Treatment of Diabetic Retinopathy

Reading time: 6 min

Treatment depends on the ophthalmologist’s observations made while examining the patient’s eyes. It may include:

Glucose test

Controlling blood sugar levels. Sometimes, just by improving a patient’s metabolic control, their vision can improve.

severe traumatism in the eye

Laser. This reduces the number of abnormal blood vessels and those which are producing oedema.

Injection

Intraocular injections. Different medicines are injected into the eye, or into the vitreous body (they are also known as intravitreal injections), to reduce the amount of fluid in the macula.

severe traumatism in the eye

Vitrectomy. Surgical intervention that eliminates any blood inside the eye. It is also the technique used to repair a retinal detachment.

Non-drug therapy

Patients should maintain good metabolic control and reduce risk factors such as high blood pressure, dyslipidaemia and/or obesity in order to prevent or treat the early stages of retinopathy.

patient doctor, woman

Therapeutic education. Therapeutic education is vital for encouraging control over diabetes and reducing its complications. Lifestyle modification programmes, which involve the health team, patient and their family, achieve improved weight control, help patients quit toxic habits (e.g., smoking) and encourage them to accept their diabetes. Patients who are well-informed about their diabetes, self-care skills and medication management participate more actively and therefore obtain better results.

Dieta adecuada, pirámide de la alimentación

Medical nutrition therapy. Diet is a basic pillar of diabetes treatment. It must be nutritionally healthy and each meal must include a controlled amount of carbohydrate-containing foods (milk, floury foods and fruit). The diet must be tailored to each patient’s bodyweight, drug treatment (insulin or tablets), physical activity, eating habits and blood sugar profile.

take part in regular physical exercise

Physical activity. Physical activity is another cornerstone of treatment, especially in the case of type 2 diabetes. Patients should complete a minimum of 150 minutes of physical activity per week, spread over 3 or 5 days. It is essential that patients adjust their diet and drug therapy according to the duration and intensity of their activity. (Link con diabetes / actividad física).

Contraindications for physical exercise:

  • Patients with moderate non-proliferative retinopathy should avoid very vigorous exercises that increase blood pressure, such as weightlifting.
  • In the case of unstable diabetic retinopathy, patients must also avoid activities that raise blood pressure, such as jumping, and those involving sudden head movements.
  • Patients with vitreous haemorrhage are advised to avoid all types of physical activity.

Oral antidiabetic medicines reduce blood glucose levels and can therefore help improve diabetic retinopathy. However, drugs with a direct influence on diabetic retinopathy are administered into the eye via injections. There are currently two types of intraocular drugs available:

Vial

Anti-VEGF drugs. These block the action of a molecule that is heavily involved in diabetic macular oedema. They are liquid medicines and must be injected several times a year because they are usually only effective for a couple of months.

Implantes corticoides

Corticosteroids. These reduce the ocular inflammation that accompanies diabetic macular oedema. They are solid medicines (implants) that continue working inside the eye for several months, so fewer injections are required.

Surgical treatment

A surgical intervention (pars plana vitrectomy) is usually required to treat advanced stages of diabetic retinopathy, such as proliferative retinopathy.

There are three main situations that require an operation: very dense or recurrent vitreous haemorrhage, tractional retinal detachment and treatment-resistant macular oedema.

The operation consists of inserting some tiny instruments (e.g., suction devices, forceps or lasers) inside the vitreous body of the eye while illuminating the retina and maintaining the internal eye pressure constant. It is a very delicate procedure, but it has evolved a lot in recent years and can often be completed without the need for stitches.

glaucoma, presión ocular

Vitreous haemorrhages that do not heal fully or which reoccur may require a vitrectomy to remove the blood and treat the damaged vessels causing the bleeding. If severe cases of vitreous haemorrhage go untreated for long periods, the eye’s pressure may increase and even cause pain, a condition known as neovascular glaucoma.

desprendimiento de retina

Tractional retinal detachment occurs when the inner retina wrinkles up due to the pulling action of membranes and filaments, thus causing vision loss and the appearance of wavy lines. Vitrectomy tends to help this problem, but vision may be permanently affected depending on the extent of damage to the inner retina.

edema macular quístico

Cases of macular oedema that do not respond to drug therapies may require surgery to clean the membranes growing on the macula. However, the patient does not always recover their full vision.

New therapies

While laser treatment for diabetic retinopathy has not changed too much in recent years, the treatment of diabetic macular oedema has witnessed great advances. Laser treatment is now accompanied by various options including intravitreal drug therapy.

These new treatments have yielded more significant and satisfactory results in terms of improving patients’ vision. For example, current therapies with anti-VEGF drugs and corticosteroids have totally revolutionised the treatment of diabetic macular oedema, but there is still a subgroup of patients with treatment-resistant oedema.

Therefore, new treatment strategies are being studied, above all, to discover therapies that require less injections. Researchers are looking into new anti-VEGF molecules, for instance, which stay active inside the eye for longer, while new corticosteroid implants which remain active for up to 3 years have recently become available for cases of chronic diabetic macular oedema.

Treatment complications

Thanks to technical breakthroughs, complications associated with treatments for diabetic retinopathy are now much less significant than they were a few years ago.

severe traumatism in the eye

Laser photocoagulation can be complicated by the development of haemorrhages and scarring in the retina if too much energy is applied to the eye fundus and, depending on the situation, this can produce some dark spots in the patient’s vision. Patients may also notice a decline in their nocturnal vision and colour vision.

Irritated eye

The severest complication associated with intravitreal drug therapy is an infection inside the eye, or endophthalmitis, which in some cases can lead to complete vision loss. Although the frequency varies, it is always very low as less than 1 in every 1,000 people who receive this treatment develop an infection. Other complications are haemorrhages inside the eye and even retinal detachment, but again they are both rare events. Finally, the administration of corticosteroids introduces a greater risk of developing cataracts and increasing the intraocular pressure.

Catarata subcapsular

Complications associated with surgery are the same as those for intravitreal injections (e.g., intraocular infection, haemorrhage and retinal detachment).

Substantiated information by:

Anna Sala
Marc Figueras
Victòria Hernández

Published: 3 July 2018
Updated: 3 July 2018

Subscribe

Receive the latest updates related to this content.

Thank you for subscribing!

We have received your information. Check your inbox, in a few moments you will receive a confirmation email.

An error occurred and we were unable to send your data, please try again later.