Amy M. Rudser, O.D.
17685 Juniper Path Suite 205
Lakeville, MN 55044
Phone: 952-898-4088
Fax: 952-898-0883
Zoom text:
Frequently Asked Questions
Diabetes
Complications and Treatment
Complications
The abnormal growth of new blood vessels in proliferative diabetic retinopathy doesn't re-supply the retina with a normal blood flow. Instead, these abnormal vessels may produce other complications:
- Vitreous hemorrhage: The new blood vessels may bleed (hemorrhage) into the vitreous. If the amount of bleeding is small, you might see only a few dark spots or floaters. In more severe cases, blood can completely fill the vitreous cavity and block all of your vision. Vitreous hemorrhage by itself usually doesn't cause permanent vision loss. The blood often clears from the eye initially - within a few weeks or months - and your vision may return to its previous clarity, unless your retina is damaged.
- Traction retinal detachment: The new blood vessels, if not stopped early in their development, are accompanied by the growth of scar tissue. The scar tissue can shrink and pull the retina away from the back wall of the eye. This causes blank or blurred areas in your field of vision, or in severe cases, complete loss of vision.
- Neovascular glaucoma: The proliferation of blood vessels in the retina and vitreous may be accompanied by the growth of abnormal new blood vessels on the iris. This can interfere with the normal flow of fluid in your eye and cause pressure in your eye to build up. The result is neovascular glaucoma, a serious complication of diabetic retinopathy that can cause damage to your optic nerve and significantly deteriorates your field of vision.
Treatment
How is diabetic retinopathy treated?
During the initial stages of diabetic retinopathy, usually no treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.
The two main treatments for diabetic retinopathy are photocoagulation and vitrectomy. In many cases, these treatments are effective and slow or stop the progression of the disease for some time. But they're not a cure. Because diabetes continues to affect your body, you may experience further retinal damage and vision loss at a later time.
Proliferative retinopathy is most often treated with laser surgery (photocoagulation). This procedure is called scatter laser treatment which helps to shrink the abnormal blood vessels. Approximately 1,000 to 2,000 laser burns in the areas of the retina away from the macula are performed, causing the abnormal blood vessels to shrink. Due to the high number of laser burns that are necessary, two or more sessions are usually required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight and also reduces the chances of a vitreous hemorrhage or traction retinal detachment. Scatter laser treatment may slightly reduce your color vision and night vision.
Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding. If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye.
Dr. Rudser doesn't perform these procedures, however if she feels that you need it she will refer you to a local ophthalmologist that specializes in treating retinal eye disease.
How is a macular edema treated?
Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Up to several hundred small laser burns in the areas of retinal leakage surrounding the macula are created to slow the leakage of fluid and reduce the amount of fluid in the retina. The treatment is usually completed in one session.
A patient may need focal laser surgery more than once to control the leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart.
Focal laser treatment stabilizes vision. In fact, focal laser treatment reduces the risk of vision loss by 50 percent and can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.
It is also important to realize that although both treatments have high success rates, they do not cure diabetic retinopathy. Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment more than once to protect your sight.
What is a vitrectomy?
If you have a lot of blood in the vitreous gel, you may need a vitrectomy (removal of the vitreous) to restore your sight. The vitreous gel that is clouded with blood is removed and is replaced with a balanced salt solution to maintain the normal shape of the eye. Because the vitreous gel is mostly water, you should not notice a change between the salt solution and the original vitreous gel after the procedure is complete. If you need vitrectomies in both eyes, they are usually done several weeks apart.
Visual perception photos above of ocular disease come from the NIH website.