Treatment - Diabetic retinopathy

Diabetic retinopathy only needs specific treatment when it reaches an advanced stage and there's a risk to your vision.

You will get treatment if diabetic retina screening shows proliferative retinopathy (stage 3).

It is also offered if you have symptoms caused by diabetic maculopathy.

You need to manage your diabetes at all stages of diabetic retinopathy.

Stages of diabetic retinopathy

Managing your diabetes

The most important part of your treatment is keeping your diabetes under control. This helps reduce your risk of getting diabetic retinopathy and preserves your vision.

Preventing diabetic retinopathy

Treatments for advanced diabetic retinopathy

For diabetic retinopathy that is affecting your sight, the main treatments are:

• laser treatment
• eye injections
• eye surgery

Laser treatment

Laser treatment is used to treat leakage (oedema) or abnormal new blood vessels at the back of the eye. These can form in the later stages of diabetic retinopathy. New blood vessels tend to be weak and can cause bleeding into the eye.

Laser treatment can help stabilise the changes in your eye caused by your diabetes. It can stop your vision getting any worse. But it will not usually improve your sight.

It is very important that you attend these treatments.

Laser treatment involves shining a laser into your eye. You'll be given a local anaesthetic to numb your eye. It is not usually painful. But you may feel a sharp pricking sensation when some parts of your eye are being treated.

The treatment is carried out as an outpatient. This means you will not need to stay in hospital overnight.

Side effects of laser treatment

After treatment, you may have side effects for a few hours.

These can include:

• blurred vision - you will not be able drive, so arrange a lift home or take public transport
• increased sensitivity to light - it might help to wear sunglasses until your eyes have adjusted
• aching or discomfort - painkillers you can get without a prescription should help

Possible complications of laser treatment

Your doctor or nurse will talk to you about the risks of laser treatment.

Complications may include:

• reduced night or peripheral (side) vision
• bleeding into the eye or objects floating in your vision (floaters)

Get medical advice if you notice that your sight gets worse after treatment.

Eye injections

If you have diabetic maculopathy (leakage), you may get medicine injected into your eye. The medicine, called anti-VEGF, treats and prevents leakage at the macula. This is the sensitive central part of our retina that we use most.

These injections can help stop the problems in your eye getting worse. It usually leads to an improvement in your vision.

During treatment, the skin around your eye will be cleaned and covered with a sheet. Small clips will be used to keep your eye open. You'll be given local anaesthetic drops to numb your eye. A very fine needle is guided into your eyeball. The procedure usually takes less than 5 minutes.

The injections are usually given once a month at the start. When your vision starts to stabilise, they'll be given less frequently or stopped.

You may get steroid injections. These are instead of anti-VEGF injections, or if the anti-VEGF injections do not help.

Risks and side effects of eye injections

Your doctor or nurse will talk to you about the risks of complications before you have anti-VEGF injections.

Possible risks and side effects of anti-VEGF injections include:

• eye irritation or discomfort
• bleeding inside the eye
• floaters or a feeling of having something in your eye
• watery or dry, itchy eyes

There are a small risk of:

• blood clots - these could lead to a heart attack or stroke, let your doctor know if you have had a recent surgery, stroke or heart attack
• an infection developing inside the eye which would need to be treated with injections of antibiotics

The main risk with steroid injections is increased pressure inside the eye and development of early cataracts.

Eye surgery

Surgery may be carried out to remove some of the vitreous jelly from the eye. The jelly is the transparent substance that fills the space behind the lens of the eye.

The operation, called a vitrectomy, may be needed if:

• a large amount of blood has collected in your eye
• there is a lot of scar tissue that can cause retinal detachment
• there is disturbance of the macula (the sensitive part of the retina responsible for fine vision)

During the procedure, the surgeon will make a small cut in your eye. They will then remove some of the jelly and any scar tissue. The surgeon will use a laser to prevent your vision getting worse.

Vitrectomy is usually carried out under local anaesthetic and sedation. This means you will not have any pain or awareness of the surgery being performed.

After eye surgery

You should be able to go home on the same day or the day after your surgery.

For the first few days, you may need to wear a patch over your eye. This is because activities such as reading and watching television can make your eyes tired.

You will probably have blurred vision after the surgery. This should improve gradually. It may take several months for your vision to return to normal.

Your surgeon will tell you about any activities you should avoid during your recovery.

Risks and side effects of eye surgery

Possible risks of vitrectomy include:

• developing a cataract
• further bleeding into the eye
• retinal detachment
• fluid build-up in the cornea (the outer layer at the front of the eye)
• infection in the eye

There's also a chance that you will need more surgery. Your surgeon will explain the risks to you.