Treatment of Diabetic Retinopathy and Macular Edema
What are the side effects of treatment for proliferative retinopathy?
Patients often notice a loss of peripheral (side) vision and more difficulty with night vision after PRP treatment; a newer type of PRP called subthreshold diode micro-pulse laser appears to minimize these side effects by using less laser energy, but has not been widely tested or adopted by retinal specialists as of yet. Vitrectomy surgery often results in cataract formation and, potentially, retinal detachment – but is proving more and more effective with advances in surgical instruments and technique, especially in patients with severe vitreous hemorrhage and type 1 diabetes.
What happens during laser treatment?
Both macular and scatter (PRP) laser treatment are performed in your doctor's office or eye clinic. Before the surgery, your doctor will dilate your pupil and apply drops to numb the eye. The area behind your eye also may be numbed to prevent discomfort.
The lights in the treatment room will be dim and you will place your chin on a chin rest of an eye microscope with a laser attached. The doctor will hold a special lens to stabilize your eye and begin applying the laser through your pupil to the retina at the back of the eye. During the procedure, you will hear a clicking noise with each laser application and may see flashes of light and feel a sensation of heat that may create a stinging sensation that can be uncomfortable (especially in younger patients).
It is advisable to have someone to drive you home after this treatment. Because your pupil will remain dilated for a few hours, you should bring a pair of sunglasses.
For the rest of the day, your vision will probably be a little blurry. If your eye hurts, your doctor can suggest treatment.
What is a vitrectomy?
If the retina is becoming detached as a result of proliferative retinopathy, or if there is a significant amount of blood in the center of the eye (vitreous gel) that does not clear within several months, you may need a vitrectomy surgery to help prevent blindness or restore your sight. If vitrectomy surgery is needed in both eyes, they are usually done several weeks apart. A vitrectomy typically is performed under local anesthesia. Several small incisions are made in the eye. Next, several small instruments are inserted to cut abnormal fibrous scar tissue attached to the retina and remove the vitreous gelatin as well as any large amounts of blood . The vitreous gel is replaced with a salt solution that functions the same as the original vitreous gel. Patients typically return home after a vitrectomy. The operated eye will be red and sensitive (though new surgical instruments and techniques have dramatically improved this) and patients are asked to wear an eye patch for a few days to protect the eye. Eye drop medications also will be prescribed to protect against infection and reduce inflammation caused by the surgery.
Are PRP (scatter laser treatment) and vitrectomy effective in treating proliferative retinopathy?
Yes. Both treatments are very effective in reducing vision loss. People with proliferative retinopathy have less than a 5% chance of becoming blind within five years when they get timely and appropriate treatment. Although both treatments have high success rates, they do not cure diabetic retinopathy.
Once patients have proliferative retinopathy, they always will be at risk for new bleeding and loss of circulation to the retina. Patients may need treatment more than once to protect your sight.
What can I do if I already have lost some vision from diabetic retinopathy?
If you have lost some sight from diabetic retinopathy, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services.
Reviewed by Dr. A. Paul Chous, MA OD, FAAO. 4/12
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