What is the treatment for diabetic retinopathy?
The treatment of diabetic retinopathy is decided on the basis of the stage of the disease. In the very initial stages, it just requires periodic follow up to look for progression of disease. The ophthalmologist decides when to see a patient next depending upon the severity of changes in the retina.

Later when the disease is more advanced he/she may decide to treat it with one or more of the following options:

Laser Treatment : There are well-defined criteria for laser therapy. Laser therapy is done when there is significant maculopathy, or when there are significant new blood vessels in the retina or iris.

Anti-VEGF agents (Lucentis, Avastin, Macugen) : These agents are being used in some selective cases alone or in addition to laser treatment or surgery.

Surgery : Vitrectomy surgery and other additional procedures may be required to manage the complications of diabetic retinopathy, like vitreous hemorrhage, retinal detachment, severe macular edema, etc.



What is Laser treatment?
Most sight threatening complications of diabetic retinopathy can be prevented by laser treatment if given early enough. It involves focusing and applying laser spots on the retina. There are two types of laser treatments depending upon the type of retinopathy:

Diabetic maculopathy: This is treated be applying laser spots in the region of macula to seal the leaking blood vessels.

Proliferative diabetic retinopathy: This condition requires more extensive application of laser in a wider area of retina. It helps the abnormal new vessels to shrink and disappear. It may require more than one sitting to complete the treatment.

It is important to remember that the laser treatment is done to prevent further loss of vision and not to improve the vision. It is highly effective and can prevent blindness in about 80% of the patients.

After the laser treatment, regular follow-ups are required to assess the effect of treatment and to monitor the progress of the disease.

How is the laser performed?
Laser treatment is performed as an outpatient procedure, that is you don't have to be admitted for it. The pupil of the eye is dilated using eye drops. The eye is then numbed with drops (topical anesthetics) so that you don't feel the pain. The patient is seated on a machine and a small contact lens is placed on the cornea. Following this laser treatment is given by this very precise machine. During the treatment, you may be asked to move your eyes in certain directions.

What are the side effects of laser?
The laser treatment may have a few side effects like decrease in the peripheral field of vision, decrease in color vision and difficulty in seeing at night. Sometimes it may also reduce the central vision. This is usually temporary but sometimes this may not improve.

Though no treatment is without any side effects, the risk of the laser treatment are far less than the risk of not having the treatment.

What are Anti VEGF agents, and what is their role in managing diabetic retinopathy?
These agents (Lucentis, Avastin, Macugen) are emerging as the new modality of treatment for various stages of diabetic retinopathy and are showing very promising results. These agents are injected within the eye (intravitreal injection) in a very small painless procedure, inside the OT under aseptic precautions.

What surgery is done for diabetic retinopathy?
In some patients in which the disease is not controlled by the laser, or who have reached the advanced stage of disease, the ophthalmologist may advise a surgery called vitrectomy. The surgeon removes the blood filled vitreous and replaces it with a fluid, using very delicate instruments with the help of a microscope.

Since the blood in the vitreous cavity is replaced by a clear fluid, the light can reach the retina now. This may help restore vision.