Diabetic Retinopathy Treatments
Tight blood glucose control lessens the risk that retinopathy will get worse. Treating other conditions, such as high blood pressure and abnormal cholesterol levels, may also slow progression of diabetic retinopathy. In most cases, no treatment is required for nonproliferative retinopathy, although the retina is carefully monitored for the development of macular edema or proliferative retinopathy. Both of these conditions can be treated with laser photocoagulation or vitrectomy.
Photocoagulation uses lasers to help close leaking microaneurysms, fostering the regression of new blood vessels. This procedure helps to halt or slow vision loss in most people if it is performed before too much damage has occurred. In people with macular edema, focal laser photocoagulation is performed to target individual capillary abnormalities.
There are two types:
- Focal laser photocoagulation targets individual blood vessels. It improves vision in only about 10% of people with macular edema, but even when vision does not improve, the risk of further deterioration is halved.
- Panretinal photocoagulation (PRP) creates a grid-like pattern across a large area of the retina. It is used to treat proliferative retinopathy and causes new blood vessels to regress, cutting the risk of blindness by more than 50% in people with proliferative retinopathy.
Although complications are rare, both types of laser photocoagulation carry a risk of vision loss. Recent research suggests that laser treatment in conjunction with a VEGF inhibitor may be an even more effective therapy.
If the extent or location of the damage makes photocoagulation ineffective, if the vitreous humor is too clouded with blood, or if there is significant pulling on the retina or retinal detachment, vision can often be improved or stabilized with a vitrectomya surgical procedure that removes the vitreous humor and replaces it with saline solution.
Photocoagulation can also be performed during a vitrectomy using a special laser that is inserted into the eye. Approximately 70% of people who undergo vitrectomy notice some improvement or even stabilization of their vision. Some individuals recover enough vision after the procedure that they are able to resume reading and driving.