Diabetes is a disease of blood sugar metabolism that can affect blood vessels all over the body. Small blood vessels in the kidneys and retina – the lining of the back of the eye – are especially susceptible to damage, even more so after many years of diabetes. When diabetes affects the retina, this is known as diabetic retinopathy. The ‘central’ part of the retina, the ‘macula’, is important for your best vision. If this is affected it is known as diabetic maculopathy. The damage to blood vessels is caused by chronic high sugar levels within the cells, which have resulted in many complex pathways of inflammation being activated. High blood pressure is also very significant in adding to blood vessel damage.
Early changes in the retina do not usually cause symptoms, but it is crucial to detect these quickly. We use a number of different imaging tools for this – widefield retinal photography with Scanning Laser Ophthalmoscopy (SLO), Optical Coherence Topography (OCT) and Fluorescein Angiography (FFA).
Monitoring may be sufficient in many cases but, if treatment is necessary, we have a number of treatments available which are extremely effective at keeping the retinopathy under control.
The best control of your diabetes and blood pressure is essential to reducing the risk of progression in these changes.
With regular monitoring – yearly if there are no changes, and more often as necessary – the risks to your vision are very low, as treatments started early are most effective.
Treatment of diabetic eye disease (DED) focuses on stopping the disease process that may result in reduced vision if left untreated. Clinica London has five Consultant Ophthalmologists providing specialist medical and surgical retina care, including for diabetic eye disease.
There are 2 main causes of reduced vision from diabetes:
This is a type of ‘light’ treatment that is performed at a slit-lamp, the instrument you have your eyes examined on by the ophthalmologist. This can be useful either performed on its own or alongside the treatments below.
Laser treatment works by drying up any leaks in the macula area and slowing any further leakage of fluid. This may not improve vision, but it is effective in some cases to stop vision from getting worse.
Prior to treatment, you will be given dilating eye drops. These open up the pupil of the eye and helps the doctor to see the back of the eye clearly during treatment. The drops can cause blurred vision for up to six hours, so you should ensure that someone else drives you home after your appointment.
The treatment usually takes around 15 minutes and is not painful. It’s important to follow the doctor’s instructions during treatment and try to keep the eye and head as still as possible.
Following treatment, you may experience some mild discomfort and vision change. This can last for 24-48 hours. It can take up to four months for laser treatment to fully take effect.
The mainstay of treatment for DMO is an injection into the white of the eye using drugs targeting a particular chemical – Vascular Endothelial Growth Factor (VEGF) – which occurs naturally in the eye and around the body, is important for blood vessel growth. An excess of this chemical can be problematic and responsible for DMO for example. The drugs used come under the heading “Anti-VEGF” drugs.
Eye injections may involve a number of different drugs given by a quick injection. There are various drugs available and the doctor will discuss with you which ones are best suited to your circumstances. Patients generally have a course of injections, sometimes over a period of several years.
A primary treatment method involves injecting anti-angiogenic (anti-VEGF) drugs into the white of the eye. This treatment can stop abnormal blood vessels from growing and can control the leakages. The timing and review periods for these injections are extremely important.
Anti-VEGF medication may be recommended for macular oedema. It can help to stem the growth of damaged vessels and reduce swelling and leakage. Beovu is another anti-VEGF.
i) Corticosteroid implant – this implant lasts for 4-5 months in the eye, giving a longer-lasting effect than the antiVEGF drugs. It has some differences in the way it works and may be used in the first instance in some cases, or in other cases antiVEGF drugs may be more appropriate to use first.
ii) There is another long-acting steroid implant that may be suitable in some cases and can last for up to 3 years.
Some patients do not respond to treatment with anti-VEGF injections, or this treatment is not suitable for them for other reasons. For these patients, treatment with steroid-based drugs is often considered.
The two different drugs used for steroid treatment that are both given as an injection into the eye as with the anti-VEGF drugs, but one of the two is delivered as a steroid-releasing implant which is discharged slowly over a period of up to three years. The other one is delivered as a pellet of steroid which dissolves over a time span of between three and six months.
It’s very rare for macular oedema to go away on its own. If left untreated, it can cause serious complications including permanent sight loss. There are treatments available to reverse the damage and slow the progression of the disease. Your doctor may decide to combine laser treatment and injections in some cases.
In specific cases in which the macular oedema is caused mainly by a band that is pulling on the retina – “tractional macular oedema” from a vitrous or epiretinal fibrosis. This is more unusual but if present, can be treated with retinal surgery by the Clinica London vitreoretinal surgeons, Ms Evgenia Anikina and Mr Julian Robins.
At Clinica London, we have five medical and surgical retinal specialists to care for all your diabetic eye disease (DED) needs.
Assessment involves consultation, measurement of your vision, eye pressure, a wide field colour retinal imaging with the Optos Californian retinal Scanning Laser Ophthalmoscopy (SLO), which also shows the deeper layers of the choroid and can see 170 to 200 degrees of retina. In addition a three-dimensional scan with the Spectralis ocular coherence tomography (OCT) retina and macula scan OCT, which shows the various cellular levels of the retina, macula optic disc. Both of these latest eye imaging techniques provide detailed scans of your retina and help assessment, diagnosis and planning and monitoring of your treatment.
We will advise you about which treatment is most suitable for your eye. Different treatments may be required at different times, and each eye may require different treatment or it may be that only one eye requires treating at any one time. The most important part of managing the diabetic changes in your eyes is that you are seen regularly, as early changes may not cause any symptoms. It is also very important to have the best diabetic, blood pressure and cholesterol control possible. Your GP and/or diabetes specialist will be required to assess this regularly, in conjunction with your medical retinal specialist at Clinica London. If vitreoretinal surgery is required, our team is on hand to do this.
If you are interested in seeking treatment for diabetic eye disease, macular oedema or any other eye condition, find out more about our team of experts. We will be delighted to hear from you to discuss how we can help to improve your symptoms and long-term eye health.
Telephone: 020 7935 7990
International Callers : +44 20 7935 7990
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