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What is diabetes?
What
is diabetic retinopathy?
Laser
treatment for diabetic retinopathy
Intravitreal
injections (Avastin) for diabetic retinopathy
Vitrectomy
for diabetic retinopathy
FAQ
Useful links to find out more about how diabetes affects your
eyes
What is Diabetes?
Diabetes is a condition that affects the use of sugar (glucose)
by the cells of the body. This causes high levels of sugar
to circulate in the blood stream, which eventually causes
damage to the small blood vessels in the body. The parts of
the body most commonly affected by this process are the eye
(retina), kidneys, heart, feet and brain.
When diabetes affects the eyes it is called Diabetic
Retinopathy.
Diabetes is a leading cause of blindness in people of working
age (30 – 60 age group). If you are diabetic it is essential
that you have your eyes checked by an Ophthalmologist every
year, and possibly more frequently, if your diabetes is affecting
your eyes. It is also very important that your blood sugar
levels, blood pressure, cholesterol and body weight are well
controlled as these factors can all affect the health of your
eyes.
The American Academy of Ophthalmology has strict guidelines
regarding the treatment of diabetic retinopathy in order to
try and prevent the complications of diabetes within the eye.
What is Diabetic Retinopathy?
Diabetes causes damage to the retinal blood vessels at the
back of the eye. These blood vessels then become weakened
and fluid, protein and blood can leak out of them and accumulate
within the layers of the retina. If this involves the macula
area (central part of the retina where best vision takes place)
this is called Macular Edema and the central
part of the vision may become blurred.
When the blood vessels at the back of the eye become damaged,
the blood supply to the eye can also be affected leading to
the formation of abnormal blood vessels within the eye. This
is called Proliferative Diabetic Retinopathy.
These abnormal blood vessels are fragile and can easily bleed
into the eye causing a sudden reduction in vision (Vitreous
Haemorrhage)
Both Diabetic Macular Edema and Proliferative
Diabetic Retinopathy require prompt treatment to
try and prevent permanent loss of vision. Treatment usually
consists of laser. Occasionally, special injections into the
eye (intravitreal injections) may be required to treat the
macular edema or the proliferation of abnormal blood vessels.
If there is bleeding inside the eye, laser therapy may be
difficult or sometimes impossible to carry out. In this case,
vitrectomy surgery may be the only way to restore vision.
LASER treatment for diabetic retinopathy
Laser is applied to the retina in 2 different ways.
If you have Macular Edema, Laser is applied
to the areas of retina that are “leaking” (Focal
or Grid Argon Laser). This process is relatively quick and completely
painless. Your vision will be blurred after the treatment for
a few yours because of the drops used to dilate your pupils.
If you have new blood vessels growing within the eye (Proliferative
Diabetic Retinopathy), LASER is applied to the peripheral
retina in a process called PanRetinal Photocoagulation or PRP
for short. This treatment causes the abnormal blood vessels
to shrink away. This form of Laser takes a little longer to
apply and may be slightly uncomfortable. We therefore recommend
taking a pain killer before this sort of treatment. You may
need 2 or more sessions of PRP to get rid of the abnormal blood
vessels.
Intravitreal injections (Avastin) for diabetic retinopathy
Avastin (Bevacizumab) is an antibody that
binds to all forms of the natural human protein called Vascular
Endothelial Growth Factor (VEGF). This VEGF stimulates the
growth of and promotes leakage from blood vessels in the eye,
like the ones we see in Proliferative Diabetic Retinopathy,
Vascular occlusions, Age-related
macular Degeneration and Neovascular glaucoma.
Avastin is the first commercially available
angiogenesis inhibitor, that prevents the formation of abnormal
blood vessels, therefore helping in the treatment of these
conditions. Although currently not approved by FDA for use
in the eye, numerous studies have demonstrated that it is
a safe and effective treatment for specific eye disorders.
Side effects: minimal side-effects have been reported with
the use of intravitreal Avastin. Complications that relate
to all intravitreal injections include: Endophthalmitis (infection
in the eye), inflammation, retinal detachment, cataract and
glaucoma. However, we do not recommend you have an Avastin
injection if you have had a heart attack or a stroke in the
last 12 months.
Vitrectomy for Diabetic Retinopathy - Vitreous Hemorrhage
Vitrectomy is the current standard technique for removal of
blood within the eye. There are numerous conditions that can
cause bleeding inside the eye, and by far the commonest is Proliferative
Diabetic Retinopathy. The technique consists of creating 3 tiny
holes on the sclera (white of the eye) through which 3 different
instruments are put through. This allows for the removal of
the vitreous gel and blood inside the eye. Once the blood has
been removed from inside the eye, the cause of the bleeding
is identified and treated. Scatter laser is then applied to
the retina, causing the bleeding vessels to shrink and disappear.
A bubble of air, gas or oil in then put in the eye to prevent
bleeding in the immediate post-operative period. In the event
that silicone oil is used, it is usually removed a few months
later once the condition of the eye has stabilized. After the
surgery, drops are used routinely for a few weeks to reduce
the inflammation in the eye. Regular checks after the operation
are required to detect and treat any complications that may
arise.
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