What is diabetic retinopathy?
Diabetic Retinopathy occurs when you get damage to the very small capillaries in the back of the eye in the retina and consists of two forms. First of all, what’s called background retinopathy, which affects the central part of the vision. You can get swelling in the retina, you can get leakage from the blood vessels, but you find that the central vision can decline.
The other sort is when you get new blood vessels growing at the back of the eye, either on the surface of the retina or in relation to the optic nerve. The risk with that component is that you may not have any symptoms until you develop a hemorrhage from these new blood vessels, which are very fragile. This is an indicator that you require not urgent treatment, but rapid treatment, and that’s usually in the form of a laser.
The things which make diabetic retinopathy worse are poor control of the diabetes and poor control of blood pressure. So it’s really important if you have diabetes that it’s really well controlled, the blood pressure is monitored and that your cholesterol also is under control.
In terms of the treatment modalities if it’s affecting the central part of the retina, the background retinopathy, sometimes called maculopathy, the options are laser treatment or injecting an anti-VEGF drug. So a drug which controls the leakage of the blood vessels in the development of new blood vessels, and typically examples are called Lucentis or Eylea. And they have been in the press of late.
The protocols for treating macular changes are very variable. Again there have been a lot of studies on this and it really depends on the interaction between patient and surgeon and choosing a treatment program which is specific for that patient. Typically you get thickening of the retina, you get a reduction in vision and therefore the injections will improve that situation and hopefully improve and result in maintenance of good visual function
The so-called proliferative form of diabetic retinopathy, whether a new blood vessel is growing in the retina or on the optic disc, really needs a very active treatment and that’s usually in the form of laser photocoagulation. There has been a lot of discussions recently about using the anti VEGF-drugs and they have a temporary role in controlling the retinopathy. And really probably they are going to be best used in a combination with a laser eye treatment.
More about Paul Rosen
Paul Rosen is a Consultant Ophthalmic Surgeon at The Grange Eye Consultants. His special expertise is in laser eye surgery, cataract surgery, and the treatment of Age-related Macular Degeneration, glaucoma, and retinal diseases. He has over 20 years experience in treating people with eye problems. Paul is invited to lecture on cataract and refractive surgery both nationally and internationally. He leads clinical trials investigating novel eye treatments. Paul has served as the President of the UK and Ireland Society of Refractive Surgeons and is currently the President of the European Society of Corneal and Refractive Surgery. More recently I’d been appointed as a member of the NICE Cataract Guidelines Committee and also on the Refractive Surgery Subcommittee of the Royal College of Ophthalmologists.