Diabetic Retinopathy
People with diabetes are unfortunately at a higher risk for numerous ocular complications, which can lead to severe vision loss and sometimes even blindness. One of those eye diseases is diabetic retinopathy, the leading cause of blindness among Americans.
Diabetic retinopathy is an eye disease that damages the blood vessels in the retina. While what exactly causes this damage is not known, poorly controlled blood sugar levels are believed to be a contributing factor. Although diabetic retinopathy can affect persons with Type I or Type II diabetes, persons with Type I diabetes are at a greater risk of developing the disease. Over time, the risk of developing diabetic retinopathy increases.
Types of Diabetic Retinopathy
There are two main categories of diabetic retinopathy:
Non-proliferative: The small blood vessels in the retina become damaged and can leak fluid into the retinal tissue. This is called macular edema, which is swelling of the retina in the area that serves central vision. Symptoms of macula edema include blurry vision and loss of portions of the field of vision.
Proliferative: Newly formed abnormal blood vessels develop along the surface of the retina and are very fragile. Their fragility can cause them to bleed, which can cause severe vision loss and even blindness.
As these vessels proliferate, bleed and subsequently scar, they can detach the retina. These forms of retinal detachment pose unique challenges for the retinal surgeon.
Another complication is the obstruction of the outflow path for fluid that is constantly being produced in the eye by newly formed blood vessels. This can lead to dangerously high pressures in the eye and is called neovascular glaucoma.
Treatment
Systemic Approach to Treat Diabetic Retinopathy
The best treatment for diabetic retinopathy is prevention. Keeping blood sugar levels and blood pressure under control can slow the development or progression of the disease. In most cases, additional ocular treatment is necessary when more advanced complications present, such as macular edema or new blood vessel growth.
Anti-Vasogenic Treatment
Anti-vasogenic injections of the medications Lucentis, Avastin, or Eylea have become the mainstay in controlling retinal edema and have become important adjuncts in treating complications of retinal neovascularization. These drugs stop abnormal blood vessel growth and leakage.
Numerous clinical trials have demonstrated their safety and effectiveness as a treatment for diabetic retinopathy, particularly diabetic macular edema. Treatment consists of fairly regular injections in the first year. Once the retinal situation stabilizes, less frequent injections are necessary. Often, laser treatment will be used to augment and prolong the effect of antivasogenic injections for diabetic macular edema. For proliferative diabetic retinopathy complicated by vitreous hemorrhages, retinal detachment or neovascular glaucoma, laser treatment cannot be replaced by anti-vasogenic treatment, but is rarely done without it now.
Preparation for the injection includes anesthetic and disinfecting eyedrops, placement of a lid speculum to hold the lids open during the injection, and injection of a tiny amount of the medication on the white part of the eye. This is usually minimally uncomfortable, and the actual injection only takes a few seconds. Usually, patients will resume their normal activities the same day.
Laser Surgery
Once diabetic retinopathy is complicated by macular edema or formation of new blood vessels, laser eye surgery for diabetic retinopathy is commonly performed. Lasers have been used to treat diabetic retinopathy for more than 30 years. Treatment is performed in an office setting. During the procedure, green, yellow, red, or infrared laser light is delivered to the retina through the dilated pupil. Typically, a contact lens is placed on the eye, through which the light is transmitted. Topical anesthetic drops are applied for comfort. A local anesthetic may be administered if an extensive amount of laser is needed, or if the patient is very sensitive. Laser surgery is generally used to treat diabetic macular edema and proliferative diabetic retinopathy.
Laser Treatment for Diabetic Macular Edema
The goal of using lasers to treat diabetic macular edema is to stabilize vision by trying to stop damaged blood vessels from leaking fluid into the retina. Compared to those not treated, this can help preserve vision longer. Focal and grid laser surgery are used to treat diabetic macular edema. Focal treatment is effective when there are small areas of leakage. If there are wider areas of leakage, grid laser surgery may be performed, meaning laser spots are transmitted in a grid pattern over the swollen areas of the retina.
At Vitreous Retina Macula Consultants of New York, one of our ophthalmologists and retina specialists will meet with you during your consultation to assess your situation. We will explain each treatment option’s pros and cons and suggest which diabetic retinopathy treatment in New York is right for you. VRMNY specializes in treating all medical and surgical retinal conditions, emphasizing diabetic retinopathy, the leading cause of retinal vision loss. Request an appointment online or call the internationally-renowned retina specialists and best-rated Diabetic Retinopathy Doctors at (212) 861-9797 to schedule your private consultation.
Vitreous Retina Macula Consultants of New York
110 Lafayette St, Suite 502
New York, NY 10013
Tel.: 212-234-3367
Tel.: 212-861-9797
Fax.: 212-628-0698
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