Diabetic Retinopathy Treatment at The Eye Care & Surgery Center in New Jersey
Treatment of Diabetic Retinopathy
Depending on the stage of diabetic retinopathy, the potential for and the amount of vision loss, it is possible to treat, stabilize and often reverse the effects of the disease. Treatment of diabetic retinopathy can entail the use retinal laser photocoagulation treatment as well as intravitreal injections of Vascular Endothelial Growth Factor (VEGF) Inhibitor drugs or other drugs. However, successful management of diabetic eye problems requires early diagnosis and treatment.
The National Institutes of Health and the National Eye Institute have funded a number of large scale, multi-center, controlled studies that have produced clinical care guidelines for Diabetic Retinopathy used by our New Jersey Retinal Specialist Milton Kahn, M.D.
- Early Treatment Diabetic Retinopathy Study (ETDRS)
- Diabetes Control and Complications Trial (DCCT)
- Diabetic Retinopathy Study (DRS)
- Diabetic Retinopathy Vitrectomy Study (DRVS)
These studies have produced treatment guidelines indicating which patients may benefit from various treatment options to preserve vision and delay progression of vision loss. Dr. Kahn uses the results of these studies to guide patients in the treatment of diabetic retinopathy since with early treatment it is possible for patients with diabetic retinopathy to have only half the likelihood of losing vision as compared to those patients who fail to receive early treatment.
About Diabetic Laser Treatment
Nonproliferative Retinopathy & Laser Treatment
During the early stages of Mild Nonproliferative Retinopathy, Moderate Nonproliferative Retinopathy and the beginning of Severe Nonproliferative Retinopathy, it is not likely that you will need Laser Treatment, unless you have Diabetic Macular Edema.
However, in order to prevent the progression of Diabetic Retinopathy it is quite important to maintain good overall health. First, tight control of blood sugar levels is key for protecting the health of the small blood vessels. Patients should work to reduce any and all risk factors for vascular disease including controlling their blood pressure, not smoking, reducing dietary fat consumption to lower cholesterol and trigycerides and exercising regularly.
Proliferative Retinopathy and Laser Treatment
Proliferative Retinopathy is treated with a Retinal Laser Photocoagulation procedure called “Scatter Laser Treatment”. The goal of Scatter Laser Treatment is to shrink abnormal blood vessels. Dr. Kahn will place approximately 1,000 to 2,000 laser spots in areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Since Scatter Laser Treatment requires a large number of laser spots, it is often necessary to use two or more sessions to complete the laser treatment.
Sometimes patients who have had Scatter Laser Photocoagulation will experience some loss of their side or peripheral vision, some loss of night vision and a decrease in color vision. However, Scatter Laser Treatment is necessary to preserve the rest of your vision and stop the progression of the disease.
Although not yet FDA approved for the treatment of Proliferative Retinopathy, Dr. Kahn may also discuss the use of anti-vascular endothelial growth factor (VEGF) treatment-such as Lucentis®, as recent studies have shown them to be of benefit.
When PRP and intravitreal injection are unsuccessful in stopping the progression of the proliferative retinopathy and when a vitreous hemorrhage occurs and does not clear on its own, or when a retinal detachment develops, then a vitrectomy is often helpful. A vitrectomy involves inserting instruments into the eye, and removing the vitreous gel, any blood present in the vitreous cavity, and removing the scar tissue that has grown on the surface of the retina.
Diabetic Macular Edema, Laser Treatment & Injections
Diabetic Macular Edema was traditionally treated with one of two types of Retinal Laser Photocoagulation procedures: “Focal Laser Treatment” and “Grid Laser Treatment”. Focal Laser treatment is used to close leaking microaneurysms in a limited area and Grid Laser treatment is used to treat a more diffuse swelling in the Macula.
With either type of laser treatment for macular edema, Dr. Kahn will place laser spots in the areas of retinal leakage surrounding the Macula. These spots act to slow the leakage of fluid and reduce the amount of fluid in the retina. It is usually possible to complete these laser treatments in one session, however depending on the results additional treatment may be necessary. You may need to have Laser Treatment for Macular Edema more than once to control the leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time.
Laser treatment of Diabetic Macular Edema works to stabilize vision. In fact, laser treatment may reduce the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it may be improved. It is important to restate that this treatment is performed to keep vision from further declining, but does not usually result in improvement in vision already lost.
For most patients, anti-VEGF injections such as Lucentis® which are less destructive and safer than laser treatments, are considered as primary therapy for the management of vision-threatening complications of diabetic retinopathy such as diabetic macular edema (DME). The latest clinical trials have demonstrated that monthly Lucentis injections improved vision in one-third to nearly one-half of patients with diabetic macular edema.