Diabetic Retinopathy Treatment Options

Dr. David Maberley, MD, MSc. (Epid), FRCSC, Ophthalmologist, discusses how diabetic retinopathy is treated.

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Dr. David Maberley, MD, MSc. (Epid), FRCSC, Ophthalmologist, discusses how diabetic retinopathy is treated.
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Featuring Dr. David Maberley, MD, MSc (Epid), FRCSC, Ophthalmologist

Duration: 3 minutes, 28 seconds

Diabetic retinopathy, we start treating from a holistic approach. We have to deal with the diabetes as it affects a patient’s body.

So our first step in treating diabetic retinopathy is making sure a patient’s blood sugar is optimized, that whatever treatments they’re receiving for their diabetes in the systemic level are optimally managed, that the blood sugar is controlled with the context of good blood pressure control, cholesterol control, kidney function is assessed, and all those potential risk factors for all the complications of diabetes, but including diabetic retinopathy, are optimized.

At that point, we tend to be in a situation where we are monitoring people for the development of diabetic retinopathy. And this can typically be done with a yearly eye assessment, dilating drops and then evaluation.

And in doing that, we would tend to pick up people who have developed early diabetic retinopathy. The follow-up interval then changes. If you have changes that are worrisome, you might be coming back at the three or four monthly interval. If everything looks good, you may even be sent away for up to two years. But in general, it’s ideal to try to stick that that one-year interval as much as possible.

The treatment of diabetic retinopathy is really based on what type of retinopathy you have in your eyes. If you have swelling in the central part of your vision or near the central part of your vision, which is called diabetic macular edema, then we tend to start with one of two treatment options.

If the leakage is not very close to your center vision, we can do a little bit of laser treatment, which is a bright flashing light in the eye, and it is pretty painless and it doesn’t really set you back in terms of recovery.

You’re pretty much good to go the same day. Up to injection treatments. And we do the injection treatments when the swelling or the leakage is more in the center vision, where it’s not safe to do laser.

And there in that setting, you may undergo a series of injections with a class of drugs called anti-VEGEF drugs, and those drugs – there’s a few different ones – they tend to reduce the fluid and the leakage from the blood vessels and help restore vision if it’s becoming deteriorated or if you’re having distortion or vision loss.

The other type of diabetic retinopathy, where blood vessels grow in the back of your eye and often lead to bleeding, that’s initially treated with more of an extensive laser, of the peripheral retina, and that tends to stop the blood vessels from growing and can cause them to regress and go away. That laser can be a bit more uncomfortable and often takes a lot longer to administer.

So that would be something to discuss with your ophthalmologist, the process around that in more detail if you were scheduled for a more extensive laser called pan retinal photo coagulation.

There’s also a role for the anti-VEGEF drugs in treating the type of diabetic retinopathy where blood vessels are growing, and that’s still being clarified in the literature. But there does tend to appear to be some significant benefit to using these injectable drugs when you have blood vessels that are growing in the back of your eye.

Now in the advanced stages of the blood vessel growth part of diabetic retinopathy, there can be bleeding in the eye, and there can be scar tissue that starts to pull your retina off. When those things occur, you’ll ultimately probably need a vitrectomy or surgical intervention to remove the scar tissue and blood from your eye.

And again, that’s a more involved procedure, and you would definitely want to discuss any issues around that with your ophthalmologist, your vitreoretinal surgeon at that point in time.

Presenter: Dr. David Maberley