This activity for Diabetic Retinopathy education is provided by Med Learning Group.
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Treatments For DR
Not all diabetic retinopathy (DR) needs treatment, but when it does, it is personalized for each patient.1 Treatment for DR has been found to be extremely effective in preventing severe vision loss.2 Vision may improve with treatment, however, generally the better the vision is prior to treatment, the better the vision will be after treatment.3
Stages and treatments:1
- Mild and moderate nonproliferative diabetic retinopathy (NPDR) will be monitored with frequent follow up appointments with your eye doctor
- Severe NPDR or proliferative retinopathy (PDR) will likely require prompt treatment
- Diabetic macular edema (DME), which can occur at any stage of retinopathy, will likely require prompt treatment
Types of treatment:
- Panretinal photocoagulation (PRP): A laser is used to make many small burns in the retina to reduce the likelihood of neovascularization of the retina.4
- Focal Laser: A laser used to make one or a few small burns in the retina to treat damaged blood vessels.5
- Anti-vascular endothelial growth factor (anti-VEGF) medication: This medication is injected into the eye to prevent blood vessels from leaking and prevent neovascularization.6 It is also used to decrease swelling from diabetic macular edema (DME).7
- Corticosteroid medication: This medication is injected into the eye to reduce inflammation and swelling in the retina.1
- Vitrectomy: A surgical treatment option for eyes with persistent vitreous hemorrhage (bleeding in the gel like tissue in front of the retina) or eyes with persistent disease despite medical, laser and injection treatment.1
Pain with eye injection is mild for the majority of people.12 There are medications to control pain when treatment with injection or laser is needed.12,13
References
- Flaxel CJ, Adelman RA, Bailey ST, et al. Diabetic Retinopathy Preferred Practice Pattern®. Ophthalmology. 2020;127(1):P66-P145.
- Ferris FL 3rd. How effective are treatments for diabetic retinopathy? JAMA. 1993;269(10):1290-1291.
- Sophie R, Lu N, Campochiaro PA. Predictors of functional and anatomical outcomes in patients with diabetic macular edema treated with ranibizumab. Ophthalmology. 2015;122(7):1395-1401.
- The Diabetic Retinopathy Study Group. Indications for photocoagulation treatments of diabetic retinopathy: Diabetic Retinopathy Study Report no. 14. Int Ophthalmology Clin. 1987;27(4):239-253.
- Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinic guidelines for photocoagulation of diabetic macular edema. ETDRS study report number 2. Ophthalmology. 1987;94:761-774.
- Writing Committee for the Diabetic Retinopathy Clinic Research Network. Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinic trial. JAMA. 2015;314:2137-2146.
- Mitchell P, Bandello F, Schmidt Erfurth U, et al. The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology. 2011;188:615-625.
- Kaplan HJ. PRP Laser. Retina Image Bank. 2013;5338. https://imagebank.asrs.org/file/5338/prp-laser
- American Academy of Ophthalmology (AAO). Proliferative and nonproliferative diabetic retinopathy. 2013. https://www.aao.org/munnerlyn-laser-surgery-center/laser-treatment-of-proliferative-nonproliferative-
- Herts Eye Surgeon. Anti-VEGF Therapy. https://hertseyesurgeon.co.uk/antivegf-therapy/
- GWeyeAssociates. Vitrectomy for floaters: is it a viable treatment? https://www.gweye.com/blog/2018/09/17/vitrectomy-for-floaters-is-it-193545
- Shiroma, HF, Takaschima, AKK, Farah, ME, et al. Patient pain during intravitreal injections under topical anesthesia: a systematic review. Int J Retina Vitreous. 2017;323.
- Wu, WC, Hsu, KH, Chen, TL, et al. Interventions for relieving pain associated with panretinal photocoagulation: a prospective randomized trial. Eye. 2006;20:712-719.
All URLs accessed 4/21/22.
