Diabetic retinopathy can cause swelling of the center of the retina, the macula, and vision loss.
Diabetic macular edema is swelling in the retina associated with diabetes. This swelling can blur and distort the vision. The swelling occurs because the walls of the small blood vessels are progressively more damaged in diabetes, and there is leakage of blood and fluid into the cells of the retina. There are a variety of options to treat diabetic macular edema. The oldest treatment is laser for retinal swelling. It has been studied for decades and has been shown to be safe and effective. As with all treatments, it is not curative, and it is not without risk, but laser is one of the safest things that we do in diabetic retinal care. Other newer treatments for diabetic retinal swelling have been shown to improve vision even more than laser in some cases, and have also been shown to be safe and effective in large modern trials. These treatments are a variety of injections given into the eye in the office, and they are sometimes given alone and sometimes given with laser in addition. There are two major classes of injections used in diabetic macular edema, and those are small molecule injections and corticosteroid injections. The injections work in different ways to reduce the leakage and swelling in the retina, and sometimes the different types of injections are both used. The injections are administered under local anesthesia, and are often relatively well-tolerated by patients. Injections are also amongst the safest procedures performed in the retinal clinic, and the specific risks and benefits of injections will be discussed by your doctor. Most patients with blurred vision from diabetic macular edema enjoy an improvement in vision with treatment. Often, treatment to maintain vision is ongoing, and the long-term treatment plan is individualized to each specific patient in our practice.
When diabetic macular edema is caused by focal areas of leakage, laser treatment can be helpful. Studies were done in the 1980's validating the use of laser to reduce the risk of vision loss and improve vision in patients with diabetic macular edema. The advantage of laser of intravitreal injections is that laser treatment usually only needs to be repeated a few times. Intravireal injections are given monthly. The disadvantage of laser, is that it does not improve vision as much as intravitreal injections do when the center of the macula is swollen. Many physicians will use both laser and intravitreal injections depending on the area of the macula that is swollen and the findings on examination and testing.
Monthly Lucentis therapy is helpful for patients with diabetic macular edema. With laser only, about 15 percent of patients have substantial visual improvement at 2 years. With Lucentis therapy, about 40 percent of patients have a substantial improvement in visual acuity. Subsequent studies have shown that ongoing monthly treatment is usually not necessary to maintain the visual benefit.
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