The eye works like a camera. It has two parts, a lens and a film. The film layer lines the back wall of the eyes and is called the retina. It has arteries that provide it blood flow and veins which drain the blood. Proliferative diabetic retinopathy is characterized by the development of abnormal new blood vessels. These abnormal blood vessels do not cause any visual changes at first. However, over time, the new blood vessels may spontaneously bleed which can significantly decrease the vision, and even require surgery in some cases. Additionally, these new blood vessels can start to scar and pull the film layer of the retina from its blood supply, thereby decreasing vision.
Fortunately, this condition is quite treatable. Avastin is a medication that is injected into the eye. It causes the abnormal blood vessels to slowly go away. It is injected once per month for a period of 6 months, then the time between injections is slowly increased. The total number of injections that each patient requires varies. Your eye care specialist will customize the treatment to the way your eye responds to the medication.
The main risk inherent to this medication is the development of floaters. This is uncommon but can occur due to silicone oil within the medication. If this occurs, it is typically temporary. It is very uncommon for patients to notice these floaters after the first few days.
The main risk of the procedure is the development of an infection called endophthalmitis. Fortunately, the risk of this infection is very low, occurring in approximately 1 in 3000 injections. Patients can decrease their risk of developing an infection by avoiding rubbing, touching their eyes, or allowing water into their eyes for at least one week.
Please review information on the intravitreal injection procedure for more helpful details. There will be no graphic photos or images.
Most patients undergoing this treatment are surprised that the injection may be administered in a painless manner.
What can patients do to decrease their risk of diabetic eye disease worsening?
Here are the goals from the perspective of an ophthalmologist:
Maintain a hemoglobin A1C of 7 or less. This is an average blood sugar of 154.
Maintain a blood pressure of 140/90 or less
It is important to know that this condition will not go away with better control of blood sugar. This condition is the result of years of sub ideal blood sugar control.
What should patients watch out for between visits?
The new onset of worsening blurry vision may be a sign of increased swelling in the retina. We ask patients to contact their eye care specialist if they note worsening vision as this may be a sign that treatment is needed sooner than the next scheduled visits.
The onset of many new floaters or decreased vision may be a sign of new bleeding. This is treatable but does require you to contact your eye care specialist.
Why is it important to follow-up with your eye care specialist?
Untreated swelling in the retina can cause permanent vision loss if present for weeks to months without treatment.
Abnormal new blood vessels may bleed and temporarily decrease vision. Your eye care specialist may be able to detect these in the early stage and initiate treatment to decrease the risk of vision loss.
It is very important to follow-up with your eye care specialist as recommended. Delays in treatment can result in permanent visual loss.
I hope you found this information helpful.
Please reach out to your eye care specialists if you have additional questions or concerns.
