Diabetic Retinopathy Treatment Overview

When to see a healthcare provider

See a healthcare provider if you have signs of diabetic retinopathy, which include blurred vision, a sudden change in your eyeglass or contact lens prescription, floaters, and sudden vision loss.

Early treatment is critical to stop the damage and prevent blindness. Diabetic retinopathy can lead to other serious eye conditions. These include

• Diabetic macular edema (DME), a leakage of blood vessels in the retina
• Neurovascular glaucoma, which causes abnormal blood vessels to grow out of the retina and block fluid from draining out of the eye

Getting diagnosed

An eye doctor (either an ophthalmologist or optometrist) can diagnose diabetic retinopathy based on an eye exam. Eye drops are used to dilate (widen) your pupil to make it easier for your doctor to look for any problems in your eyes. Other tests that may be ordered include:

• Optical coherence tomography, a type of scan that uses light waves that can show DME
• If severe diabetic retinopathy is suspected, you may have a test called a fluorescein angiogram. After dilating your eyes, your doctor injects a dye in your arm that can identify leaks and blockages in the blood vessels in the eyes. It also shows if any abnormal blood vessels are growing.

What to expect from your doctor visit

• If you have mild to moderate diabetic retinopathy, treatment may not be necessary. Your doctor may recommend ways to better control your diabetes, like changes to your medications, to slow the progression of diabetic retinopathy.
• Once your retinal blood vessels start leaking fluid or bleeding, you will likely need treatment to help prevent it from getting worse. Injectable medication called anti-vascular endothelial growth factor inhibitor (anti-VEGF) is often recommended to reduce swelling. Inhibiting VEGF is important because it plays a key role in diabetic retinopathy, causing blood vessels to leak and triggering abnormal blood vessel growth, which can damage the eye.
• Steroid injections into the eye can help reduce inflammation and swelling.
• A type of laser treatment called panretinal photocoagulation (scatter laser surgery) may be part of your treatment. Your doctor will use a medical laser to reduce swelling and shrink blood vessels in the eye that are causing vision problems.
• If bleeding gets out of control (vitreous hemorrhage) or causes scar tissue to form (tractional retinal detachment), you might need a surgical procedure called vitrectomy to repair the retina and clear the bleeding. The surgeon makes a tiny incision in your eye to remove blood from the middle of the eye (vitreous) and any scar tissue that may be pulling on the retina.

Prescription diabetic retinopathy medications

• Vascular endothelial growth factor inhibitors (anti-VEGF): ranibizumab (Lucentis), aflibercept (Eylea), bevacizumab (Avastin), brolucizumab (Beovu), faricimab-svoa (Vabysmo)
• Steroids: acetonide (Triesence), triamcinolone acetonide (Kenalog)

Types of diabetic retinopathy providers

• An endocrinologist, who specializes in hormone conditions, can check for signs of diabetic retinopathy and slow the progression of the disease through careful management of your diabetes.
• Diabetic retinopathy is usually treated by an ophthalmologist, who specializes in eye and vision care and is trained to perform eye surgery.
• An optometrist can examine, diagnose, and treat vision problems.

Managing diabetic retinopathy at home

See a healthcare provider if you have signs of diabetic retinopathy, which include blurred vision, a sudden change in your eyeglass or contact lens prescription, floaters, and sudden vision loss.

While there aren’t any home treatments, you can help prevent vision loss by carefully managing your diabetes.

• Have regular visits with your healthcare provider and follow all treatment instructions to control your blood sugar levels.
• You may also need a dilated eye exam with an eye doctor (either an ophthalmologist or optometrist) as often as every 2 to 4 months.
• Monitor your blood sugar. The number one prevention for diabetic retinopathy is getting your diabetes under control.
• Don’t smoke.
• Exercise regularly.
• Limit alcohol.
• Keep blood pressure and cholesterol levels in a healthy range.