Laser Eye Surgery for Diabetic Retinopathy

Diabetic retinopathy is a serious condition that can cause vision loss if not treated on time. Pristyn Care provides optimal treatment for diabetic retinopathy at all stages. We leverage the techniques as required to address the patient’s concern. The treatment options include anti-VEGF and steroid injections, laser treatment, and vitrectomy. 

Pristyn Care has a highly experienced team of ophthalmologists who are well-trained in treating diabetic retinopathy. We have our own clinics and partnered hospitals across India to make the treatment easily accessible for every patient. Our treatment centers have modern infrastructure and top amenities that are essential to provide optimum care to each patient. 

With us, you can rest assured knowing that you will get the best-in-class treatment for diabetic retinopathy at cost-effective prices. You can give us a call and schedule your consultation with our eye specialists. 

Diagnosis 

Diabetic retinopathy is usually detected during a comprehensive eye examination that includes the following- 

• Visual Acuity Test- An eye chart is used to measure how well the person can see at different distances. 
• Pupil Dilation- The pupils are dilated so that the doctor can see the retina clearly to look for signs of diabetic retinopathy. 
• Fundus Photography or Ophthalmoscopy- Ophthalmoscopy is an exam specifically for the retina, which the eye care professional uses- 

1. A slit lamp biomicroscope that has a special magnifying glass to get a narrow view of the retina. 
2. A headset or indirect ophthalmoscope is used to gain a wide view of the retina. 

This test is not sufficient to identify the damage done by diabetic retinopathy. Fundus photography captures the considerably larger areas of the fundus. It creates photo documentation of the central and peripheral retina, optic disc, and macula. 

• Fundus Fluorescein Angiography (FFA)- This examination involves using an imaging technique (a fluorescein dye) to detect the circulation of blood & dye into the retina. It helps to identify the stains of the dye that signifies leakage in the retinal vessels. 
• Retinal Vessel Analysis- This exam is often used by eye care professionals for autoregulation of the retinal arteries and veins before diabetic retinopathy manifests. The earliest marker of the condition is vascular dysfunction which can be successfully analyzed with the help of a special fundus camera. 
• Optical Coherence Tomography- This exam involves using a laser beam interference to produce cross-sectional images of the retina that measures the thickness of the retina to identify swelling. 

All these examinations are done to check the retina and look for early signs of diabetic retinopathy, such as- 

• Leaking blood vessels 
• Retinal swelling 
• Pale, fatty deposits on the retina 
• Neuropathy or damaged nerve tissues
• Abnormal changes in the retinal vessels 

Once an individual is diagnosed with diabetes, he/she is more carefully screened for diabetes-related conditions, such as diabetic retinopathy, diabetic glaucoma, retinal detachment, diabetic macular edema, etc. 

Depending on which treatment the eye specialist has suggested, the preparation steps may slightly differ. No specific preparation is required for injections that are given to slow down the progression of diabetic retinopathy. 

Preparation Before Laser Treatment 

• Ask a family member or friend to accompany you as you won’t be able to drive back home due to blurry vision. 
• The patient is advised to eat proper food and diabetic medications before the surgery. 
• Avoid taking blood thinners, including aspirin, ibuprofen, warfarin, etc. 

Preparation before Vitrectomy 

The instructions given to the patient prior to vitrectomy are somewhat similar to laser treatment. Common guidelines are- 

• Stop taking blood thinners at least one week before the surgery. The doctor will only advise against it if you have an increased risk of blood clots that can cause stroke or heart attacks. 
• Get your eye tested thoroughly and provide all test reports to the doctor team. 
• Take your diabetes medications with a small sip of water. 
• Do not eat or drink anything on the day of surgery. 
• Avoid wearing makeup and wear loose and comfortable clothes. 

The laser treatment involves treating the newly formed abnormal blood vessels at the back of the eye. The laser helps to stabilize the new blood vessels as they are weak and stops the bleeding that prevents the vision from getting worse. 

