Treatment - Diabetic retinopathy

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

It's offered if diabetic eye screening detects stage 3, proliferative retinopathy. It is also offered if you have symptoms caused by diabetic maculopathy.

At all stages, managing your diabetes is crucial.

Stages of diabetic retinopathy

Managing your diabetes

The most important part of your treatment is to keep your diabetes under control. This helps prevent development of 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) and /or abnormal new blood vessels at the back of the eyes in the advanced stages of diabetic retinopathy. New blood vessels tend to be very weak and often cause bleeding into the eye.

Treatment can help stabilise the changes in your eyes caused by your diabetes. It can stop your vision getting any worse, although it will not usually improve your sight.

It is very important that you attend these treatments.

Laser treatment involves shining a laser into your eyes. You'll be given a local anaesthetic to numb your eyes. The treatment is usually carried out as an outpatient. This means you will not need to stay in hospital overnight. It is not usually painful. But you may feel a sharp pricking sensation when certain areas of your eye are being treated.

Side effects

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

These can include:

• blurred vision – you will not be able to drive until this passes. You'll need to arrange for a friend or relative to drive you home or take public transport
• increased sensitivity to light. It might help to wear sunglasses until your eyes have adjusted
• aching or discomfort – over-the-counter painkillers, such as paracetamol, should help

Possible complications

You should be told about the risks of treatment in advance.

Potential complications include:

• reduced night or peripheral (side) vision - discuss this with your doctor
• bleeding into the eye or objects floating in your vision (floaters)
• being able to 'see' the pattern made by the laser on the back of your eye for a few months
• a small, but permanent, blind spot close to the centre of your vision

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

Eye injections

In some cases of diabetic maculopathy (leakage), injections of a medicine called anti-VEGF may be given into your eyes. This is to treat and prevent leakage (oedema) at the macula. This is the sensitive central part of our retina that we use most.

These can help stop the problems in your eyes getting worse. it will usually lead to an improvement in your vision.

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

The injections are usually given once a month, to begin with. Once your vision starts to stabilise, they'll be stopped or given less frequently.

Injections of steroid medication may sometimes be given. These are instead of anti-VEGF injections, or if the anti-VEGF injections do not help.

Risks and side effects

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's also a risk that the injections could cause blood clots to form. This could lead to a heart attack or stroke. This risk is small, but it should be discussed with you before you give your consent to treatment. let your doctor know if you have had a recent surgery, stroke or heart attack.

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 humour from the eye. This is the transparent, jelly-like substance that fills the space behind the lens of the eye.

The operation, known as vitrectomy, may be needed if:

• a large amount of blood has collected in your eye
• there's extensive scar tissue that's likely to cause, or has already caused, retinal detachment
• disturbance of the macula (the sensitive part of the retina responsible for fine vision)

During the procedure, the surgeon will make a small incision in your eye. They will then remove some of the vitreous humour and any scar tissue. The surgeon will use a laser to prevent further deterioration in your vision.

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

After the procedure

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 tire your eye.

You will probably have blurred vision after the operation. 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

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 further retinal surgery afterwards. Your surgeon will explain the risks to you.