Diabetic macular degeneration (DME) occurs when high blood sugar levels damage the tiny blood vessels of your retina, which may leak or close altogether or form new abnormal ones that bleed and lead to vision loss.

Northwestern Medicine ophthalmologists conducted a national study which demonstrated that Eylea, one of two existing drugs for treating Diabetic Macular Edema (DME), is superior in improving eye sight for people suffering from vision loss due to diabetes.

Injections of medications called anti-VEGF drugs

Anti-VEGF drugs may help to reduce swelling of the macula, slow vision loss and possibly improve it. They are administered via eye injections (shots). Your doctor will tell you how many shots will be necessary over time.

Diabetes can damage small blood vessels in your retina and lead to diabetic macular edema (DME), where fluid leaks out from damaged vessels into the center of the retina – known as macula – resulting in swelling that obscures straight-ahead vision and requires immediate medical treatment if worsened.

Over the years, researchers have gained much insight into what causes vision loss from diabetes. They’ve discovered that the chemical vascular endothelial growth factor, or VEGF, plays a critical role in creating abnormal blood vessels under the retina that leak blood into the eye causing macular edema or scar tissue that pulls on it to form scar tissue that pulls it apart altogether resulting in retinal detachments. Drugs that block VEGF have revolutionized treatment; retina specialists can use them to slow new blood vessel growth or bleeding by retina specialists using three anti-VEGF drugs: Avastin Eylea and Lucentis.

These medications have been found to be highly effective at reducing floaters and improving vision in people living with DME, though these treatments might not suit everyone; your doctor may suggest another course of treatment depending on your specific circumstances.

As the next step to treating DME, an ultrasound of your retina may be in order. A special machine uses sound waves to produce images of the back of your retina that your ophthalmologist can use to identify any areas of fluid or swelling before administering anti-VEGF medication to stop fluid from leaking and decrease scar tissue formation.

Injections of VEGF drugs may increase intraocular pressure (IOP). You will require regular checks with an ophthalmologist in order to monitor it effectively. There are other drugs which may lower IOP, including Tyseral sodium and Aflibercept, with low risks of arterial thromboembolic events (ATEs) for people living with type 2 diabetes.

Laser surgery

The retina is a layer of cells lining the inside wall of your eye that detects light and sends signals to your brain that allow you to see. High blood sugar levels damage this sensitive layer, and can result in vision loss. Early diagnosis increases chances of successful treatment and less damage will occur; regular dilated eye exams are an essential way of detecting early stages of diabetic retinopathy.

Diabetic retinopathy causes the blood vessels that provide nutrition to your retina to leak, swell, or close off, leading to vision problems such as macular edema and macular ischemia. Hemorrhages also may occur which affect central vision resulting in blurry or blank areas in your field of view.

Laser surgery utilizes high-energy light sources to stop new blood vessels from growing in your eye by creating scar tissue, which limits their development while helping absorb fluid into your system more easily. A special lens will focus the laser onto your retina; typically multiple sessions of laser treatment will be necessary.

If your ophthalmologist detects proliferative diabetic retinopathy, he or she will use scatter laser photocoagulation – an innovative laser treatment technique – to shrink abnormal blood vessels and lower the risk of serious vision loss. Over 1,000 laser pulses will be directed toward areas away from your macula to cause the retinal blood vessels to shrink back down and close off.

At this procedure, anesthetic eye drops will be administered to reduce pain. After receiving this treatment, ask an adult family member or friend to drive you home and rest at home for at least 24 hours after this treatment. Furthermore, try not smoking during this period and continue taking all prescribed medications, particularly any blood thinners that have been recommended by your healthcare provider.

Vitrectomy surgery may be used to treat severe diabetic retinopathy. During this procedure, your surgeon will extract any fluid or debris accumulating on your retina – this treatment may even be combined with laser therapy therapy for maximum effect.

Fluorescein angiography or OCT angiography

OCT or OCT angiography is a diagnostic test that allows your doctor to observe blood vessels within your retina, making this an essential test for people living with diabetes as it shows whether fluid exists in their macula as well as any new blood vessel growth (neovascularization).

At first, eye drops will be given to dilate your pupils. Next, fluorescein dye will be injected into one of your veins (typically arm). A special camera takes pictures as this dye travels through its blood vessels highlighting any that are blocked, leaking or abnormal – as well as showing if any are growing abnormally. This procedure is painless – though you may experience mild flushing or nausea which usually passes within seconds; furthermore, your urine may take on an orange tint for some time after taking this test.

Fluorescein angiography and optical coherence tomography angiography provide more than an assessment of fluid and new blood vessels – it also directs treatment decisions. Studies have revealed that their results agree in at least 85% of cases and can help identify features associated with neovascular AMD such as microaneurysms, hard exudates and areas of macular edema.

However, in some instances of neovascular diabetic macular degeneration (NVDMD), fluid may still be present despite no new blood vessels growing; when this occurs, diagnosis depends on other factors, including history of non-neovascular macular degeneration, presence of other risk factors (high blood pressure or smoking) as well as severity of neovascular AMD.

Sometimes laser surgery alone is insufficient to treat proliferative diabetic retinopathy as the leaky new blood vessels may form scar tissue that pulls on the retina and causes it to detach – this condition is known as vitreous hemorrhage. When this occurs, surgery such as vitrectomy – which removes vitreous fluid and destroys unhealthy abnormal blood vessels – may be required.

Vitrectomy

In severe cases of PDR, when fluid leakage from retinal blood vessels causes the macula to distort or detach itself, vitrectomy surgery may be required. Performed in an operating room setting, vitrectomy involves extracting blood-filled vitreous and replacing it with clear solutions like saline or silicone oil; additionally if a macular hole or tear exists during this microsurgical process the surgeon may use this time to repair it by either inducing a gas bubble into your eye to keep it stable or sealing off with special adhesive; additionally a drug like bevacizumab or triamcinolone may also need injection to help stop fluid leaking again in future years.

Surgery may be used to treat vitreous hemorrhages in the eye, but more frequently it’s used to help those living with diabetic macular edema (DME). Surgery improves vision by draining retinal blood vessels of excess fluid and decreasing fluid pressure within the eye; typically done alongside laser surgery and anti-VEGF drug injections.

Vitrectomy is the primary vitreoretinal surgery performed for proliferative diabetic retinopathy. Additionally, panretinal photocoagulation and intravitreal ranibizumab treatment is often combined to address diabetic macular edema (DME) or neovascular glaucoma.

Under local anesthesia, the surgical procedure is performed, with an eye patch covering it followingward. Although you may experience discomfort, soreness, and blurred vision post-treatment, this should pass within several days and an ophthalmologist may provide eye drops to alleviate your symptoms; if these do not provide relief contact your physician directly.

Vitrectomy can also be used to treat combined traction and rhegmatogenous retinal detachments in diabetic patients with advanced proliferative retinopathy. Such cases feature tightly adhering vitreous and retinal tissue due to active fibrovascular proliferation, with progressive tension leading to retinal breakage due to progressive tension from progressive traction. Vitrectomy’s aim in these instances is typically elevating the posterior hyaloid which adheres strongly at sites of active fibrovascular proliferation or at its interface between vitreous and retinal tissues – something vitrectomy alone cannot do.