What is diabetic retinopathy?
Here you can see the blood vessels in the normal eye
Blood is carried to the eye by arteries and away from the eye by veins, these blood vessels are damaged in diabetes due to disease that affects the whole circulatory system.
In diabetic retinopathy the blood vessels can dilate, leak and bleed
Damage to the blood vessels from diabetes can cause swelling of the retina, leakage of protein out of the blood vessels, abnormal new blood vessels developing and bleeding in the eye.
What is diabetic eye disease?
Diabetes can affect the eye in a variety of ways. The small blood vessels in the retina (camera film of the eye) can leak as a result of damage to the blood vessels. This leakage can result in the retina becoming thickened by fluid that leaks into the retina. Diabetes can cause damage to the circulation of the eye which results in fine new blood vessels growing abnormally.
How does diabetes affect the eye?
Leakage of the small blood vessels in the eye can result in the vision becoming more blurred and distorted. Also the fine new blood vessels which grow can bleed into the jelly of the eye (vitreous) and cause patients to notice floating objects or lose vision altogether.
How is diabetes in the eye treated?
Diabetes can be treated in a variety of different ways. Injections of medicines called anti VEGF agents can be given which both reduce any swelling of the retina and can block the formation or growth of abnormal blood vessels on the retina. The NHS can provide injections for swelling of the retina though there are restrictions who can access these injections, and only patients who have very significant thickening can have these injections via the NHS. The NHS also does not provide injections for patients who develop abnormal blood vessels growing on the retina. As a private patient, these injections can be provided at any stage.
Lasers can also be used to treat diabetes. There are a variety of different ways lasers can be used but in each case they are energy applied to the retina in different ways to encourage a different response from gentle stimulation to absorb leaked fluid to high energy burns to destroy parts of the retina to discourage new blood vessels growing. All these methods are very successful but can cause changes to the function of the retina.
How are injections into the eye given?
Local anaesthetic drops are used to numb the surface of the eye, a small device is placed on the eye, which keeps the eyelids apart, stabilises the eye and enables the injection to be delivered through the coats of the eye with little or no discomfort, with the patient only able to see the face of the injector.
Will I feel any pain during an injection?
Patients feel some pressure on the eye and then a momentary sharp scratch, then the procedure is complete. The whole process takes around 5 minutes in total.
What happens after the injection?
The nurse will sit you upright and go through a list of dos and don’ts after the injection and give contact details for the department to get in touch if there are any problems. Patients often report seeing a jellyfish like object in the eye which is the medicine, this usually clears after a few minutes. Occasionally some bubbles can be seen in the eye if air follows the medicine, but these clear quickly. After a few hours, the eye can feel gritty and irritable but usually settles down quickly.
Why have the injections as a private patient?
As a private patient you are able to access treatment which the NHS does not provide. You are also able to access treatment without any restrictions imposed on when treatment can be given. You can also have your treatment individually tailored to your needs by a consultant.
Case Studies
Mr. BP, 42 year old professional driver
The Problem: Mr BP has been diabetic since childhood.
- Developed proliferative diabetic retinopathy aged 38.
- He was suffering regular bleeds into his eye which threatened his sight.
- Proliferative diabetes causing high risk of bleeding and loss of vision
- Standard treatment of proliferative diabetes results in destruction of peripheral retina which would cause loss of driving license
The Solution:
Injections of Avastin into the eyes which have cause regression of the abnormal blood vessels and no further bleeds. The injections now are given 10 weekly and this maintains stable vision and he can continue to work safely.
Mrs. PC 75 year old lady
The Problem: She has had type 2 diabetes for 25 years, she drives and vision is dropping in left eye.
- Reducing vision in left eye with distortion
- Diabetic macular oedema (swelling of the central part of the eye due to leaking blood vessels)
- No benefit from a variety of other treatments given
The Solution:
Mrs SC has had 3 injections of Avastin into the left eye which has completely resolved the leakage in the left eye, all fluid has gone and vision has improved back to normal with no distortion in vision. She now feels confident to drive again.