The treatment of diabetes-related retinopathy
What can I do?
Even with extensive diabetes-related retinopathy changes, you can do lots to improve this yourself with what we term ‘lifestyle changes’:
- Quit smoking – stopping smoking. Lots of support can be given by your GP from patches to support groups. You are more likely to give up smoking if you get help.
- Eat better – reduce salt, fats and sugar. Seeing a dietitian and/or enrolling on a free diabetes education course such as DESMOND or DAFNE can really help.
- Lose weight – maintaining a healthy weight, with a BMI from 18.5 – 24.9, can improve your diabetes control, cholesterol and blood pressure.
- Move more - being active will improve your blood sugar, cholesterol and blood pressure, therefore improving your eye health. Exercise can take any form, from walking to cycling to swimming, whatever you enjoy. It is recommended you do 30 minutes exercise at least 5 days a week.
In cases of proliferative diabetes-related retinopathy, some maculopathy and some pre-proliferative retinopathy, laser treatment is recommended.
The aim of laser treatment is to stabilise the retina, and reduce the risk of losing further vision. It does not usually improve your vision.
The laser procedure takes place in the eye clinic. Your eye is numbed with anaesthetic drops and the laser is applied over 5 to 30 minutes, depending upon the type of retinopathy. You may need to return for several sessions. It is not normally painful.
If your doctors recommend this treatment they will discuss the benefits and risks with you.
In certain cases your eye doctor may recommend having injections into the eye, called intravitreal injections. These are done mainly if patients have diabetic maculopathy, and major trials have shown these improve this condition.
The injections are designed to decrease fluid build up in the macula, which usually leads to an improvement in vision. Most of the injections can be given in special clinics, and so it’s the same process as visiting any clinic. If your doctor recommends these treatments they will fully explain all of the benefits and the small risks.
Many patients are very concerned about the idea of an injection into the eye, but it is a very quick process, you do not see any needles and you should feel no pain.
In rare cases, surgery to the retina or the jelly (the vitreous) at the back of the eye may be recommended.
This is usually in advanced cases of proliferative diabetes-related retinopathy, in which a large bleed called a vitreous haemorrhage has happened, or scar tissue from new blood vessels has pulled the retina off of the back of the eye (retinal detachment). In these cases patients' vision is usually greatly impaired.
The surgery is carried out as a day case, and all the specific risks and benefits need to be discussed between the patient and the surgeon.
Making good lifestyle changes can help you manage diabetes, and will bring many other benefits, too, like keeping your eyes more healthy.Evelyn Mensah, Consultant Eye Surgeon