Diagnosis and Treatment of Diabetic Retinopathy

Diabetic retinopathy, which is a complication of diabetes that affects the eyes, is detected during a comprehensive eye exam that includes:

• Visual acuity testing.
• Dilated exam in which drops are placed to widen the pupil to allow examination of the retina.
• Tonometry. Measurement of the eye pressure inside the eye.

Supplemental testing may include:

• Optical coherence tomography (OCT). This is a non-invasive test that images the retina to detect any fluid or diabetic macular edema.
• Fluorescein Angiography. This test involves an injection of a dye into your arm and a series of pictures that are taken as the dye flows through the retinal vessels. This may show leakage of fluid or the growth of new blood vessels in the retina.

Treatment for Diabetic Retinopathy

The best treatment is prevention of diabetic retinopathy by strict control of blood sugars. Once diabetic retinopathy is present, treatment of diabetic retinopathy will slow progression but won’t cure it.

Diabetic macular edema can be treated with several different therapies that may be used alone or in combination.

These include:

• Injection therapy. Anti-VEGF drugs are injected into the eye to block a substance called vascular endothelial growth factor (VEGF). This medication will block abnormal blood vessel growth and decrease the leakage of fluid into the retina. The three most commonly used drugs include Avastin, Lucentis and Eylea. Steroids are another option for treatment of diabetic macular edema but are used less often due to side effects of possible cataracts and increased eye pressure.
• Laser therapy. Small laser burns are applied in the area of the retinal swelling to slow the leakage of fluid. Laser treatment can be combined with anti-VEGF injections.

Proliferative diabetic retinopathy can be treated with:

• Laser therapy. Laser is applied on the retina to shrink the new blood vessels and to prevent bleeding inside the eye. Bleeding inside the eye will cloud the vision and cause floaters, which are small moving spots that appear in your field of vision.
• Surgery. When there is significant amount of blood or scar tissue inside the eye, then a vitrectomy surgery is performed to remove the blood and scar tissue. Laser and anti-VEGF therapy may also be applied during the surgery.

In the end, the best treatment is prevention of diabetic retinopathy. An annual comprehensive dilated eye exam is recommended for anyone who has been diagnosed with diabetes, since early mild non-proliferative diabetic retinopathy can show no symptoms.

Article contributed by Jane Pan M.D.

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