Diabetic Retinopathy: Management, Medications, and Treatment Options

Diabetic retinopathy (DR) is a condition that affects the retina, or the light-sensitive part of the eye that helps create visual images. DR affects around 8 million people in the United States, and the number is expected to double by the year 2050.1 There are currently several treatments available for treating DR, and more are being studied in clinical trials each year.

Treatments for Early Diabetic Retinopathy

Early DR, also known as non-proliferative DR (NPDR), affects many people with diabetes. In NPDR, tiny blood vessels begin to leak in the eyes, which causes swelling around the retina. In some people, the blood vessels may also close off, cutting off the blood supply to the macula (area near the center of the retina). NPDR usually results in blurry vision or even vision loss.2

In mild cases of NPDR, treatment isn’t always necessary. Your eye doctor will continue to closely monitor your eyes at your yearly exams to see if the condition progresses. You can also work with your endocrinologist to help control your blood sugar levels with medication, proper diet, and exercise. Lowering and controlling your blood sugar levels can help slow DR progression. In some cases, it may even help bring some of your vision back.

Keeping healthy blood pressure levels can also help keep your blood vessels healthy. This is especially important in the eyes. Since diabetes and high blood pressure often occur together, it’s important to work with your endocrinologist to keep your levels in check.3

Treatments for Advanced Diabetic Retinopathy

Advanced DR, also known as proliferative DR (PDR), develops when new blood vessels begin to grow from the retina. This process is known as neovascularization, and it tends to create leaky blood vessels. If you have bleeding in the retina, you may notice dark floating spots (floaters) in your vision. In severe cases of bleeding, you may lose vision entirely. The new blood vessels can also cause scarring, which can lead to further vision problems.2

Fortunately, there are a few different treatment options to help manage PDR. These include drugs to stop the formation of new blood vessels, laser treatments, and surgical procedures.

Anti-VEGF Medications for Advanced Diabetic Retinopathy

Anti-vascular endothelial growth factor (VEGF) medications are designed to stop the formation of new blood vessels. They also reduce swelling in the macula, which can help improve your vision. Examples of anti-VEGF medications used to treat EDR include:4

  • Bevacizumab (Avastin®)
  • Ranibizumab (Lucentis®)
  • Aflibercept (Eylea®)

Bevacizumab and ranibizumab are known as monoclonal antibody drugs, which are laboratory-made proteins (antibodies) engineered to bind specifically to VEGF. Aflibercept is an antibody fragment drug, meaning it’s made of a small portion of an antibody that also binds to VEGF. Together, these medications prevent the growth factor from binding to receptors on blood vessels. As a result, new blood vessels can’t receive growth signals, and they stop growing.

In some cases, steroids can also be used alongside anti-VEGF medications to treat inflammation. Triamcinolone acetonide (Triesence) is a laboratory-made hormone that works similarly to the anti-inflammatory hormone cortisol.5

Side effects of anti-VEGF medications include:

  • Dry, red, or itchy eyes, which may last for a few days
  • Feeling like something is in your eye
  • Floaters
  • Blurry vision (temporary)

All three anti-VEGF medications are given by intravitreal injection, meaning they’re injected directly inside the inner eye. The medication can then reach the retina, which is at the back of the eye. During the injection, your eye is numbed and a small device is used to hold your eyelids open. Your eye doctor then injects the medicine using a very thin needle into the white portion of your eye.4 The risks associated with intravitreal injections include:6

  • Pain or feeling like something is in your eye
  • Infection
  • Vision loss
  • Bleeding
  • Tears in the retina
  • Increase in pressure in the eye that may cause damage to the optic nerve
  • Inflammation in the eye (uveitis)

Surgery for Advanced Diabetic Retinopathy

In advanced cases of PDR, surgery may be used to help relieve pressure in the eye and clear away blood leaking from blood vessels. There are two different types of surgery used to treat PDR, including laser surgery and vitrectomy.

Laser Surgery to Treat Advanced Diabetic Retinopathy

Laser surgery, also known as photocoagulation therapy, uses a focused beam of light to seal off leaking blood vessels in the eye. This helps reduce swelling, allowing vision to return to normal. Another procedure known as panretinal photocoagulation uses scattered bursts of laser beams on the sides of the retina to create scarring on the abnormal blood vessels. This prevents them from growing, helping to reduce swelling.7

Before the procedure, you’ll be given eye drops to dilate (widen) your pupils. In some cases, your eye doctor may also give you a numbing agent on the eye. You’ll sit in a chair with your chin on a rest, and your eye doctor will shine the laser at the area of the retina that’s affected. You’ll see a flash of light as the laser enters your eye.

Some side effects of laser surgery include:8

  • Blind spots
  • Trouble focusing your vision
  • Some vision loss
  • Reduction in night vision
  • Blurred vision
  • Reduced side vision

You’ll likely have blurry vision for the first 24 hours after the procedure. You may have floaters as well, but these should go away over time. In general, laser surgery helps prevent your vision from becoming worse while living with EDR.

Vitrectomy for Advanced Diabetic Retinopathy

PDR can also be treated with a vitrectomy. This surgery involves removing the vitreous, or the gel that fills the inside of your eye. A vitrectomy can help clear blood or scar tissue away from the retina to help improve vision.9

During a vitrectomy, your eye doctor numbs your affected eye and makes a small incision in which to insert instruments. Using these tiny instruments and a microscope, your eye doctor will remove the cloudy vitreous, along with any scar tissue present. This surgery can take a few hours to complete.

Most people don’t have pain after a vitrectomy, but you may feel a sandy, gritty, or scratchy sensation on your eye. Your doctor will prescribe eye drops that can help. Some risks associated with the surgery include:

  • Bleeding
  • Infection
  • Blurred vision
  • Torn or detached retina
  • Cataracts
  • Increased pressure in the eye

Future Diabetic Retinopathy Treatments

Doctors and researchers continue to look for new treatments for DR. Many of these are currently in diabetic retinopathy clinical trials to be tested for their safety and efficacy. Some examples include anti-VEGF eye drops and medications used to treat other health conditions, such as Parkinson’s disease.