Treating diabetic retinopathy

Diabetic retinopathy usually only requires specific treatment when it reaches an advanced stage and there's a risk to your vision.

It'stypically offered if diabetic eye screening detects stage three (proliferative) retinopathy, or if you have symptoms caused by diabetic maculopathy.

At all stages, managing your diabetes is crucial.

Read about the stages of diabetic retinopathy for more information about what these terms mean.

Managing your diabetes

The most important part of your treatment is to keep your diabetes under control.

In the early stages of diabetic retinopathy, controlling your diabetes can help prevent vision problems developing.

In the more advanced stages, when your vision is affected or at risk, keeping your diabetes under control can help stop the condition getting worse.

Read about what you can do to reduce the risk of diabetic retinopathy progressing .

Treatments for advanced diabetic retinopathy

For diabetic retinopathy that is threatening or affecting your sight, the main treatments are:

• laser treatment to treat the growth of new blood vessels at the back of the eye (retina) in cases of proliferative diabetic retinopathy, and to stabilise some cases of maculopathy
• eye injections to treat severe maculopathy that's threatening your sight
• eye surgery to remove blood or scar tissue from the eye iflaser treatment isn't possible becauseretinopathy is too advanced

Laser treatment

Laser treatment is used to treat new blood vessels at the back of the eyes in the advanced stages of diabetic retinopathy. This is done because the new blood vessels tend to be very weak and often cause bleeding into the eye.

Treatmentcan help stabilise the changes in your eyes causedby your diabetes and stop your vision getting any worse, althoughit won't usually improve your sight.

Laser treatment:

• involves shining a laser into your eyes you'll be given Local anaesthetic drops to numbyour eyes; eye drops are used to widen your pupils and special contact lenses are used to hold your eyelids open and focus the laser onto your retina
• normally takes around 20-40 minutes
• is usuallycarried outon an outpatient basis, whichmeans you won't needto stay in hospital overnight
• mayrequiremore than onevisit to a laser treatment clinic
• isn't usually painful, although you may feel a sharp pricking sensation when certain areas of youreye are being treated

Side effects

After treatment, you may have some side effects for a few hours. These can include:

• blurred visionyou won't be able to drive until this passes, so you'll need to arrange for afriend or relative to drive you home, or take public transport
• increased sensitivity to light it might help towear sunglasses untilyour eyeshave adjusted
• aching or discomfortover-the-counter painkillers, such as paracetamol , should help

Possible complications

You should be told about the risks of treatment in advance. Potential complications include:

• reduced night or peripheral (side) visionsome people may have to stop driving as a result of this
• bleeding into the eye orobjects floating in your vision ( floaters )
• being able to "see" the pattern made by the laser on the back of your eyefor a few months
• asmall, but permanent, blind spot close to the centre of your vision

Get medical advice ifyou notice that your sight gets worseafter treatment.

Eye injections

In some cases of diabetic maculopathy, injections of a medicine called anti-VEGF may be given directly into your eyes to prevent new blood vessels forming at the back of the eyes.

The main medicines used are called ranibizumab (Lucentis)and aflibercept (Eylea). These can help stop the problems in your eyes getting worse, and may also lead to an improvement in your vision.

During treatment:

• the skin around your eyeswill be cleaned andcovered with a sheet
• small clips will be used to keep your eyes open
• you'll be given local anaestheticdrops to numb your eyes
• avery fineneedle is carefully guided into your eyeball and the injectionis given

The injections are usually given once a month to begin with. Once your vision starts to stabilise, they'll be stopped or given less frequently.

Injections of steroid medication may sometimes be giveninstead ofanti-VEGF injections, or if the anti-VEGF injections don't help.

Risks and side effects

Possible risks and side effects of anti-VEGF injections include:

• eye irritation or discomfort
• bleeding inside the eye
• floaters or a feeling of having something in your eye
• watery or dry,itchyeyes

There's also a risk that the injections could cause blood clots to form, which could lead to a heart attack or stroke . This risk is small, but it should be discussed with you before you give your consent to treatment.

The main risk with steroid injections is increased pressure inside the eye.

Eye surgery

Surgery may be carried out to remove some of thevitreous humour from the eye. This isthe transparent, jelly-like substance that fills the space behind the lens of the eye.

The operation, known as vitreoretinal surgery, may be needed if:

• a large amount of blood has collected in your eye
• there's extensive scar tissuethat's likely to cause, or has already caused, retinal detachment

During the procedure, the surgeon will make a small incision in your eye before removing some of the vitreous humour, removing any scar tissue and using a laser to prevent a further deterioration in your vision.

Vitreoretinal surgery is usually carried out under local anaesthetic and sedation. This means you will not experience any pain or have any awareness of the surgery being performed.

After the procedure

You should be able to go home on the same day or the day after your surgery.

For the first few days, you may need to wear apatch overyoureye.This is because activities such as reading and watching television can quickly tire your eye to begin with.

You will probably have blurred vision after the operation. This should improve gradually, although it may take several months for your vision to fully return to normal.

Your surgeon will advise you about any activities youshould avoid during your recovery.

Risks and side effects

Possible risks of vitreoretinal surgery include:

• developing a cataract
• further bleeding into the eye
• retinal detachment
• fluid build-up in the cornea (outer layer at the front of the eye)
• infection in the eye

There's also a small chance that you will need further retinal surgery afterwards. Your surgeon will explain the risks to you.