Diabetic Retinopathy

Diabetic retinopathy is a complication of diabetes that affects the blood vessels of the retina. It occurs when these vessels weaken and begin to leak, leading to swelling, bleeding, and a loss of oxygen and nutrients in the retina. Over time, this can result in significant vision loss.

While there is no cure, annual dilated eye exams are essential for early detection, diagnosis, and treatment. According to recent data from the Centers for Disease Control and Prevention, diabetes affects approximately 26 million people in the U.S., and nearly 10 million individuals aged 40 and older have diabetic retinopathy. Diabetes is now the leading cause of new blindness in adults aged 20–74.

Stages of Diabetic Retinopathy

Diabetic retinopathy progresses in stages:

  • Mild Nonproliferative Retinopathy:
    This earliest stage is marked by “dot” and “blot” hemorrhages and microaneurysms in the retina. It may occur without any changes in vision and often doesn't require treatment unless it progresses or is accompanied by diabetic macular edema (DME).
  • Moderate Nonproliferative Retinopathy:
    In this stage, some retinal blood vessels become blocked, reducing the retina’s oxygen and nutrient supply.
  • Severe Nonproliferative Retinopathy:
    A significant number of vessels are blocked, leading to retinal ischemia, or oxygen deprivation, which puts the retina at risk for further damage.
  • Proliferative Retinopathy:
    This advanced stage involves the growth of abnormal, fragile blood vessels-a process called neovascularization-in response to ischemia. These vessels may bleed into the vitreous and can lead to vision-threatening complications, even if vision is still good. Prompt treatment is crucial to prevent permanent damage.

Diabetic Macular Edema (DME)

Diabetic macular edema is a major cause of vision loss in diabetes. It occurs when leaky retinal vessels cause swelling in the macula, the central area responsible for sharp vision.

DME can develop at any stage of diabetic retinopathy and varies in severity. We use Optical Coherence Tomography (OCT) to detect even subtle macular thickening. Early detection is key for effective treatment.

Most patients benefit from intravitreal injections of anti-VEGF medications such as:

  • Eylea® (Aflibercept)
  • Eylea HD® (Aflibercept)
  • Avastin® (Bevacizumab)
  • VABYSMO® (Faricimab)
  • Lucentis® (Ranibizumab)

Steroid implants may also be used in some cases:

  • Ozurdex® (Dexamethasone)
  • Iluvien® (Fluocinolone Acetonide)

These treatments help reduce swelling and stabilize vision, though they may not restore vision already lost.

Treatment of Diabetic Retinopathy

Treatment depends on the stage and severity of the disease. The goal is to stabilize, prevent progression, and, in some cases, reverse damage.

Nonproliferative Retinopathy Treatment

In early stages (mild to early severe), treatment may not be necessary unless DME is present. Close monitoring is essential.

Diabetic Macular Edema Treatment

Traditionally, retinal laser photocoagulation was used to seal leaky vessels. This may still be used to stabilize vision, reducing the risk of further loss by up to 50%. However, improvement in vision is less common.

Intravitreal anti-VEGF injections and steroid implants are now the first-line treatments for most patients with DME, offering less tissue damage and greater visual potential than laser alone.

Proliferative Retinopathy Treatment

Advanced stages are treated with scatter laser photocoagulation to shrink abnormal blood vessels. This involves placing 1,000–2,000 laser spots in the peripheral retina, often requiring multiple sessions.

While side effects may include decreased night vision or peripheral vision, this treatment is vital to prevent further vision loss.

Anti-VEGF injections may be used alongside or instead of laser treatment, depending on the specific case.

When Surgery Is Needed: Vitrectomy

If bleeding into the vitreous (vitreous hemorrhage) does not clear, or if a retinal detachment occurs, a vitrectomy may be necessary. This surgical procedure involves removing the vitreous gel, clearing any blood, and carefully removing scar tissue from the retina’s surface to restore or preserve vision.