Early-stage retinopathy may not need to be treated, but more advanced retinopathy may require laser treatment or injections of medicine into the eye.
While early-stage (background) retinopathy may not need any immediate treatment, you should have your eyes examined every year by an ophthalmologist to monitor the progress of your retinopathy. An ophthalmologist is a specialist in identifying and treating eye conditions.
If stage two (pre-proliferative) retinopathy is detected during screening, you will be referred for a more detailed assessment of your condition.
You may not need any immediate treatment, but you will need to have regular eye examinations (once or twice a year) so the condition can be closely monitored. You may also be given advice about how to control your diabetes more effectively.
Laser treatment may be recommended in more advanced stages of retinopathy if there is a considerable amount of bleeding from the blood vessels in your eye. Alternatively, a new treatment for retinopathy – intravitreal anti-VEGF injections – may be recommended (see below).
If laser treatment is not possible because retinopathy is too advanced, a type of eye surgery called vitreous surgery may be required (see below).
Laser treatment
The type of laser treatment used to treat diabetic retinopathy is called photocoagulation.
A course of photocoagulation usually involves one or more visits to a laser treatment clinic. An ophthalmologist will carry out the procedure, which is usually available on an outpatient basis. This means you will not have to stay in hospital overnight.
Before the procedure, you will be given a local anaesthetic to numb the surface of your eye and eye drops to widen your pupils. A special contact lens will be placed on your eye to hold your eyelids open and allow the laser beam to be focused onto your retina.
Small laser beams will be aimed at the damaged area of your retina. These will seal any blood vessels that are leaking and destroy any abnormal blood vessels that have grown in your retina.
Photocoagulation is not usually a painful procedure but you may feel a sharp pricking sensation when certain areas of your retina are being treated.
If you have had laser treatment in the past, you may experience some discomfort during the treatment. If this is the case, you may wish to ask your doctor for stronger painkilling medication or a mild sedative.
After the procedure
After laser treatment, your vision may be blurred. However, it should return to normal after a few hours.
Your eyes may also be more sensitive to light, so you may want to wear a pair of sunglasses until your eyes have adjusted.
You will not be able to drive after having laser surgery so ask a friend or relative to drive you home.
Your eyes may ache if you have had previous eye treatment. Over-the-counter painkillers such as paracetamol should help ease the pain.
Sometimes, photocoagulation can damage the outer part of the retina. If this occurs, there is a chance that your night vision and your peripheral vision (side vision) may be affected.
Over 50% of people who have laser treatment for diabetic retinopathy notice some difficulty with their night vision, and 3% have some loss of peripheral vision.
Contact your doctor or ophthalmologist if you experience any new problems with your eyes following treatment.
Intravitreal anti-VEGF injections
Intravitreal anti-VEGF injections are often used to treat age-related macular degeneration (ARMD). However, research has shown that they can also improve the vision of people with diabetic retinopathy.
Intravitreal anti-VEGF injections are given by an ophthalmologist on an outpatient basis. A few days before the procedure, you will be given antibiotic eye drops to help prevent infection.
Before the procedure, your eye and the skin around it will be cleaned and the area around your eye will be covered with a drape to keep it sterile (free of infection). A small clip will be used to keep your eye open during the procedure.
You will be given local anaesthetic eye drops to numb your eye so you do not feel any pain during the injection. Medication will be injected into your eye which stops the damaged blood vessels in your eye leaking.
After the procedure
After an intravitreal anti-VEGF injection, the pressure in your eye will be measured. The pressure may increase after the treatment and you may need further treatment if it remains high.
Your vision may be blurred for a few hours after treatment, but it should soon start to improve. You may also be able to see the medication moving around in your eye for a few weeks after the injection.
You should notice an improvement in your vision one month after the injection. However, it is recommended that further injections are given at one-month intervals until there is no further improvement to your vision for three consecutive months.
At this point, treatment should be stopped. Your eyes will need to be checked regularly to assess whether further treatment is required.
The long-term effectiveness of intravitreal anti-VEGF injections is unknown because they have not been used to treat diabetic retinopathy for very long. More research is also needed to determine their effectiveness compared to laser treatment.
Vitrectomy
A vitrectomy is surgery to remove some or all of the vitreous humour. This is the transparent jelly-like substance that fills the space behind the lens of the eye. This type of surgery may be needed if:
- a large amount of blood has collected in the centre of your eye, obscuring your vision
- there is extensive scar tissue that is likely to cause, or has already caused, retinal detachment
During the procedure, the surgeon will make a small incision in your eye before removing the vitreous humour in front of the retina. Any scar tissue will be removed from your retina and tiny clamps may be used to strengthen the position of the retina. The vitreous gel will be replaced with a gas or liquid to help hold the retina in place.
The gas or liquid will gradually be absorbed by your body, which will create new vitreous gel to replace the gel that was removed during surgery.
Vitreous surgery 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 an eye patch at certain times of the day. This is because activities such as reading and watching television can quickly tire your eye. Wearing an eye patch will allow you to gradually make more and more use of your eye.
If gas was used to hold your retina in place, you should not travel by plane until all the gas has been absorbed by your body. Your surgeon will be able to advise you about this.
After vitreous surgery, you are likely to have blurred vision for several weeks. This should improve gradually, although it may take several months for your vision to return to normal.
