Diabetic Retinopathy

What is Diabetic REtinopathy?
Patients with diabetes may develop diabetic retinopathy, an eye disease that occurs when high blood sugar levels damage the blood vessels in the retina. These blood vessels can swell, leak, close, or new abnormal blood vessels may grow. Diabetic retinopathy is the most common reason for vision loss for people with diabetes.
There are two stages of Diabetic Retinopathy: Non-Proliferative and Proliferative.

Non-Proliferative Diabetic Retinopathy (NPDR)
NPDR is the early stage of diabetic retinopathy. With NPDR, high blood sugar levels can cause blood vessels in the retina to leak, causing the retina to swell. This swelling can then cause the macula, the center of the retina, to swell or thicken. When the macula swells or thickens, this is known as macular edema. Since the macula is responsible for allowing you to clearly see details of objects in front of you, macular edema will affect your ability to see clearly.
With NPDR, blood vessels in the retina can also become blocked. When this occurs, blood cannot reach the macula. NPDR can progress from mild to severe, as more blood vessels are damaged.

Proliferative Diabetic Retinopathy (PDR):
PDR is the advanced stage of diabetic retinopathy. This is when damaged blood vessels become blocked, causing the growth of new, abnormal blood vessels in the retina. These new blood vessels can also leak into the clear, jelly-like substance that fills the center of your eyeball (vitreous).
Eventually, scar tissue stimulated by the growth of new blood vessels may cause the retina to detach from the back of your eye.
PDR is very serious and can affect your central and peripheral (side) vision.

Who is at Risk for Diabetic Retinopathy?

Anyone who has diabetes can develop diabetic retinopathy. The following factors may increase your risk of developing diabetic retinopathy:
• Duration of diabetes — the longer you have diabetes, the greater your risk of developing diabetic retinopathy
• Poor control of your blood sugar level
• High blood pressure
• High cholesterol
• Pregnancy
• Smoking cigarettes

Treatment and Prognosis

Non-Proliferative Diabetic Retinopathy (NPDR)
If you have mild or moderate nonproliferative diabetic retinopathy, you may not need treatment right away. However, your physician will closely monitor your eyes to determine when you might need treatment.
We recommend that you work with your endocrinologist (diabetes doctor) to determine if there are ways to improve your diabetes management. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the progression.

Proliferative Diabetic Retinopathy (PDR)

Laser Treatment
          • Focal laser treatment can stop or slow the leakage of blood and fluid in the eye. During the procedure, leaks from abnormal blood vessels are treated with laser burns. Focal laser treatment is usually done in our office in a single session. If you had blurred vision from macular edema, the treatment might not return your vision to normal, but it's likely to reduce the chance the macular edema may worsen.
          • Scatter laser treatment (commonly called PRP laser) can shrink the abnormal blood vessels. During the procedure, the blood vessels are treated with scattered laser burns. The burns cause the abnormal new blood vessels to shrink and scar.This treatment is usually done in our office in two or more sessions. Your vision will be blurry for about a day after the procedure. Some loss of peripheral (side) vision or night vision after the procedure is possible.

Anti-VEGF Treatment
          VEGF, also known as Vascular Endothelial Growth Factor, is a molecule that causes the growth of leaky blood vessels in patients with PDR. Anti-VEGF medications help stop the growth of new blood vessels. These medications include:
                    • Bevacizumab (Avastin)
                    • Ranibizumab (Lucentis)
                     • Aflibercept (Eylea)
Our retina specialists will inject these medications into the affected eye. You may need injections every four weeks to maintain the beneficial effect of the medication. In some instances, patients may partially recover vision as the blood vessels shrink and the fluid under the macula is absorbed.

This procedure uses a tiny incision in your eye to remove blood from the middle of the eye (vitreous) as well as scar tissue that's tugging on the retina. This is done in a surgery center or hospital using local or general anesthesia.