Treatment

Diabetic retinopathy is usually treated with laser treatment and in some cases surgery.

Laser treatment 

Diabetic retinopathy is initially treated with lasers, a procedure known as photocoagulation. In this procedure a laser beam (high-energy light beam) is applied in small bursts onto the damaged retina. This treatment is designed to maintain vision, not improve it, and is highly effective in most patients. Blindness is prevented in at least one eye of 80-90% of cases.

There are two laser techniques according to the type of retinopathy.

• Maculopathy requires laser treatment around the macula at the centre of the retina to seal the leaking blood vessels.
• With proliferative retinopathy, extensive laser treatment to the starved retina is undertaken. The new vessels then shrink and this reduces the long-term chance of haemorrhage, retinal detachment and severe visual loss.

For more information on these types of retinopathy, please see the Facts about diabetic retinopathy section.

Before the laser is applied, a local anaesthetic is put on the eye to numb it, and drops are instilled to dilate the pupil. A contact lens is placed in the eye which helps keep the lids open, focuses the laser beam, and allows the doctor to view the back of the eye in greater detail. It is important that you keep your eyes still during the procedure.

Will the laser hurt?

Sometimes a dull thud sensation or occasionally a sharp pain is felt. You can relieve any discomfort experienced the same evening by taking a mild painkiller (like Paracetamol) and resting. If you have had pain on previous treatments it is a good idea to take painkillers prior to expected treatment. If pain is still persistent 24 hours after treatment report to an eye casualty department.

Will the laser treatment affect my sight?

Yes. Immediately after treatment you will be completely dazzled by light. Later, vision can be blurred temporarily. Changes may occur in colour vision, night vision and in the field of vision (the range of vision you have on each side of an object on which your gaze is fixed). On very rare occasions vision can be made worse. It is rare for the effect on colour vision to be a problem.

What happens after the laser treatment?

Usually, most of the disease is controlled, but may require more laser treatment. You will have regular eye checks to determine this.

Surgery

In some patients where there has been recurrent bleeding and the vitreous is clouded with blood or a retinal detachment is present, a vitrectomy operation may be necessary.

What is a vitrectomy operation?

This is the removal of the vitreous (the jelly-like substance which fills the eye) with the help of delicate instruments and an operating microscope. The vitreous is replaced with a clear substance, usually a form of saline, air, gas or silicone fluid. Very fine stitches are used to close the wound and these do not need removal.

Will a vitrectomy operation allow me to see properly again?

This exchange of a clear substance for cloudy vitreous allows light to reach the retina again, and can help to restore some vision. However, the improvement in vision can be limited, and sight may take weeks or even months to improve. In some cases of severe diabetic retinopathy, success means stabilising the vision, that is, preventing it from getting worse.

What should I do if I see blood in my vision?

Don't bend so that your head is below your heart and avoid strenuous activity, and see a doctor as soon as possible.