Diabetic eye disease comprises a group of eye conditions that affect people with diabetes. These conditions include: diabetic retinopathy, diabetic macular edema (DME), cataract and glaucoma.
All forms of diabetic eye disease have the potential to cause severe vision loss and blindness. However, early detection, timely treatment and appropriate follow-up care of diabetic eye disease can protect against vision loss.
The first step in any treatment for diabetic eye disease is to maintain blood glucose, blood pressure, and blood cholesterol levels as close to normal as possible.
Treatment of diabetic macular edema (swelling or the accumulation of blood and fluids in the macula, the part of the retina that provides sharp central vision), has evolved a great deal in the last five to ten years, and is based on the severity of the edema. At present, there are three options:-
This technique is used by retinal surgeons to treat a number of eye conditions, one of which is diabetic eye disease. A beam of high-intensity light is directed into the eye to seal off leaking blood vessels and prevent additional blood and fluid from leaking into the vitreous, which is the jelly-like substance that fills the inside of the back part of the eye. The doctor administers eye drops to dilate (open up) the pupil and numb the eye before treatment begins.
Because lasers cannot restore lost vision, it is critical to maintain regular eye examinations so that treatment can be initiated as soon as diabetic eye changes are detected. There are two types of laser treatments for diabetic eye disease:
- Focal laser treatment – also called photocoagulation; whereby the retina is treated to stop or slow the leakage of blood and fluid from abnormal blood vessels within the eye. Focal laser, however, can also destroy surrounding healthy retinal tissue as it seals the leakage from abnormal blood vessel growth; therefore, it is not used on blood vessels directly under the macula, the centre of the retina.
- Scatter laser treatment, also called panretinal photocoagulation, is used to treat the area of the retina away from the macula to shrink abnormal blood vessels.
During the treatment, the eye doctor will use a precise laser beam to directly seal the leaking blood vessels in the back of the eye, very close to the central vision. In time, the macular edema, or thickened retina, decreases, and this may result in improved vision.
After surgery, it is normal for one’s vision to be blurry for a few weeks, so do not worry. Some patients may also notice tiny spots in the vision, which are caused by the laser. These small spots tend to become less bothersome with time. Remember that diabetes continues to affect eyesight, and can lead to blindness if left untreated.
In diabetic eye disease, abnormal blood vessels develop that can break, bleed and leak fluid. If left untreated, these damaged blood vessels can result in a rapid and severe loss of vision. The most effective treatments to date for this blood vessel damage are anti-angiogenic drugs.
At present, the drugs are administered by injection directly into the eye after the surface has been numbed. The needle is very small and is inserted near the corner of the eye – not the center. During the injection procedure, the doctor will ask the patient to look in the opposite direction to expose the injection site, which also allows the patient to avoid seeing the needle.
An intravitreal injection is an injection of a medication into the vitreous, – the jelly like structure that fills the middle of the eye. Eye care professionals often recommend administering medications directly into the vitreous, as it allows the medication to be placed much closer to where the disease is occurring, while decreasing the risk of side effects.
If left untreated these diseases can lead to severe vision loss, that can significantly impact a patient’s quality of life. Intravitreal injections are typically performed in an eye care professional’s office. Once the eyes are dilated and examined, the actual procedure only takes about fifteen minutes.
Before the actual injection, drops are administered to numb the eye and help prevent infection. Next, a small syringe is used to inject the medication directly into the vitreous cavity. Patients may feel slight pressure on the eye when this is done, but they should not experience pain.
After the procedure, the doctor will check the eye and place some eyedrops in the eye, to help prevent infection. Some patients may notice the appearance of floaters after the procedure, but these usually disappear after several days. Although intravitreal injections are able to maintain visual acuity in most patients and improve vision in a significant number of patients, injections must be administered as frequently as every month to attain the best results.
These drugs are powerful. The abnormal vessels will disappear within 24 to 48 hours; however, the vessels are not gone forever. They will come back, since the effect of the drug will wear off.
Steroids are very good at treating the swelling caused by diabetic macular edema. As with the anti-angiogenic drugs, the steroid is injected into the vitreous, the jelly-like substance that fills the inside of the back part of the eye. Click on the following links to discover our treatment options for: retinal detachments, cataracts, glaucoma and diabetic retinopathy.
Controlling diabetes by taking medications as prescribed, staying physically active and maintaining a healthy diet can prevent or delay vision loss.
Because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year.
Steroids are powerful drugs that can reduce retinal edema dramatically; however, they also have side effects that can be significant. The use of steroids to treat eye disease is associated with the development of glaucoma and cataracts in some patients. Nevertheless, steroid treatment can be a useful tool especially when combined with laser and other treatments to control difficult cases of diabetic macular edema.
It is important to see your eye care professional regularly. With early detection, and modern treatment options, the threat of vision loss from Diabetic Macular Edema is far less than ever before.
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Exeter Eye is a specialist ophthalmic eye clinic treating all eye conditions and offering the very best in patient care and comfort. We always ensure we fully understand your condition and lifestyle before identifying your treatment options and then help you choose the best one for you.