There are two main categories of diabetic retinopathy: nonproliferative diabetic retinopathy and proliferative retinopathy. Treatment depends primarily upon the type and severity of the retinopathy. The most important aspect of treatment, however, is prevention. By regularly monitoring blood sugar, and maintaining a healthy program of diet and exercise, you can significantly reduce your chances of developing retinopathy.
The milder of the two forms of diabetic retinopathy is nonproliferative retinopathy. NPDR is characterized by the presence of microaneurysms, hemorrhage, exudate, and/or fluid in the retina. At its earliest detection, NPDR may not require any treatment, but in more severe stages of NPDR, treatment such as intravitreal injections and/or laser may be necessary to stabilize or to reverse some of these diabetic changes in the retina.
Patients who have had diabetes for a long time or patients that have poor blood glucose control have a higher likelihood of developing diabetic retinopathy. In its earliest forms, diabetic retinopathy does not typically impact a patient’s vision so it is imperative to be examined annually by a diabetic eye specialist to detect diabetic retinopathy.
PDR is the more advanced form of diabetic retinopathy and can have devastating visual consequences if undiagnosed or untreated. PDR is characterized by the growth of abnormal blood vessels in the context of longstanding or uncontrolled diabetes mellitus. Typically, these abnormal blood vessels arise due to underlying ischemia (poor blood flow) due to diabetes, and they can grow unchecked in the retina, on the optic nerve, into the vitreous, or on the iris. Because these blood vessels are intrinsically abnormal, they tend to bleed and/or result in scar tissue formation within the eye, leading to devastating visual sequelae such as vitreous hemorrhage, tractional retinal detachment, and neovascular glaucoma.
Two main classes of medications can be used to treat diabetic eye disease — Anti-VEGF (Vascular Endothelial Growth Factor) agents and steroids
This in-office procedure utilizes local anesthesia to deliver potent medications into the vitreous cavity to arrest or reverse underlying diabetic retinopathy.
Laser surgery for diabetic retinopathy is performed by directing a beam of light into the eye to treat the damaged parts of the retina. In cases of background diabetic retinopathy with macular edema, the laser is used to seal off leaking blood vessels and to stimulate the eye to reabsorb the fluid. When abnormal blood vessel growth is present, as in proliferative diabetic retinopathy, laser is used to decrease and prevent blood vessel growth. Laser surgery is often performed in the office and usually only requires topical or local anesthesia. Multiple laser treatments are often necessary.
Vitrectomy is typically required for more advanced forms of proliferative diabetic retinopathy, which may involve vitreous hemorrhage and/or tractional retinal detachment. In cases such as these, surgery may be recommended to remove the vitreous gel in order to better visualize and possibly treat abnormal blood vessels in the retina. It may also be necessary to access and release scar tissue on the surface of the retina.
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