Treatment of Diabetic Retinopathy

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

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

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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