Laser treatment takes place in the following steps-

• Local anesthesia drops are given to the patient to numb the eyes. Eye drops are used to dilate the pupils and special contact lenses are used to keep the eyelids open during the procedure. 
• The laser is focused onto the retina and then activated. 
• The heat from the laser creates small burns on the abnormal blood vessels. Once the blood vessels are destroyed and sealed, blood doesn’t leak from them, which reduces the swelling in the retina. 
• In some cases, laser photocoagulation is used only to shrink the blood vessels and prevent them from growing again. 

To achieve optimal results, more than one session of the treatment will be required. The treatment is done on an outpatient basis and the patient is discharged after 2-3 hours of observation. 

Risks & Complications of Laser Treatment 

The potential risks and complications associated with laser treatment for diabetic retinopathy are- 

• Reduced night or peripheral vision
• Bleeding into the eye 
• Objects floating in the vision 
• Seeing the pattern made by the laser on the back of the eye 
• Small but permanent blind spot close to the center of the vision 

If your sight gets worse after the treatment, you should see the doctor immediately. 

Either anti-VEGF or steroid injections are given to the patient to slow down the progression of diabetic retinopathy. The treatment takes place in the following steps- 

• The skin around the eyes is cleaned and covered by a sheet. 
• Small clips are used to hold the eyes open. 
• Local anesthetic drops are given to numb the eyes. 
• A fine needle is carefully guided into the eyeball and the medication is inserted. 

Usually, the injections are given once a month to stabilize the vision. Later, the frequency is reduced based on the progression rate. 

Risks & Complications of Eye Injections 

This method can increase the risk of blood clot formation, which can lead to heart attack or stroke. In the case of steroids, there is a potential risk of increased eye pressure which can lead to glaucoma. 

The surgical treatment of diabetic retinopathy involves removing some or all of the vitreous humour from the eye. It is recommended if a large amount of blood has collected in the eye or there is extensive scar tissue that can or already has caused the retinal detachment. 

The surgery includes the following- 

• General anesthesia is given to the patient to numb the eyes, and a lid speculum is used to keep the eyes open. 
• A small incision is made in the sclera (white part of the eye) using a special blade to insert the surgical instruments. 
• A microscope will be inserted to get a clear view of the eye. 
• Tiny instruments will be used to remove all the cloudy vitreous and scar tissues from the retina. 
• The eye surgeon will do other repairs to the eye as required. For instance, if there is a tear in the retina, a laser will be used to repair it. 
• The vitreous will be replaced with some sort of fluid, typically silicone oil or saline. 
• In some cases, the surgeon may inject a gas bubble into the eye to keep the retina in place. 
• Once all repairs are done, the incisions will be closed with stitches. Often stitches are not even required. 
• An antibiotic ointment will be placed on the eye to prevent infections while the eye heals. 
• The eye will be covered by a patch and the nursing staff will monitor your vitals for a few hours. 

The entire procedure takes around 1-2 hours, depending on the severity of the condition. As the surgery is performed on an outpatient basis, the patient is discharged on the same day. 

Risks & Complications of Vitrectomy 

The chances of complications with vitrectomy are not that common. The risks usually depend on the age of the patient and other medical problems. Some risks and complications that may occur are- 

• Infection in the eye 
• Excess bleeding 
• Increased pressure in the eye (glaucoma)
• New retinal detachment 
• Lens damage 
• Increased risk of cataract formation 
• Problem with eye movements 
• Change in refractive power 

Immediately after the treatment, you will feel slight discomfort and mild pain in the eye. When you wake up, the vision is likely to be blurry and take several days to stabilize. 

There will be some side effects, such as blurry vision, sensitivity to light, eye pain, irritation, bleeding in the eye, floaters, watery or dry eyes, infection, etc. The doctor will give you specific instructions and prescribe medications to resolve these temporary side effects. 

The role of early treatment of diabetic retinopathy is crucial to preventing severe vision problems. In the advanced stages, especially Proliferative Diabetic Retinopathy, the vision is already affected to a great extent and it is not possible to reverse the damage. The surgical treatment stops the progression of the disease and prevents vision loss. 

Early treatment is also beneficial in cost aspects. Getting Anti-VEGF or steroid injections are cost-effective than laser treatment and vitrectomy. 

Besides laser treatment and vitrectomy, diabetic retinopathy can also be treated by injecting a medication into the eye directly. There are two types of medications that can be given through injections. 

