Diabetic Retinopathy Treatment

What is diabetic retinopathy?

Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the light-sensitive area at the back of the eye (retina). If left untreated, it can eventually cause blindness.

The retina is surrounded by a network of tiny blood vessels. Over time, persistently high levels of blood sugar can damage these blood vessels in three main stages:

• Background retinopathy, an early stage of damage which does not affect your vision. This occurs when the blood vessels bulge and may bleed slightly.
• Pre-proliferative retinopathy where there is significant bleeding in the eye due to the blood vessels experiencing severe changes
• Proliferative retinopathy where new blood vessels and scar tissue which bleed easily, develop on the retina, resulting in vision loss

When should I see a specialist for diabetic retinopathy treatment?

There are usually no symptoms in the early stages. This is why people with diabetes are advised to have their eyes screened once a year to pick up problems before your vision is affected. Early treatment can help prevent or reduce vision loss.

You should see your ophthalmologists if you experience:

• poor vision over time
• impaired colour vision
• sudden vision loss
• shapes floating in your field of vision (also known as “floaters”)
• blurred vision
• dark areas in your vision

Did you know?

The Singapore Indian Eye Study showed that 10% of the 3,400 ethnic Indian participants aged 40 and older participating in the study, had some form of diabetic retinopathy¹.

What are the risks of diabetic retinopathy treatment?

Diabetic retinopathy affects the blood vessels in the retina. Complications such as those listed below can affect vision:

• Vitreous haemorrhage occurs when the blood vessels bleed into the jelly-like substance that fills the eye. In severe cases, the blood can fill the eye and block your vision. The blood often clears within a few weeks to months. Unless the retina is damaged, your vision will return then the blood clears.

• Retinal detachment can occur when the abnormal blood vessels cause scarring to occur which can cause the retina to pull away from the back of the eye. This causes floaters or severe vision loss.

• Glaucoma is a condition when the blood pressure in the eye increases due to the new blood vessels affecting the fluid flow out of the eye. The pressure damages the optic nerve, the nerve that carries visual information from your eye to your brain. This can lead to complete vision loss if untreated.

How should I prepare for my appointment?

The ophthalmologist will discuss your personal and family medical history with you particularly focusing on your diabetes. Your specialist is likely to ask questions regarding your vision problems, your diabetes control, your last haemoglobin A1c reading, any other health condition such as hypertension and if you had any other eye surgery.

The following information should be prepared for the appointment:

• Your diabetes history, when you were diagnosed, past and current medication, blood sugar readings and your haemoglobin A1C readings
• Your symptoms and how long you have had these symptoms
• All medication currently being consumed including dosage, vitamins, and other supplements

As the eye exam will require your eyes to be dilated, affecting your vision for a brief period after the consultation, you may find it helpful to have someone accompany or drive you after your appointment.

To confirm a diagnosis of macular degeneration, your specialist may do several other tests, including:

Examination of the back of your eye (also called a dilated eye exam) to look for:

• Abnormal blood vessels
• Swelling, blood, or fatty deposits in the retina
• Growth of new blood vessels and scar tissue
• Bleeding in the clear, jelly-like substance that fills the centre of the eye (vitreous)
• Retinal detachment
• Abnormalities in your optic nerve
• Fluorescein angiography where images of your eye will be taken before and after an injection of dye in your arm, to determine if you have abnormal blood vessels or retinal changes.
• Optical coherence tomography which is a non-invasive imaging test identifies areas of retinal thinning, thickening or swelling to indicate fluid leakage into the retinal tissue.

What can I expect during diabetic retinopathy treatment?

In the early stages, you may not need treatment immediately. Your ophthalmologist is likely to monitor your condition closely to determine when you need to start treatment. If your blood sugar control is good, you are likely to slow down the progression of diabetic retinopathy.

If you have proliferative diabetic retinopathy, prompt surgical treatment such as those listed below may be possible:

Laser treatment treats or shrinks abnormal blood vessels with laser burns. This is done as a day surgery procedure using local anaesthetic eye drops and takes about 20-40 minutes. After the treatment, you may experience blurred vision, increased sensitivity to light and discomfort which can be relieved with over-the-counter pain relief. Some possible complications from the laser treatment include some loss of peripheral or night vision, floaters, or being able to “see” the laser pattern made on the retina, a small permanent blind spot close to the centre of the eye.

Vitrectomy uses a tiny incision in your eye to drain blood from the middle of the eye (vitreous) as well as to remove scar tissue affecting the retina. This is carried out under local anaesthetic and sedation, which means you will not be aware of the surgery being performed. You may be able to go home on the day of the surgery or the next day, wearing an eye patch for the following few days. Your vision will be blurred for the first few days and will improve over several months. Possible risks of the surgery include cataract development, further bleeding within the eye, infection, or retinal detachment.

What happens after my diabetic retinopathy treatment and how do I maintain healthy vision?

While surgery often slows or stops the progression of diabetic retinopathy, it does not cure. Diabetes is a lifelong condition. Future vision loss is still possible. Regular eye exams, good control of your blood sugar and blood pressure, and prompt treatment can help prevent severe vision loss.

1. Zheng Y, Lamoureux EL, Lavanya R, et al. Prevalence and Risk Factors of Diabetic Retinopathy in Migrant Indians in an Urbanized Society in Asia: The Singapore Indian Eye Study. Ophthalmology. 2012;119(10):2119-2124. doi:10.1016/J.OPHTHA.2012.04.027.