What Treatments Are Available for Diabetic Eye Disease?
By Lori Coors, M.D.,
Edited by Sefy Paulose, M.D., March 2022
Importance of Controlling Your Diabetes
The best way to treat your diabetic retinopathy is to control your diabetes and to follow up with your scheduled eye exams. If you have mild or moderate non-proliferative diabetic retinopathy, you may not need any medical treatment. However, you may be encouraged to keep good blood sugar control. You can assess your control of your diabetes by monitoring your Hemoglobin A1C, a lab that is sent by your diabetes doctor. It is recommended that this number stays below 7%. Ensure you follow up with your primary care provider or endocrinologist regularly to improve your diabetes management.
If you have severe non-proliferative diabetic retinopathy, macular edema and/or proliferative diabetic retinopathy, your doctor may treat you with an injection of anti-VEGF medicine. Vascular endothelial growth factor (VEGF), is a protein produced by damaged retina that causes the production of abnormal blood vessels. However, these blood vessels damage your eye more by causing worsening swelling, bleeding and can cause scars that can pull on your retina and cause a retinal detachment. Anti-VEGF medicine blocks VEGF which prevents the growth of new blood vessels in the eye. Although the main role of anti-VEGF injections is to prevent your vision from getting worse, this medication can sometimes improve your vision. There are three types of anti-VEGF medications that your ophthalmologist may give you – Avastin, Lucentis and Eylea.
At present, Avastin, Lucentis, and Eylea are administered by injection directly into the eye after the surface has been numbed. The needle is very small and is inserted near the corner of the eye – not the center. During the injection procedure, the doctor will ask the patient to look in the opposite direction to expose the injection site, which also allows the patient to avoid seeing the needle. These medications are powerful however, the vessels are not gone forever. As the effect of the drug will wear off in about 4 weeks, these vessels may come back depending on the severity of the retinopathy
Based off of your imaging, your doctor may also recommend laser treatment. The purpose of the laser is to slow down the leakage of fluid and blood in the eye. There are two main types of laser treatment:
- Photocoagulation or focal laser treatment: This laser treatment targets an area of your retina that is leaking fluid or blood into your eye. This treatment burns the abnormal leaking blood vessels to prevent further vision loss. This treatment is usually done in one or a few sessions.
- Panretinal photocoagulation or scatter laser treatment: This treatment lasers the ischemic retina that is causing the release of VEGF. The burning from the laser treatment causes the abnormal new blood vessels to shrink and scar away. For this treatment, your doctor may ask that this treatment be done in a course of two or more session.
If there is still concern for worsening diabetic retinopathy, your doctor may suggest a surgical treatment. One of these procedures is a Vitrectomy. This procedure uses a small cut in your eye to remove the vitreous, or the transparent gel that fills the interior of the eye. This helps remove any blood that is in the middle section of your eye and also removes scar tissues that may be tugging on your retina in order to prevent a retinal detachment, or separation of the retina from the underlying supportive tissues.