Diabetic retinopathy is a type of eye disease that can sometimes happen as a result of diabetes. High blood glucose levels from diabetes can harm the blood vessels in the retina. These blood vessels, located at the back of the eye, may leak or become swollen; they could also close and disrupt or stop blood flow to the retina. Occasionally, diabetic retinopathy can cause abnormal growth of extra blood vessels in the retina. In the earliest stages, the condition often has no symptoms, but as it progresses, patients may notice blurred vision, spots or floaters in their visual field, blockages or blank areas in their vision, and difficulty seeing colors. If left untreated, diabetic retinopathy leads to loss of vision. The condition normally affects both eyes. Patients with diabetes are encouraged to have annual eye health exams with an ophthalmologist to prevent diabetic retinopathy and related eye conditions. The treatment methods listed below may help in the management of diabetic retinopathy.
Vitrectomy is a surgery used to remove the vitreous, a type of fluid inside the eye. In patients with diabetic retinopathy, this procedure can be done to repair bleeding caused by the condition. It may also be performed to make it easier for surgeons to repair other problems with the retina. The procedure can be performed under a general anesthetic, and patients may also choose to have it done with local anesthesia instead. Patients may have the operation done at an outpatient facility, though some may prefer or need to have the procedure done in a hospital setting, and these patients often require one night of hospitalization following the surgery.
During the procedure, the surgeon will fill the eye with a special oil to replace the drained fluid. Some patients may also need to have a gas bubble injected into the eye during the surgery to keep the retina in its proper position. After surgery, the eye will be covered with a patch, and patients may need to hold their head in a particular way for a few hours or days following the procedure. Antibiotic eye drops are often recommended post-surgery, and patients typically need to use these for a few weeks.
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This treatment is a type of laser eye surgery used to seal blood vessels in the retina that are bleeding. Depending on the extent of a patient's condition, several types of the procedure can be performed. Focal photocoagulation is done when there is minor bleeding from just a few blood vessels in the retina. The procedure is usually an outpatient operation, and it does not require general anesthesia. Anesthetic eye drops are used to numb the eye before surgery instead. The eye is dilated with additional eye drops so the surgeon can see everything in detail. The surgeon will begin by identifying the bleeding vessels over a small area and seal these off one at a time with small burns from the laser. After the surgery, patients will need someone to drive them home. Their vision will be blurry for a few days, and there may also be eye pain or headaches during this time. This operation is typically done to help preserve existing vision and prevent additional vision loss in patients with diabetic retinopathy.
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Panretinal photocoagulation is another type of laser surgery similar to the procedure described above. It is done when diabetic retinopathy is more advanced, and can be used to treat a much larger area of the retina at one time. In particular, this procedure can help remove abnormal blood vessels that may be growing in the retina, and it can also slow the growth of these abnormal vessels. Also known as scatter photocoagulation, panretinal photocoagulation involves making hundreds of small holes with a laser to stop the overgrowth of blood vessels. Patients will likely need to have at least two treatment sessions for this particular operation. Recovery may take longer than with other types of this procedure.
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Improved Blood Sugar Control
Diabetic retinopathy often occurs in patients with diabetes who do not have their blood glucose levels well controlled. Since the condition results from high blood sugar, improved blood sugar control and taking steps to lower blood glucose can help prevent the disease and slow its progression. Doctors recommend following healthy lifestyle guidelines and taking medication to keep blood sugar under control. Adopting a diet high in fruits and vegetables and low in processed foods and fast food can help improve glucose readings. Exercise is recommended to help the body become more responsive to insulin.
Many diabetes patients will need to take medication to achieve adequate control over their sugar levels. Oral medications will generally be recommended first, and doctors may recommend taking a combination of these. Patients who cannot gain control of their glucose with oral tablets may be recommended a variety of non-insulin injections, which help the body use insulin more effectively and may also help with weight loss. Patients who don't respond to these medications will likely be placed on insulin injections in addition to their other injectable or oral medicines.
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Medicine Injection Into The Eye
For diabetic retinopathy patients who have abnormal blood vessels in the retina, a medicine injection into the eye can be beneficial. The most common medicine used for this particular treatment is anti-VEGF. Ranibizumab and aflibercept are two kinds of this medication, and most patients receive an injection of one of these each month. Before the injection, the patient's eye is numbed with anesthetic drops, and special clips are used to hold the eye open. The injection uses a very fine needle, and most patients do not experience any pain while it is given. If anti-VEGF injections do not work, doctors may use steroid injections instead. Having injections in the eye may help slow the progression of diabetic retinopathy and could lead to an improvement in vision.