When you have diabetes, your body does not use or store sugar properly, causing changes in the vessels that carry blood throughout your body, including your eyes. These blood vessel changes can damage your eye’s retina, harming your vision. This eye disease is called diabetic retinopathy.
An ophthalmologist may treat your diabetic eye disease with a combination of medication injections and laser surgery. These treatments can help slow the progression of diabetic eye disease and may save the remaining sight.
To understand how diabetic eye disease affects your vision, let’s look at how the eye works. Light rays enter the eye through the cornea, pupil, and lens and are focused on the retina, the light-sensitive tissue lining the back of the eye.
The retina has two areas: the peripheral retina, which gives us our side or wide-angle vision, and the macula, the small area at the center of the retina, gives us our pinpoint vision allowing us to see detail clearly.
Diabetic Macular Edema
With diabetic retinopathy, damaged blood vessels in the retina leak fluids and blood. When this fluid leaks, it can cause the macula to swell or thicken. This swelling is called diabetic macular edema or DME.
Diabetic macular edema is the most common cause of vision loss for people with diabetes. Because the macula is responsible for our central or pinpoint vision, macular edema will affect your ability to see clearly. Your ophthalmologist will treat your macular edema with a medication injection called anti-vascular endothelial growth factor or anti-VEGF.
This medication helps reduce the macula’s swelling, which helps to slow vision loss or even improve your vision. Your ophthalmologist will determine how many injections you need overtime to prepare for your medication injection.
Your ophthalmologist will clean your eye to prevent infection and numb your eye with anesthesia to reduce discomfort during the injection. Your pupils may be dilated or widened with dilating eye drops.
The anti-VEGF medication is injected into the vitreous or jelly-like substance in the center of the eye. You may feel pressure in your eye when the medication is injected. Your ophthalmologist will also perform laser surgery to help reduce swelling of the macula. An anesthetic is used to numb your eye, and a special contact lens is placed on your eye to help keep the eye from moving to help focus the laser.
It is important to keep your eyes as still as possible during the treatment. The procedure takes about 15 minutes with focal laser treatment.
For macular edema, the laser is aimed at specific areas on the retina to seal off leaking blood vessels. The laser is not focused directly on the macula’s center since this would affect your central vision. The goal is to reduce the macula’s blood vessel leakage to reduce swelling and slow vision loss. Your ophthalmologist may recommend several laser treatments to get the best results.
It is essential to keep in mind that people who have developed blurred vision from macular edema might not recover their full normal vision after laser surgery. As with any medication or procedure, there are risks of side effects and complications. With anti-VEGF treatment and with laser surgery, potential side effects may include:
- Eye pain
- Bloodshot eye
- Floaters (small specks in your vision)
- Inflammation (swelling) of the eye
- Retinal detachment (when the retina pulls away from the back of the eye)
- Cataract (clouding of the lens of the eye)
- Damage to the retina, cornea, or lens
- Eye infection
- Vision loss
Although it is rare, it is possible for some people using anti-VEGF medications to have a stroke, hemorrhage, or heart attack. Tell your ophthalmologist if you have had a heart attack or stroke in the last few months.
Risks and complications associated with focal laser treatment may include:
- Blind spots in your vision
- Abnormal blood vessel growth
- Ongoing or increasing vision loss
- Need for more laser surgery, eye surgery, or medication
Any or all these complications may decrease your vision or possibly even cause blindness. Additional procedures may be needed to treat these complications. Other forms of treatment may be available.
For a case of macular edema, these options could include other types of anti-VEGF medication, steroids, or just laser surgery without medication injection. Your ophthalmologist can explain why they chose medication injections and focal laser surgery for your particular treatment course. You do not have to be treated for your diabetic retinopathy; however, diabetic eye disease will likely lead to severe vision loss without treatment.
Anti-VEGF therapy – reducing the risk of vision loss and diabetic retinopathy severity
The primary goal of treating diabetic eye disease is to prevent further vision loss. Treatment does not cure diabetic retinopathy, but it is often effective in helping you keep your sight. Be sure to keep all appointments with your ophthalmologist or retinal specialist after treatments. Also, if you have any changes in your vision, you should call your ophthalmologist right away. Monitoring your vision is a vital step toward the goal of preserving your sight.
Pharmacological or laser or surgical treatment should be tailored for every patient with diabetes, depending on their eye condition. Anti-VEGF therapy is now the mainstay and almost standard of care for most patients with diabetes. In fact, the FDA recently approved the use of anti-VEGF medications for all forms of diabetic retinopathy.
There are many treatment options for patients with diabetic eye disease. It is best to treat these patients before they have significant symptoms and prevent the need for more aggressive therapies. Multiple studies have shown the benefit in patients not only to reduce their risk of vision loss but also to reduce diabetic retinopathy severity.
It used to be the standard of care could never really reverse the severity of diabetic retinopathy. All that could be done was to treat the causes of vision loss. Now, eye doctors can not only treat the causes of vision loss but reverse the degree of severity, making it less likely patients will need further treatment.