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 may spontaneously rupture filling up the inside of the eye with blood. This occurs as a spectrum from a very small amount of blood perceived as a few black specks in the vision to a large amount of blood that completely obscures the vision.
Fortunately, this condition is quite treatable. Eylea is a medication that is injected into the eye. It causes the abnormal blood vessels to slowly go away. This prevents new bleeding.The injections do not cause the bleeding that has already occurred to resolve. Your body will start to absorb the blood over a period of several months. There are cases in which the blood does not resolve and a safe outpatient surgery is required.
Eylea is injected once per month for a period of 3-6 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 new 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 cause the blood to go away faster?
The blood will settle down to the bottom of the eye and outside of your central vision with gravity. It is recommended to sleep with at least two pillows, avoid bending, and attempt not to perform any fast head or eye movements. It may also be helpful to avoid significant straining or heavy lifting as this can encourage new bleeding.
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 suboptimal 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.
