right now. We're learning all about Diabetes so I automatically recognized the diabetic retinopathy! Voted up and useful.

Robin Edmondson from San Francisco on September 06, 2012:

Your opthalmic Hubs are so incredibly informative. Thank you for providing everyone with such solid advice and information. ;)

Melissa Flagg COA OSC (author) from Rural Central Florida on September 04, 2012:

Thank you Kulsum Mehmood! Greatly appreciated!

Dr Kulsum Mehmood from Nagpur, India on September 03, 2012:

Thanks for sharing such useful info. Very useful and well written article on a fairly common ailment.

Melissa Flagg COA OSC (author) from Rural Central Florida on September 03, 2012:

@Julie Thank you! Very much appreciated! :D

Melissa Flagg COA OSC (author) from Rural Central Florida on September 03, 2012:

Thank you Pauline, I agree, too many diabetics don't take their illness seriously. If they were diligent about keeping their blood sugar under control, many of the complications of diabetes could be prevented. I think because there is no obvious immediate benefit, people don't think they need treatment, or that it doesn't matter if they don't keep their sugar in check. But in the case of diabetes, no news is good news, so to speak. My mom is a perfect example. She thinks because she feels fine, she doesn't need the medication. But she feels fine because the medication is doing its job!!

Blurter of Indiscretions from Clinton CT on September 03, 2012:

Though I don't have diabetes, I can appreciate the time and effort you took in writing this hub. Excellent job. Voting up!

Pauline Davenport from Isle of Man on September 03, 2012:

This really is so informative. so many ( sadly young) diabetics treat their condition in a very off hand way without thought for the consequences in later life. As well as near blindness, I have nursed people who have had double amputations because of gangrene. Not all, but most could have been prevented with proper care of themselves. I find it incredibly sad. This hub is a must read' for everyone with diabetes. Thanks for this Daughter of Maat

Melissa Flagg COA OSC (author) from Rural Central Florida on September 03, 2012:

Thank you jaydawg808! There was so much information to pack into one article! lol

jaydawg808 on September 03, 2012:

Wow! This is very informational! Thank you!

Melissa Flagg COA OSC (author) from Rural Central Florida on September 03, 2012:

Thank you manatita44! I'm glad you found it useful!

manatita44 from london on September 03, 2012:

A very informative article.