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There are two
treatments for diabetic retinopathy. They are very effective in
reducing vision loss from this disease. In fact, even people with
advanced retinopathy have a 90 percent chance of keeping their
vision when they get treatment before the retina is severely
damaged.
These two treatments are laser surgery and
vitrectomy. It is important to note that although these
treatments are very successful, they do not cure diabetic
retinopathy.
Laser Surgery
Laser surgery is performed in a doctor's office or eye clinic.
Before the surgery, your ophthalmologist will: (1) dilate your pupil
and (2) apply drops to numb the eye. In some cases, the doctor also
may numb the area behind the eye to prevent any 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 eye. During
the procedure, you may see flashes of light. These flashes may
eventually create a stinging sensation that makes you feel a little
uncomfortable.
You may leave the office once the treatment is done, but you will
need someone to drive you home. Because your pupils will remain
dilated for a few hours, you also should bring a pair of
sunglasses.
For the rest of the day, your vision will probably be a little
blurry. If your eye hurts a bit, your eye care professional can
suggest a way to control this.
The
retina prior to focal laser treatment.
The
retina immediately after focal laser treatment.
Doctors will perform laser surgery to treat severe macular
edema and proliferative retinopathy.
Macular Edema: Timely laser surgery can reduce
vision loss from macular edema by half. But you may need to have
laser surgery more than once to control the leaking fluid.
During the surgery, your doctor will aim a high-energy beam of
light directly onto the damaged blood vessels. This is called
focal laser treatment. This seals the vessels and stops them
from leaking. Generally, laser surgery is used to stabilize vision,
not necessarily to improve it.
Proliferative Retinopathy: In treating advanced
diabetic retinopathy, doctors use the laser to destroy the abnormal
blood vessels that form at the back of the eye.
Scatter
laser treatment.
Rather than focus the light on a single spot, your eye care
professional will make hundreds of small laser burns away from the
center of the retina. This is called scatter laser treatment.
The treatment shrinks the abnormal blood vessels. You will lose some
of your side vision after this surgery to save the rest of your
sight. Laser surgery may also slightly reduce your color and night
vision.
Once you have proliferative retinopathy, you will always be at
risk for new bleeding. This means you may need treatment more than
once to protect your sight.
Vitrectomy
Instead of laser surgery, you may need an eye operation called a
vitrectomy to restore your sight. A vitrectomy is performed
if you have a lot of blood in the vitreous. It involves removing the
cloudy vitreous and replacing it with a salt solution. Because the
vitreous is mostly water, you will notice no change between the salt
solution and the normal vitreous.
Studies show that people who have a vitrectomy soon after a large
hemorrhage are more likely to protect their vision than someone who
waits to have the operation.
Early vitrectomy is especially effective in people with
insulin-dependent diabetes, who may be at greater risk of blindness
from a hemorrhage into the eye.
Vitrectomy is often done under local anesthesia. This means that
you will be awake during the operation. The doctor makes a tiny
incision in the sclera, or white of the eye. Next, a small
instrument is placed into the eye. It removes the vitreous and
inserts the salt solution into the eye.
You may be able to return home soon after the vitrectomy. Or, you
may be asked to stay in the hospital overnight. Your eye will be red
and sensitive. After the operation, you will need to wear an
eyepatch for a few days or weeks to protect the eye. You will also
need to use medicated eye drops to protect against
infection.
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