Diabetic
Retinopathy
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What Is Diabetic Retinopathy?

How Do I Know If I Have Diabetic Retinopathy?

What Are The Symptoms Of Diabetic Retinopathy?

How Is Diabetic Retinopathy Treated?

How Can I Prevent Vision Loss?

 

How Is Diabetic Retinopathy Treated?

woman_dr.jpg (22822 bytes) The good news about diabetic retinopathy is that treatment may not be necessary. Even when it is, vision loss can usually be prevented or impaired vision improved.

Good control of your diabetes with intensive management and control of your blood sugar will delay, and possibly prevent, both the development and progression of diabetic retinopathy.

If the ophthalmologist finds that you have diabetic retinopathy, you may need to have special photos of your retina taken. This series of photos is called fluorescein angiography.

When you have fluorescein angiography, a yellow dye is injected into your arm which then passes through the blood vessels in your retina. This makes it easier to see the blood vessels in the photos. Your ophthalmologist can then use the photos if you need laser surgery for diabetic retinopathy.

Helpful hint: If you have fluorescein angiography, your urine may appear orange, and you may notice a yellowish tint to your skin. This is normal, and will disappear after about a day.

Types of Treatment

  • Laser photocoagulation is one of the most common treatments for diabetic retinopathy. In this kind of surgery, short spots of the laser's beam are directed at the retina to seal leaking blood vessels.

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    The laser beam spots can also be scattered through the sides of the retina to reduce abnormal blood vessel growth (neovascularization) and help seal the retina to the back of the eye. This can help prevent retinal detachment.

    Laser surgery can usually be done in the ophthalmologist's office or outpatient surgery center. Special eye drops will be put in your eyes to numb them (topical anesthesia) to reduce any discomfort during the procedure. You may also have an injection of local anesthesia to numb the entire area around the eye. Often, topical or local anesthesia is all that's needed, but you and your surgeon may decide you need some sedation—medication to make you less anxious—as well.

    There is little recuperation needed after laser surgery for diabetic retinopathy.

    Laser surgery may require more than one treatment to be effective.

  • If you have very advanced proliferative diabetic retinopathy or retinal detachment, your ophthalmologist may recommend vitrectomy. In vitrectomy, the surgeon removes the blood-filled vitreous and replaces it with a clear solution. This allows light to pass through the clear fluid to the retina, where the images you see are conveyed to the brain.

    Vitrectomy is performed in the hospital or outpatient surgery center under local or general anesthesia. You may need to stay in the hospital overnight. The surgeon will use a special microscope to look into your eye, and will perform the procedure using microsurgical instruments.

    After vitrectomy surgery to repair a detached retina, you may experience some discomfort. Your ophthalmologist can give you medication to alleviate this. You may also need to wear an eye patch to protect your eye, and refrain from some activities. Your ophthalmologist will advise you when you can resume your normal activities.

The type of retinopathy you have, your general health and eye structure will determine the kind of treatment (if any) you need for your condition, and the kind of anesthesia you will have.

Possible Complications

As with all surgery, there are risks associated with surgery for diabetic eye conditions. Complications are unusual, but can include:

  • infection
  • cataract
  • bleeding
  • elevated pressure in the eye, which can lead to glaucoma
  • retinal detachment or scarring
  • loss of vision

If You're Scheduled for Surgery

Before your surgery:

(TIPS)

  1. Make sure you understand the risks and benefits of the surgery. Here are some questions you may want to ask your ophthalmologist:
    • Why do you think surgery is the best treatment for my condition?
    • What kind of surgery do you recommend for my condition, and why?
    • Are there other treatment options I should consider?
    • What do you think might happen if I don't have the surgery?
    • Do you think I am likely to need further treatment after the surgery (i.e. further surgery)?
    • What change should I expect in my condition after surgery?
    • What kind of anesthesia will you use for my surgery?
    • Where will my surgery take place?
    • When will my surgery take place?
    • Approximately how long will my surgery take?
    • Should I discontinue any of my medications prior to surgery? If so, how long before my surgery should I stop taking them?
    • Can I eat prior to my surgery?

