- Treatments Quigley Eye Specialists
Diabetic retinopathy is a complication of diabetes and a leading cause of blindness. It occurs when diabetes damages the tiny blood vessels inside the retina, the light-sensitive tissue in the back of the eye. A healthy retina is necessary for good vision.
If you have diabetic retinopathy, at first you may notice no changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.
Diabetic retinopathy has four stages:
All people with diabetes-both type 1 and type 2- are at risk. That’s why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor at Quigley Eye Specialists can recommend treatment to help prevent its progression.
During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, EVERY pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.
Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:
Diabetic retinopathy often has no early warning signs. Don’t wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.
At first, you will see a few specks of blood, or spots, “floating in your vision”. If spots occur, see your doctor at Quigley Eye Specialists as soon as possible. You may need treatment before more serious bleeding occurs. Hemorrhages tend to happen more than once, often during sleep.
Sometimes, without treatment, the spots clear, and you will see better. However, bleeding can reoccur and cause severely blurred vision. You need to be examined by your doctor at Quigley Eye Specialists at the first sign of blurred vision, before more bleeding occurs.
If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. Also, the earlier you receive treatment, the more likely treatment will be effective.
Macular edema and diabetic retinopathy are detected during a comprehensive eye exam that includes:
Your doctor at Quigley Eye Specialists checks your retina for early signs of disease, including:
If your doctor at Quigley Eye Specialists believes you need treatment for Macular Edema, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The tests allow your doctor to identify any leaking blood vessels and recommend treatment.
Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Your doctor at Quigley Eye Specialists places up to several hundred small laser treatments in the areas of retinal leakage surrounding the macula. These treatments slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed.
A patient may need focal laser surgery more than once to control a leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart.
Focal laser treatment stabilizes vision. In fact, focal laser treatment reduces the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it can be improved.
During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macula edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.
Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser treatments in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser treatments are necessary, two or more sessions are usually required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision.
Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams at Quigley Eye Specialists. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding.
Both focal and scatter laser treatment are performed in our office at Quigley Eye Specialists. 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 office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eyes. During the procedure, you may see flashes of light. These flashes eventually may create a stinging sensation that can be uncomfortable.
You will need someone to drive you home after surgery. 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.
If you have a lot of blood in the center of the eye (the vitreous gel), you may need a vitrectomy to restore your sight. If you need vitrectomies in both eyes, they are usually done several weeks apart.
A vitrectomy is performed under either local or general anesthesia. Your doctor makes a tiny incision to your eye. Next, a small instrument is used to remove the vitreous gel that is clouded with blood. The vitreous gel is replaced with a salt solution. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original vitreous gel.
You will probably be able to return home after vitrectomy. Some people stay in a hospital overnight. Your eye will be red and sensitive. You will need to wear an eye patch for a few days or weeks to protect your eye. You also will need to use medicated eye drops to protect against infection.
Yes. Both treatments are very effective in reducing vision loss. People with proliferative retinopathy have less than a five percent chance of becoming blind within five years when they get timely and appropriate treatment. Although both treatments have a high success rate, they do not cure diabetic retinopathy.
Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment more than once to protect your sight.
If you have lost some sight from diabetic retinopathy, ask your doctor at Quigley Eye Specialists about low visions 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’s organizations and agencies offer information about low vision counseling, training, and other special service for people with visual impairments. A nearby school of medicine or optometry may provide low vision services.
The National Eye Institute (NEI) is conducting and supporting research that seeks better ways to detect, treat, and prevent vision loss in people with diabetes. This research is conducted through studies in the laboratory and with patients.
For example, researchers are studying drugs that may stop the retina from sending signals to the body to grow new blood vessels. Someday, these drugs may help people control their diabetic retinopathy and reduce the need for laser surgery.
The NEI urges everyone with diabetes to have a comprehensive dilated eye exam at least once a year. If you have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care.
A major study has shown that better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reduces the need for sight saving laser surgery.
This level of blood sugar control may not be best for everyone, including some elderly patients, children under age 13, or people with heart disease. Be sure to ask your doctor if such a control program is right for you.
Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health as well as help protect your vision.
Today, patients take an active role in their health care. Be an active patient about your eye care.
If you have diabetes, get a comprehensive dilated eye exam at least once a year.
Proliferative retinopathy can develop without symptoms. At this advanced stage, you are at high risk for vision loss.
Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy.
You can develop both proliferative retinopathy and macular edema and still see fine. However, you are at high risk for vision loss.
For more information about low vision programs, you may wish to contact:
American Foundation for the Blind
11 Penn Plaza, Suite 300
New York, NY 10001-2006
Council of Citizens with Low Visions International
111 East 59th Street
New York, NY 10022-1202
National Association for Visually Handicapped
22 West 21st Street, 6th Floor
New York, NY 10010-6493