Diabetic Eye Disease Treatments

Bevacizumab (Avastin)

• Is often administered in an outpatient department or eye clinic
• If vision is worsened due to macular edema before surgery, prognosis may not be restored. However, it can prevent the worsening of the condition.

Triamcinolone

• Administered intravitreally (injected into the eye); a corticosteroid used in the treatment of diabetic macular edema.
• Is an intraocular steroid injection.

Glucose Control

• The Diabetes Control and Complications Trial found that intensive glucose control for patients with type 1 diabetes reduced the occurrence and progression of diabetic retinopathy.
• The same principles may apply to type 2 diabetes.

Grid Laser Photocoagulation

• Treatment of choice for cases not responding to anti-VEGF and steroids
• Used for diffuse clinically significant diabetic macular edema.
• Used for “recalcitrant” (Stubborn) cases, DM Ret

Panretinal Photocoagulation (PRP)

• Laser treatment, also known as scatter laser treatment, can shrink abnormal blood vessels.
• Areas of the retina away from the macula are treated with scattered laser burns.
• The light-sensitive tissue in the back of the eye contains specialized cells called photoreceptors.
• Photoreceptor cells are responsible for converting light rays to electrical impulses to the brain.

Optometric Management

• Comprehensive Eye Examination should include close monitoring for patients suspected to have or at risk of developing diabetic retinopathy.
• Dilated retinal examination is also recommended.
• Refer patients with any level of macular edema, severe nonproliferative diabetic retinopathy (a precursor of proliferative diabetic retinopathy) or complete blind spots, large shadows, or something “blocking” the vision in a certain area.

Noticeable Vision Issues That Worsen Over Time

• Drastic changes in a short period of time are cause for concern.

Macular Hole

Stages of Macular Hole

• Stage 1: Known as foveal detachments, the first indication of a small macular hole. About half of all stage 1 macular holes will progress into a worsened state without treatment. Expected vision 20/40.
• Stage 2: Partial-thickness holes. The vitreous gel continues to pull on the edges of the hole; it's more likely to continue and require medical intervention. Distorted vision.
• Stage 3: A full-thickness hole exists. The central and detailed vision has become severely affected. See a small black patch “missing patch” in the center of the vision. It is still attached with partial vitreomacular adhesion/traction. Expected vision 20/160.
• Stage 4: A full-thickness macular hole exists with a complete separation of the vitreous from the macula and the optic disc. The posterior vitreous detaches. Expected vision 20/200.

Types of Macular Hole and Etiology

• Trauma-Related Macular Hole: Thought to be linked to a concussive blow delivered from the opposite site of the head. As a result, the macula ruptures at its thinnest point.
• Idiopathic Related Macular Hole: The retina is connected tightly to the vitreous, a layer surrounding the interior of the eye that is filled with vitreous gel. The vitreous is constructed of millions of very fine intertwined fibers. As we age, the vitreous gel begins to liquefy and/or clump and shrink. This causes the vitreous to pull to the side as the gel and vitreous sac contracts. The retina is attached to the vitreous, and when the vitreous shrinks, it pulls the retina and creates a hole at the thinnest part of the macula.

Central Serous Retinopathy (CSR)

• Usually occurs in patients over age 55
• Results in progressive, irreversible loss of central visual function from either fibrous scarring or diffuse, geographic atrophy of the macula.

Age-Related Macular Degeneration (AMD)

Classification

• Dry AMD (non-vascular/non-exudative type): Deterioration of the retina associated with the formation of small yellow deposits, known as drusen (under the macula). This leads to a thinning and drying out of the macula causing it to lose its function. The amount of central vision loss is directly related to the location and amount of retinal thinning caused by the drusen. Dry AMD is called non-neovascular AMD and non-exudative AMD because it does not involve the exuding that is leakage of fluids from blood vessels.

Symptoms

• Dry AMD (non-vascular/non-exudative type): Distorted (fuzzy) vision in the form of metamorphopsia. A grid of straight lines appears wavy and parts of the grid may appear blank. Extreme glare, photophobia, and visual acuity drastically decreasing (two levels or more), from 20/20 to 20/80.
• Nonexudative macular degeneration: Blurred vision.
• Open-Angle Glaucoma: “Open-angle” means that the angle where the iris meets the cornea is as wide and open.
• Angle-Closure Glaucoma: A less common form of glaucoma. Caused by blocked drainage canals. Has a closed or narrow angle between the iris and cornea. Occurs when the drainage angle in the eye (formed by the cornea and the iris) closes or becomes blocked.

Open-Angle Glaucoma

• Strong Risk Factors: High eye pressure, Family history of glaucoma, Age 40 and older for African Americans.
• Potential Risk factors: High myopia (very severe nearsightedness), Diabetes, Eye surgery or injury, High blood pressure, Use of corticosteroids.
• Symptoms: Gradual loss of peripheral vision, Tunnel vision in the advanced stages.

Angle-Closure Glaucoma (Medical Emergency)

• Demands immediate medical attention: Intense pain in your eye, Nausea, Red eyes, Blurred vision.
• Risk Factors: Age 40 and older, Family history of glaucoma.

Pigmentary Glaucoma

• This is a type of open-angle glaucoma that typically develops during early or middle adulthood.
• It involves changes in the pigment cells that give color to the iris.
• Cells build up in the channels that drain fluid from the eye, they can affect the normal flow of fluids in the eye.

Traumatic Glaucoma

• Caused by injuries that “bruise” the eye (called blunt trauma) and injuries that penetrate the eye.
• Causes bleeding inside the eye. An excess amount of blood, plasma and debris can accumulate and clog the drainage system.