• Anti-VEGF Medication- In this injection, vascular endothelial growth factor (VEGF) inhibitors are used to reduce the swelling of the macula to slow down the progression of diabetic retinopathy. It blocks the growth signals sent by the body to create new blood vessels in the retina.
  The anti-VEGF medication is available in variants like Avastin, Eylea, and Lucentis. The medication is chosen based on the severity of the condition. Typically, 3-4 injections are given to the patient over a specified period and the effects are monitored by optical coherence tomography. If the injections are not helpful in resolution, pan-retinal laser photocoagulation is recommended for the patient.
• Steroids- Steroid medications are also given through injections to treat diabetic retinopathy. It can reduce swelling in the macula and stabilize the vision. The steroid medication can be administered as eye drops, eye injections, or an implanted device.
  However, there is a significant risk of using corticosteroids as it can increase the risk of developing glaucoma and cataracts.

If diabetic retinopathy is not treated on time, the damage to the blood vessels in the retina continues to worsen the condition. As the blood and fluid from the vessels leak into the vitreous humour, the retina gets further damaged, and the chances of developing macular edema increase. 

The narrowing of the retinal arteries reduces the retinal blood flow and causes dysfunction of the neurons of the inner retina. Gradually, the damage reaches the outer retina disrupting the visual function and blood-retinal barrier, which protects the retina from toxins and immune cells present in the blood. The base membrane of the retinal blood vessels becomes thick and capillaries degenerate, causing microscopic aneurysms. 

As the already present blood vessels cannot function properly, new blood vessels start to form in the retina. But due to lack of oxygen, the growth is improper and the vessels become fragile. Without treatment, the blood vessels bleed into the vitreous humour destroying the retina and making the vision cloudy. The fibrovascular proliferation sometimes also leads to retinal detachment. And the abnormal blood vessels can lead to neovascular glaucoma if the growth is in the anterior chamber of the eye. 

All these conditions can lead to permanent vision loss or blindness. Thus, seeking proper treatment for diabetic retinopathy is critical for preserving vision. 

The recovery from diabetic retinopathy treatment slightly varies depending on the technique used. 

After Laser Treatment for Diabetic Retinopathy 

The full recovery after laser photocoagulation treatment can take several weeks, depending on the patient’s healing abilities. After surgery, there will be some temporary side effects, such as discomfort, blurred vision, dark spots, etc. 

These effects can also take up to a week to go away on their own. If they persist, you should see your ophthalmologist to address these problems. 

After Vitrectomy 

Vitrectomy is recommended for patients with severe diabetic retinopathy. After the surgery, the eyes will be swollen for several days. The post-op recovery instructions will depend on whether additional treatments were performed in combination with vitrectomy or not. For example, if the retinal detachment is also treated during vitrectomy, you will be asked to keep your face down for several days to allow the bubble to settle in the right position. 

The complete recovery will take around 4 to 6 weeks. Throughout this time, you will have to follow the doctor’s advice strictly. 

• Driving is usually allowed after 1-2 days of surgery. But this must be confirmed by the doctor. 
• Showering is allowed from the 3rd day after surgery. But it will be better to use a bathtub instead of showering to prevent the water from entering the eyes. 
• Wait for at least one or two weeks before putting on eye makeup or using chemical products in your hair or for your face. 
• Do not swim for at least 2-3 weeks, and even after that, use goggles during the swimming session. 
• Use an eye patch as directed by the eye doctor. 
• Wear sunglasses or prescription glasses during the day as necessary. Cover the treated eye using an eye shield while sleeping for at least a week. 
• Stay away from dusty environments and avoid rubbing your eyes. 
• Watching television or using the computer is permitted but make sure that you take regular breaks after every 20 minutes. 

Listening to the doctor’s advice will ensure that there are minimal chances of post-surgery complications and that the healing is also quick. 

If you are expecting that diabetic retinopathy treatment will address all eye problems at once, then you are mistaken. The treatment will restore vision to what it was before the onset of diabetic retinopathy. 

It can take several weeks to months for the vision to restore completely. However, if your vision was significantly damaged, the treatment cannot undo the damage. Even after treatment, you will have to follow the doctor’s instructions to control and manage diabetes and prevent the condition from recurrence.