What Are the 3 Types of Diabetic Retinotherapy?
People with diabetes are at risk of developing diabetic retinopathy, a serious eye condition that can eventually lead to blindness.
During its early stages, the best way to manage retinopathy is by keeping glucose levels, blood pressure and cholesterol under control. However, people with more advanced retinopathy may benefit from treatment known as retinotherapy.
Here’s all you need to know about diabetic retinotherapy, how it works and when it should be used.
What Is Diabetic Retinotherapy?
Retinotherapy is a treatment that people with diabetic retinopathy can use to preserve their vision. There are three main types of retinotherapy and the most appropriate one will depend on the stage of the patient’s retinopathy.
Retinotherapy may be:
- Laser treatment
- Eye injections
We will discuss each treatment and when they are used in more detail throughout the article.
How Is Retinotherapy Used to Treat Diabetes?
In its early stages, most patients do need treatment for diabetic retinopathy. It is usually possible to manage symptoms and slow disease progression by keeping glucose, blood pressure and cholesterol levels in check.
However, for some people, diabetic retinopathy can reach a stage known as proliferative retinopathy. This means that the blood vessels at the back of the eye become weakened and burst, causing bleeding and scar tissue.
New blood vessels form, but they function abnormally. They are also often weak and prone to bleeding. In some cases, the macula can also become damaged (maculopathy). The macula is the part of the eye responsible for central vision and detecting detail. These issues can cause progressive loss of vision and, eventually, blindness.
Another dangerous situation is when scar tissue pulls on the retina, causing it to detach. This is a medical emergency and requires prompt treatment to prevent sight loss. Diabetic retinotherapy aims to treat retinopathy before it reaches this stage.
What Does Diabetic Retinotherapy Include?
The exact process involved in diabetic retinotherapy depends upon the treatment type. Let’s look at each one in detail:
This type of retinotherapy is sometimes known as laser photocoagulation. It works by sealing leaking blood vessels and preventing new ones from forming. It is useful for people with proliferative retinopathy and in some cases of maculopathy. The process is as follows:
- Eye drops are used to anesthetize the eye and widen the pupil.
- A special contact lens keeps the eye open during the procedure.
- The laser shines into the eye and targets damaged areas.
- The procedure usually lasts 20 to 40 minutes.
This is generally the retinotherapy of choice when diabetic maculopathy threatens the eyesight. It involves the use of medication known as anti-VEGF to prevent new blood vessels from forming. In some cases, steroid injections may be used to reduce inflammation. Here’s the process:
- Antibiotic eye drops are used before the procedure to prevent infections.
- The eyes are cleaned and covered with a sheet.
- The eyes are clipped open and anesthetic drops applied.
- The medication is injected into the eye using a fine, short needle.
If retinopathy becomes too advanced for laser therapy, a type of surgery known as vitreoretinal surgery may help. It involves removing the jelly-like substance in the eye called vitreous humor. A surgeon can then manually remove excess blood and scar tissue from the eye:
- The procedure is usually performed under local anesthetic.
- A small incision is made in the eyeball.
- Vitreous humor, blood and scar tissue is removed.
- A clear substance such as gas, saline, or silicone is used to replace the vitreous humor. The body will eventually absorb and replace this.
Is Diabetic Retinotherapy Effective?
Diabetic retinotherapy is usually effective. However, it cannot restore eyesight that has already been lost. It can only prevent retinopathy from getting worse.
Furthermore, patients must continue to keep their diabetes under control to stop the disease from progressing further. Therefore, it is essential to maintain healthy eating and exercise habits, take medication as directed, and monitor blood pressure, glucose, and cholesterol regularly.
The Side Effects
There are several possible side effects associated with diabetic retinotherapy. They vary slightly depending on the type of treatment:
Laser therapy side effects:
- Pricking sensations during the procedure
- Blurred vision
- Increased light sensitivity
- Aching or uncomfortable eyes
- Decreased night and peripheral vision
- Continually seeing the laser pattern several months after treatment
- A small but permanent blind spot
The side effects of eye injections:
- Eye irritation or discomfort
- A sensation that something is stuck in the eye
- Dry, itchy, or watery eyes
- Slight risk of blood clots that could detach and cause heart attacks or strokes
The side effects of eye surgery:
- Detached retina
- Risk of cataracts
- Fluid build-up in the eye
- Risk of infection
Not all of these side effects will affect everyone who undergo diabetic retinotherapy. However, most people will experience blurred vision directly after their treatment. Therefore, it is advisable for someone to accompany the patient to their appointment as they will be unable to drive.
Wearing sunglasses or an eye patch can also help with side effects, such as light sensitivity.
When Is It Used?
Diabetic retinotherapy is only used when retinopathy has progressed to a stage where it threatens the patient’s eyesight. Therefore, it may be preventable by practicing good diabetes management.
It is critical that people with diabetes attend annual eye examinations to monitor the health of their retina. Doing so will allow any changes to be detected and treated before they become severe.