Treatment Options for Diabetic Retinopathy
By - Suber S. Huang, M.D., M.B.A. Chair, Diabetic Eye Disease Subcommittee
National Eye Health Education Program, National Eye Institute

Can diabetic retinopathy be treated?
How is diabetic retinopathy treated?
How is a macular edema treated?
What happens during laser treatment?
What is a vitrectomy?
Are scatter laser treatment and vitrectomy effective in treating proliferative retinopathy?

Can diabetic retinopathy be treated?
Yes. Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost, which is why finding diabetic retinopathy early is the best way to prevent vision loss.

How is diabetic retinopathy treated?
During the early stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. To prevent progression of the disease, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.

Proliferative retinopathy, the advanced stage of retinopathy, is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision.

How is a macular edema treated?
Macular edema is treated with laser surgery or by injection therapy. One procedure is called focal laser treatment. Your doctor places up to small laser burns in the areas of retinal leakage involving the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed.

A patient may need focal laser surgery more than once to control the leaking fluid. If you have macular edema in both eyes and need laser surgery, generally only one eye will be treated at a time, usually several weeks apart.

One of the latest advancements in treatment for macular edema is injection therapy. This involves injections of medication inside the eye. In April 2010, a study funded by the National Eye Institute of the National Institutes of Health demonstrated the safety and effectiveness of a new medication to treat diabetic macular edema. Ranibizumab, also called Lucentis, is injected into the eye by a very fine needle. This painless office procedure is usually repeated at 4 to 6 week intervals until the leakage in the retina disappears. The procedure takes less than a minute and there are usually no restrictions on your activity following the injection other than keeping the eye clean. Antibiotic drops may be prescribed for a few days. A retina specialist usually performs this treatment and performs tests to see if the eye has responded to treatment.

What happens during laser treatment?
Both focal and scatter laser treatment are performed in your doctor’s office or eye clinic. Before the surgery, your doctor will dilate your pupil and apply drops to numb the eye. The area behind your eye also may be numbed to prevent discomfort.

The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of light. These flashes eventually may create a stinging sensation that can be uncomfortable. You will need someone to drive you home after surgery. Because your pupil will remain dilated for a few hours, you should bring a pair of sunglasses.  For the rest of the day, your vision will probably be a little blurry. If your eye hurts, your doctor can suggest treatment.

Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.

What is a vitrectomy?
If you have a lot of blood in the center of the eye (vitreous gel), you may need a vitrectomy to restore your sight. If you need vitrectomies in both eyes, they are usually done several weeks apart.

A vitrectomy is performed under either local or general anesthesia. Your doctor makes a tiny incision in your eye. Next, a small instrument is used to remove the vitreous gel that is clouded with blood. The vitreous gel is replaced with a salt solution. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original vitreous gel.

You will probably be able to return home after the vitrectomy. Some people stay in the hospital overnight. Your eye will be red and sensitive. You will need to wear an eye patch for a few days or weeks to protect your eye. You also will need to use medicated eye drops to protect against infection.

Are scatter laser treatment and vitrectomy effective in treating proliferative retinopathy?
Yes. Both treatments are very effective in reducing vision loss. People with proliferative retinopathy have less than a five percent chance of becoming blind within five years when they get timely and appropriate treatment. Although both treatments have high success rates, they do not cure diabetic retinopathy.

Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment more than once to protect your sight.