Everywhere there are articles about the epidemic of diabetes in the world. The US has the highest prevalence of diabetes of developed countries. As a retina surgeon, I see the misery that this disease causes. My diabetic patients not only are on their way to blindness, but many of them are on dialysis, have lost legs, and suffer from many other unpleasant conditions. Fortunately in diabetic eye treatment, there have been many breakthroughs.
The most common cause of blindness in diabetics is swelling of the macula, the center part of the retina. This happens when the glucose level exceeds the normal level and damages the walls of the blood vessels. The traditional treatment was to laser where the leaks were and this worked well. However the average result was that the vision stayed the same so any vision that was lost before the laser treatment was permanent. Today we have antigrowth hormones that block the pathway that starts the damage and this allows the body to heal. The injections are placed through the white part of the eye and are usually given every one to three months. The vision often improves. The other amazing finding is that the severity of the disease decreases after several years of treatment. Treated patients are less likely to need more aggressive treatment like laser or hospital surgery.
Other drugs that decrease the swelling are corticosteroids, a prednisone like medication. These come in the form of slow release pellets lasting from a few months to one that lasts up to three years. I find these very helpful for patients that have difficulty with the rather strict appointment schedule. Some patients after stabilization with the antigrowth hormone drugs do well with the long acting corticosteroid pellet. Patients have a lot of anxiety about eye injections and they are relieved to have an injection that lasts years. Unfortunately for the patient with a lot of damage, these do not work as well as the antigrowth hormones.
Although we use the laser much less than 10 or 20 years ago, it is still vital for many patients. A newer laser, micropulse, stimulates the pumps in the retina to pump out fluid from the leaky diabetic vessels. It is great for patients that have mild amounts of fluid and don’t want to start injections. It is also useful for patients that have had some of the antigrowth injections and are reluctant to keep going. The results are not as good as with a strict injection schedule but still very worthwhile.
Earlier treatment still results in better vision. A large number of diabetic patients are still not seen promptly. Many don’t go for an eye exam when they are diagnosed with diabetes and also miss their annual exam. Patients may not understand the importance of the eye exams because diabetic damage does not cause symptoms until it is severe. The new treatments will prevent an epidemic of blindness only if used in time.
Igor Westra MD
Retina of Coastal Carolina
1801 New Hanover Medical Park Dr., Wilmington, NC 2840