Level 4, 187 Macquarie Street
Sydney NSW 2000
Phone: 02 9247 9972
Fax: 02 9232 3086
Email: patientservices@eyeassociates.com.au

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What can be done and how can you help?

With Diabetic Retinopathy it is easier to prevent loss of vision than to restore lost vision. Regular check ups are essential for people with diabetes to detect vision threatening diabetic retinopathy. Even when vision appears normal your eye doctor may need to apply treatment  to prevent loss of vision.Eye examinations should begin at the time you have been diagnosed with diabetes then you will be reviewed as directed by your ophthalmologist. People with no diabetic retinopathy are reviewed every two years. People with diabetic retinopathy are reviewed more frequently depending on the extent of the disease.diabetic

The focus of control in Diabetes is the blood sugar level, however Diabetes is best thought of as a blood vessel disease. The small and large blood vessels throughout the body are damaged by Diabetes either by particularly erratic blood sugar levels over the shorter term or eventually over decades even in the best controlled diabetic patients. Diabetic eye examinations are essential to preserve of your vision. They also allow us to inform your team of doctors (your GP, Endocrinologist) as to the likely state of the similarly sized vessels in your kidneys and brain. We are lucky enough to see the vessels directly in the back of your eye. At your consultation we will be particularly looking for Diabetic damage to the Macula (Diabetic Maculopathy and Diabetic Macular Oedema) and whether you have developed fragile new blood vessels (Proliferative Retinopathy) that could bleed and fill your eye with blood. Both of these problems are treatable and better detected early rather than after your vision is reduced.

Keeping blood sugar levels as normal as possible will help reduce the risk of developing diabetic retinopathy. Discuss with your GP the best ways to reduce blood sugar levels. If you are having difficulties it is a good idea to consider seeing an endocrinologist with a particular interest in diabetes. These specialists are also known as ‘Diabetologists’.

The best measure of the blood sugar control is the ‘glycosylated haemoglobin’, or HbA1c. The results of this test, which measures the amount of glucose that attaches to your red blood cells over a three month period, is the strongest predictor we have of whether you will lose vision or not. You should set a target glycosylated haemoglobin level in consultation with your doctors and strive to achieve it. Unfortunately, a significant period of poor blood glucose control increases the risk of loss of vision for up to ten years even if you are able to bring your glycosylated haemoglobin to near normal levels. Diabetic retinopathy rarely goes away (sometimes it does in the early phases) even when blood glucose levels improve dramatically, but improving blood sugar levels reduces the risk of further progression.

The other risk factor that you can work on is high blood pressure. Even small reductions of blood pressure have a highly beneficial effect on your eyes for a prolonged period.

The most useful test to detect diabetic retinopathy is a dilated examination by an Ophthalmologist with specific training in Diabetic Retinopathy. At Eye Associates, Professor Gillies and Dr Hunt sub-specialise in diabetic retinopathy. If other tests are required such as macular scans (Optical Coherence Tomography) or a dye test to demarcate areas of leakage (Fluorescein Angiography) they are available on site, as are treatment facilities including Retinal Laser and Intravitreal injections should they be necessary.”

Eye Injections for Diabetic Maculopathy

Over the last 10 years, injections of drugs into the eye have become first line treatments for most cases of diabetic macular oedemawith decreased vision. High concentrations of powerful drugs can be injected into an eye with very little of it getting into the blood so the risk of side effects in other parts of the body is very small (but not completely absent). These drugs can be highly effective but usually need to be repeated, sometimes frequently. They reduce leakage and the resultant retinal swelling or oedema from diseased vessels. They also lead to temporary regression of new blood vessels. For more information of eye injections see CLICK HERE TO INTRAVITREAL INJECTIONS INFORMATION

Laser Treatment For Diabetic Maculopathy

Laser treatment used to be the mainstay of  treatment  for decades but still has a place in Diabetic Maculopathy. Although injections have reduced the need for laser significantly, laser is still a very helpful treatment option for small areas of diabetic leakage around the macula. Laser treatment may allow a patient to avoid or reduce the burden of intravitreal injections. Often laser is not possible if leakage is too close to the centre of the macula as treatment could damage the central vision, particularly in patients with severe diabetic retinopathy who need multiple treatments. However, even when the side effects are taken into account, laser treatment is still highly effective because it reduces the risk of loss of reading and driving vision in eyes with vision threatening macular oedema from 1:3 without treatment, to 1:10 over a three year period.

Laser treatment for Proliferative Diabetic Retinopathy

Laser treatment of proliferative diabetic retinopathy is a more extensive treatment, called ‘pan retinal photocoagulation’ (PRP), in which the diseased peripheral retina is destroyed. This treatment removes the signal leading to new blood vessel growth This is performed in two to four sessions per eye, with around 400 laser burns per session. This can be quite painful – some patients feel it more than others. If the pain is intolerable then a ‘block’ can be performed by injecting local anaesthetic behind the eye, but it is best to avoid this if possible.

Adverse events associated with PRP include reduced visual field and impaired night vision, sometimes (but usually not) to an extent that may impair your ability to drive. PRP does not improve central vision, sometimes it makes it a little worse. However, these adverse events rarely stop an eye doctor strongly recommending PRP to patients with proliferative diabetic retinopathy because once patients develop this condition they have a 50% chance of becoming blind over a five year period, PRP reduces this risk to only 5%.

PRP laser treatment is ideally performed on proliferative diabetic retinopathy when the vision is still normal. If the treatment does not work the eye may still go blind – but that does not mean that the laser treatment caused the blindness. Sometimes the harsh reality is unavoidable – that  these eyes were going to go blind anyway and the laser treatment failed to prevent it.

Other treatments for Diabetic Retinopathy

Prof Gillies Research Unit at the Save Sight Institute, University of Sydney, often conducts clinical trial of new drugs for diabetic retinopathy, often as part of global studies. Dr Hunt is involved in similar studies at Western Sydney Eye Hospital within the Westmead Hospital Campus of the University of Sydney.Participation in these studies will be offered to patients who may benefit from them.

Surgical treatment, including removal of the vitreous (vitrectomy) in eyes with advanced diabetic retinopathy can also be helpful in advanced disease. These treatments will be discussed with you further by your eye doctor if appropriate.