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How is retinopathy treated?

Laser treatment

The type of laser treatment used to treat diabetic retinopathy is called photocoagulation. Many people having laser treatment have very little visual impairment. Others who may have early or moderate maculopathy and proliferative retinopathy will also benefit from laser treatment.

Laser treatment has revolutionised retinopathy treatment. Together with effective screening, good blood glucose control and good blood pressure, it can successfully maintain vision.

How does it work?

Tiny laser burns allow more oxygen and nutrients to reach the retina, which improves the blood circulation. This signals that there is no need for 'new vessels' to be produced. You may need more than one treatment as the vessels may start growing again.

What’s the procedure?

  1. You have local anaesthetic and pupil-dilating eye drops put in your eye.
  2. A special contact lens is placed on your eye to hold your eyelids open and allow the laser beam to focus onto your retina
  3. The laser beam is directed at damaged areas of the retina.
  4. Small bursts of tiny beams of laser light then seal leaky blood vessels and destroy abnormal new blood vessels in the retina.

An eye specialist (ophthalmologist) carries out laser treatment and nearly always as an outpatient procedure, allowing you to go home afterwards. A session of treatment can vary in length from person to person. Ask your eye specialist how long your sessions will last and whether you will be expected to come back for more treatment.

Is it painful?

As a local anaesthetic is used, laser treatment is not painful for most people, although a few will experience some discomfort. Many people say that the first laser sessions are not painful, but treatment can become uncomfortable if many sessions are needed. Before your laser sessions, speak to your eye specialist about using your usual methods of pain relief, should it be needed.

What should I do after treatment?

Some lasers operate with bright flashes of light during a session. In others, the beam is invisible to the person. Whichever method is used, most people describe feeling slightly dazzled or say that their vision is affected for a while immediately after treatment. However, vision should return to normal after a few hours. It is a good idea to ask a friend or family member to come home with you after a session, and to allow yourself time to rest quietly.

As your eyes will take time to return to normal after the treatment, remember to:

  • take sunglasses with you as your eyes may be more than usually sensitive to bright light for a while
  • arrange for someone to drive you home, because the dilating drops will temporarily blur your vision.

Are there any side effects?

  • Some people develop macular oedema (gathering of fluid in the macula, causing swelling) after laser treatment. This may cause a temporary worsening of vision, but in most people this improves within a few weeks.
  • People who have had many sessions of laser treatment may notice some loss of quality in their sight. This is because laser treatment burns abnormal vessels in the retina but can also damage healthy parts of the retina.
  • Also, if people have had many sessions, the edges of vision, called the ‘peripheral visual field’, may sometimes be reduced. This means that driving would be unsafe in this instance, even if your central vision is quite good.
  • People may have difficulty seeing in low light or at night, distinguishing colours, and may also see shimmering or flashing lights.

Anti-VEGF (intra-ocular) injection

An anti-VEGF injection is for the treatment for maculopathy and can stablise and help rapidly improve vision.

Vascular endothelial growth factor (VEGF) is a protein produced by the retina that stimulates the growth of new blood vessels. It is part of the system that restores the oxygen supply to tissues when blood circulation is inadequate. It is activated when blood vessels are blocked due to high blood glucose levels. In recent years new treatments, called anti-VEGFs, have been developed to bind to and inhibit VEGF.

  • Lucentis, made by Novartis, is currently the only anti-VEGF ophthalmic treatment licensed for use in patients with maculopathy in the UK. The intra-ocular treatment is injected directly into the eye and helps to reduce the leakage of fluids into the macular.
  • Avastin, made by Roche, is another anti-VEGF but is approved as a treatment for colon and rectal cancer. Some eye specialists (opthalmologists) use Avastin in the eye. However, it is not licensed for use in the eye.

What’s the procedure?

The treatment is administered during an outpatient appointment by an ophthalmologist and you will be able to go home afterwards. You will be given antibiotic eye drops to prevent infection, a few days before or just before your treatment.

  1. Anti-VEGF drugs are given as an injection, and this may be done in an operating theatre or a clean room.
  2. The eye and skin around it will be cleaned to prevent infection, and your face and the area around the eye will be covered by a drape to keep the area sterile.
  3. A small clip (a speculum) will be used to keep the eye open.
  4. Local anaesthetic eye drops will be used to ensure the injection is painless.
  5. The needle used is very sharp, small and short. The injection itself only takes a few seconds and feels like a tiny scratch.
  6. Your eye pressure will be measured following treatment.
  7. You will not be required to wear sunglasses after anti-VEGF treatment.
  8. You should arrange for someone to drive you home, because the treatment may temporarily blur your vision.

Are there any side effects?

Your eye pressure may go up for a few hours and, if it remains high, treatment may be required. Your vision may be blurry for several hours afterwards due to the dilating eye drops, but this should improve by the next day. You may also see the medicine floating around your eye for the next few weeks.

By one month after your first injection most people will notice some improvement in vision – however, it is recommended that all patients receive further injections at one-monthly intervals until there is no further improvement in vision seen for three consecutive months. When this happens, your treatment is stopped, but it is important that your vision is regularly checked to see if further treatment is required.

Steroid

Iluvien, made by Alimera Sciences, is an implant (a tiny tube) that is inserted into the affected eye to treat vision loss associated with chronic diabetic macular oedema. It is recommended as an option when other available treatments have failed to help.

The implant contains a steroid that has anti‑inflammatory and anti‑VEGF properties. This is a sustained-release low-dose long-acting steroid, so it is released in very small amounts over a period of about 3years. In some cases, an additional implant may be administered after 12 months.

What's the procedure?

The procedure is done by an ophthalmologist who will administer an injection into the affected eye, under local anaesthetics.  To prevent infections, antiseptic drops will be applied to the eye. Iluvien is not recommended to be injected into both eyes at the same time.

Are there any side effects?

Your vision may be affected after the procedure so it is advisable not to drive until this has resolved.

Other possible side effects include cataract, increased eye pressure, floaters, glaucoma, blurred vision, eye pain, an infection inside the eye, headaches etc.

It is important to read the Patient Information Leaflets (PIL) and discuss any concerns you have with your healthcare team.

Vitrectomy

This is an operation that may be done when a haemorrhage does not clear within several weeks, or when the person has advanced proliferative retinopathy, or when the retina detaches or peels away from its underlying tissue. This surgery may restore useful vision but it is a major procedure and you need to discuss how well it may work with your eye specialist.

What’s the procedure?

During this operation the vitreous, which gives shape and support to the back of the eye, is surgically removed and replaced with a clear substance. This operation is usually done under general anaesthetic, requiring a stay in hospital. The outcome depends on a number of factors. The best person to advise you on your suitability for this or any other eye treatment is your eye specialist.

Are there any side effects?

You may find your vision is blurred for several weeks. It’s quite common for your eyes to be sensitive, swollen or red following the operation.

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