Diabetic retinopathy is a complication of diabetes characterized by a weakening of blood vessels in the retina so that they leak, causing the retina to swell, bleed, and become deprived of oxygen and nutrients, ultimately leading to vision loss. By working together with patients and their primary care physicians, the eye doctors at D’Ambrosio Eye Care can help to slow or even prevent vision loss from diabetic eye problems and diabetic retinopathy. While there is no cure for diabetic retinopathy, annual dilated eye exams for patients with diabetes are essential for early detection, diagnosis and treatment of diabetic retinopathy. Recent data from the Centers for Disease Control and Prevention shows that diabetes affects approximately 26 million people in the United States with almost 10 million people ages 40 and older suffering from diabetic retinopathy, and that diabetes is now the leading cause of new blindness in adults 20-74 years of age.
Stages of Diabetic Retinopathy
Diabetic Retinopathy occurs and progresses in stages.
Mild Nonproliferative Retinopathy is the earliest stage of diabetic retinopathy and is characterized by the presence of “dot” and “blot” hemorrhages and “microaneurysms” in the retina. Mild Nonproliferative Retinopathy can be present without any change in your vision and usually does not require treatment unless it progresses or is accompanied by Diabetic Macular Edema.
Moderate Nonproliferative Retinopathy is the second and slightly more severe stage of diabetic retinopathy in which some of the small blood vessels in the retina may become blocked causing a decrease in the supply of nutrients and oxygen to certain areas of the retina.
Severe Nonproliferative Retinopathy is the third stage of diabetic retinopathy and is characterized by a significant number of small blood vessels in the retina becoming blocked resulting in more areas of being deprived of nourishment and oxygen-called retinal ischemia.
Proliferative Retinopathy is the next stage of diabetic retinopathy that carries a significant risk of vision loss. The retina responds to a lack of oxygen, or ischemia, by growing new, but abnormal blood vessels, a process called neovascularization. When retinal neovascularization is present, you have progressed into Proliferative Retinopathy. Retinal neovascularization involves new blood vessels that are extremely fragile and tend to break easily and bleed into the Vitreous. It may be possible for patients to have Proliferative Retinopathy and Retinal Neovascularization and yet still have good vision. Even if Proliferative Retinopathy and Retinal Neovascularization do not appear to be causing any vision loss, it is critical that you be treated as quickly as possible in order to stop the progression and preserve vision.
Diabetic Macular Edema
Diabetic macular edema is a common cause of vision loss from diabetes. One of the early effects of diabetes is to cause the blood vessels in the retina to begin to leak by weakening the inner lining of the blood vessels so that they become porous. Leakage from the retinal blood vessels may cause the center of the retina, the Macula, to actually swell, a condition called Diabetic Macular Edema (DME). DME can occur in any stage of diabetic retinopathy and can vary quite a bit in its severity and its effect on vision. By using Optical Coherence Tomography (OCT) we can detect very slight thickness changes in the macula that may indicate the presence of leakage. It is important that leaking blood vessels be found as early as possible so that they can be most effectively treated. In most cases, early intravitreal injections of Vascular Endothelial Growth (VEGF) Inhibitor like Eylea® (Aflibercept), Avastin® (Bevacizumab), VABYSMO® (Faricimab) or Lucentis® (Ranibizumab), or steroid implants Ozurdex® (Dexamethasone) or Iluvien® (Fluocinolone Acetonide) will reduce the swelling and prevent further vision loss, but may not restore vision that has already been compromised.
Treatment of Diabetic Retinopathy
Depending on the stage of diabetic retinopathy, the potential for and the amount of vision loss, it is possible to treat, stabilize and often reverse the effects of the disease. Treatment of diabetic retinopathy can entail the use retinal laser photocoagulation treatment as well as intravitreal injections of Vascular Endothelial Growth Factor (VEGF) Inhibitor drugs or other drugs. However, successful management of diabetic eye problems requires early diagnosis and treatment.
Nonproliferative Retinopathy Treatment
During the early stages of Mild Nonproliferative Retinopathy, Moderate Nonproliferative Retinopathy and the beginning of Severe Nonproliferative Retinopathy, it is not likely that you will need Laser Treatment, unless you have Diabetic Macular Edema.
Diabetic Macular Edema, Laser Treatment & Retina Injections
Diabetic Macular Edema was traditionally treated with Retinal Laser Photocoagulation procedures to close leaking microaneurysms or treat a more diffuse swelling in the Macula. Laser treatment of Diabetic Macular Edema works to stabilize vision. In fact, laser treatment may reduce the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it may be improved. It is important to restate that this treatment is performed to keep vision from further declining, but does not usually result in improvement in vision already lost.
For most patients, Vascular Endothelial Growth (VEGF) Inhibitor Injections like Eylea® (Aflibercept), Avastin® (Bevacizumab), VABYSMO® (Faricimab) or Lucentis® (Ranibizumab), or steroid implants Ozurdex® (Dexamethasone) or Iluvien® (Fluocinolone Acetonide), which are less destructive and safer than laser treatments, are considered as primary therapy for the management of vision-threatening complications of diabetic retinopathy such as Diabetic Macular Edema (DME).
Proliferative Retinopathy, Laser Treatment & Retina Injections
Proliferative Retinopathy is treated with a Retinal Laser Photocoagulation procedure called “Scatter Laser Treatment”. The goal of Scatter Laser Treatment is to shrink abnormal blood vessels. Our Retina Specialists will place approximately 1,000 to 2,000 laser spots in areas of the retina away from the macula, causing the abnormal blood vessels to shrink.
To complete this laser treatment, your pupils will be dilated so our retina specialist will be able to see the areas needing treatment. Since Scatter Laser Treatment requires a large number of laser spots, it is often necessary to use two or more sessions to complete the laser treatment. Sometimes patients who have had Scatter Laser Photocoagulation will experience some loss of their side or peripheral vision, some loss of night vision and a decrease in color vision. However, Scatter Laser Treatment is necessary to preserve the rest of your vision and stop the progression of the disease.
It is likely that our Retina Specialist will also use Anti-Vascular Endothelial Growth Factor (VEGF) treatment-such as Eylea® (Aflibercept), Avastin® (Bevacizumab), VABYSMO® (Faricimab) or Lucentis® (Ranibizumab) as these retina injections when used in combination with laser treatment or even alone may be the preferred treatment in your individual case.
When diabetic laser treatment and intravitreal injection are unsuccessful in stopping the progression of the proliferative retinopathy and when a vitreous hemorrhage occurs and does not clear on its own, or when a retinal detachment develops, then a Vitrectomy is often helpful.
A Vitrectomy involves a Retina Specialist & Vitreoretinal Surgeon inserting instruments into the eye, and removing the vitreous gel, any blood present in the vitreous cavity, and removing the scar tissue that has grown on the surface of the retina.