    You might find it helpful to write your questions down prior to your office visit, or to take notes during your appointment. This can help ensure you understand everything your ophthalmologist discusses with you.

  2. If you have medical insurance, you should find out if your policy will cover your surgery, and how much - if anything - you should expect to pay out of pocket.
  3. Most importantly, don't be afraid to ask your ophthalmologist questions. If you have any concerns, now is the time to discuss them with your doctor.

The day of your surgery:

(TIPS)

  1. If you've been told not to eat before surgery, it is very important to follow that instruction. It can be dangerous to eat prior to undergoing some kinds of anesthesia.
  2. Most hospitals and outpatient facilities recommend you leave valuables, such as money or jewelry at home. You may not be allowed to take those items into the procedure room.
  3. If you are having your procedure in a hospital or outpatient surgery facility, make sure you get there in time to fill out any registration forms that may be required.

What will happen the day of surgery?

After you have registered or checked in, you may go to a waiting room or area prior to your surgery. You may be asked to change into a patient gown for your surgery. Depending on the kind of anesthesia you and your doctor selected for your procedure, an anesthesiologist may spend a few minutes talking with you to make sure it is the safest kind for you, and to answer any additional questions.

In the procedure room, you may be asked to sit in a special chair or lie on a table, depending on what kind of surgery you are having.

Your ophthalmologist or an assistant will probably put drops in your eyes to numb them. This is the only anesthesia necessary for some patients having laser surgery. He or she may also give you an injection to help numb the whole area around your eye. This usually involves a minimum of discomfort.

If you and your ophthalmologist decide you need sedation—medication to make you less anxious—you may be given an injection or have an intravenous line (i.v.) placed in your arm. (This means a small needle will be placed in your arm and connected to some tubing and a bag of sterile solution and medication.) This usually doesn't hurt any more than getting a shot or giving blood.

If your surgery is a laser procedure, you will be seated in a special chair in front of the laser instruments while the surgeon uses a beam of laser light to perform the procedure.

If you are having a vitrectomy, the ophthalmologist or the assistant will place sterile drapes around your eye. You won't be able to feel the surgery, or see it with the eye having the surgery.

The time your surgery takes depends on many factors, such as your eye structure, and the kind of surgery you're having.

After your surgery:

After your surgery, the ophthalmologist or assistant may put more drops in your eyes. You may be given medication for discomfort. You might need to wear an eye patch to protect the eye. You will probably have to wait for a period after your surgery to make sure it's safe for you to return home. You may have to stay a little longer if you've had sedation.

(TIPS)

  1. Prior to leaving, you should be given instructions about:
    • medications—when you should start taking them, and how often;
    • what to expect in the next few hours or days—i.e. how much discomfort or swelling you may have;
    • what signs to look for that might indicate infection or other problems;
    • what activities you must refrain from, and for how long;
    • when you should return to the ophthalmologist for follow up;
    • how to contact your ophthalmologist if you have questions or concerns.
  2. If you have any other questions or concerns, ask your ophthalmologist or his/her assistant or nurse before you leave.
  3. Make sure you have a friend or family member to drive you home after your procedure. You may have an eye patch, or feel slightly groggy after your surgery.
  4. Make sure you understand your ophthalmologist's instructions and follow them carefully. This will help ensure a speedy recovery and good outcome.
  5. Keep your follow-up appointment(s), even if you have no sutures (stitches) to remove and are experiencing no complications.
  6. Above all, take care of yourself and your eyes. Maintain a healthy diet and get regular exercise. Keep your blood sugar under good control. Wear sunglasses with adequate UV protection when you're in the sun, and make sure your eyes are protected when you play sports or use heavy machinery.