The maculopathy (macular edema)
By Some patients it comes to an escape of fluid and blood components in the point of sharpest vision, the macula. This is called macula edema and can lead to significant Vision reduction.
What does the patient notice?
The insidious thing of diabetic retinopathy is the symptom poverty in the early stages. The first microaneurysms and exudates in the retina almost never lead to subjective complaints. For this reason, in about 30 to 35 percent of type 2 diabetes, when the metabolic disease is diagnosed, there already exist retinal changes. Often it is even an eye exam that can only arouses the suspicion of diabetes and the eye doctor, through the examination of the fundus who notices the characteristic vascular changes.
Only when the point of sharpest vision, the macula is involved, the patient notices very quickly that with his eyes, something is wrong.
In addition of the fundus examination (ophthalmoscopy) depending on the stage of the disease examination such as fluorescence angiography, which represents the blood vessels of the retina, may be needed. Especially before a laser treatment, this is obligatory.
In the last years a new laser technology, the optical coherence tomography (OCT), is used, many times in combination with the angiography.
This method is particularly suitable for the detection and evaluation of the progression of diabetic macular edema. All forms of retinopathy remain asymptomatic for most patients for a very long time. Only in the late stage by participating the macula, or vitreous hemorrhage, the patient notices a worsening of his vision.
The treatment of diabetic retinal disease depends on the stage of the diabetic retinopathie.
A true “cure” of diabetic retinal disease, is not possible at present. Nevertheless, it is through various treatments and good control of diabetes, an improvement of the vascular damage can be reached. In general, the earlier the diabetic retinal disease is detected and the sooner the treatment begins, the better the chances of success.
The patient plays the main role in the therapy: by consistent implementation of diabetes therapy with adequate nutrition, avoiding smoking and excessive alcohol consumption.
Retinal laser therapy
Laser therapy is an indication once neovascularization have been formed or vitreous hemorrhage. There are different procedures available:
Panretinal laser treatment: this laser treatment reduces the oxygen consumption of the scarred retina, so that is improving the oxygen supply situation of the retina. Possible side effects of the therapy are disturbances of color vision and dark adaptation.
Focal laser treatment: This method is being chosen at the onset of macular edema.
New anti-VEGF therapies
By the treatment of diabetic macular edema new treatment options have been introduced. Injections of drugs directly into the vitreous of the eye (intravitreal injections) have been established in the recent years as a treatment method:
Anti-angiogenesis drugs (anti-VEGF). These agents block the vascular growth-promoting substances directly in the eye and can thus lead to a decrease of themacular edema. Often they are repeatedly injected at intervals of several weeks in the eye. (Drugs: bevacizumab, ranibizumab and pegaptanib).
When a persistent hemorrhage into the vitreous or a retinal detachment exists then a removal of the vitreous (vitrectomy) is needed. The vitreous is replaced by gas or silicone oil, in order to attach the retina again.
The successful treatment of diabetic retinopathy depends from the early diagnosis of the diabetes, the early diagnosis of the retinopathy and the consistent therapy. Because diabetic retinopathy can progress for long periods without causing any significant discomfort, the diabetic patients once a year visit the eye doctor. If he shows signs of diabetic eye disease, the examinations should be repeated at shorter time intervals (usually every 3-6 months).