Diabetic retinopathy is best diagnosed with a comprehensive dilated eye exam. For this exam, drops placed in your eyes widen (dilate) your pupils to allow your doctor to better view inside your eyes. The drops may cause your close vision to blur until they wear off, several hours later.

During the exam, your eye doctor will look for:

Abnormal blood vessels

Swelling, blood or fatty deposits in the retina

Growth of new blood vessels and scar tissue

Bleeding in the clear, jelly-like substance that fills the center of the eye (vitreous)

Retinal detachment

Abnormalities in your optic nerve

In addition, your eye doctor may:

Test your vision

Measure your eye pressure to test for glaucoma

Look for evidence of cataracts

Fluorescein angiography

With your eyes dilated, your doctor takes pictures of the inside of your eyes. Then your doctor will inject a special dye into your arm vein and take more pictures as the dye circulates through your eyes’ blood vessels. Your doctor can use the images to pinpoint blood vessels that are closed, broken down or leaking fluid.

Optical coherence tomography

Your eye doctor may request an optical coherence tomography (OCT) exam. This imaging test provides cross-sectional images of the retina that show the thickness of the retina, which will help determine whether fluid has leaked into retinal tissue. Later, OCT exams can be used to monitor how treatment is working.

Treatment

Treatment, which depends largely on the type of diabetic retinopathy you have and how severe it is, is geared to slowing or stopping progression of the condition.

Early diabetic retinopathy

If you have mild or moderate nonproliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine when you might need treatment.

Work with your diabetes doctor (endocrinologist) to determine if there are ways to improve your diabetes management. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the progression.

Advanced diabetic retinopathy

If you have proliferative diabetic retinopathy or macular edema, you’ll need prompt surgical treatment. Depending on the specific problems with your retina, options may include:

Photocoagulation. This laser treatment, also known as focal laser treatment, can stop or slow the leakage of blood and fluid in the eye. During the procedure, leaks from abnormal blood vessels are treated with laser burns.Focal laser treatment is usually done in your doctor’s office or eye clinic in a single session. If you had blurred vision from macular edema before surgery, the treatment might not return your vision to normal, but it’s likely to reduce the chance the macular edema may worsen.

Panretinal photocoagulation. This laser treatment, also known as scatter laser treatment, can shrink the abnormal blood vessels. During the procedure, the areas of the retina away from the macula are treated with scattered laser burns. The burns cause the abnormal new blood vessels to shrink and scar.It’s usually done in your doctor’s office or eye clinic in two or more sessions. Your vision will be blurry for about a day after the procedure. Some loss of peripheral vision or night vision after the procedure is possible.

Vitrectomy. This procedure uses a tiny incision in your eye to remove blood from the middle of the eye (vitreous) as well as scar tissue that’s tugging on the retina. It’s done in a surgery center or hospital using local or general anesthesia.

Injecting medicine into the eye. Your doctor may suggest injecting medication into the vitreous in the eye. These medications, called vascular endothelial growth factor (VEGF) inhibitors, may help stop growth of new blood vessels by blocking the effects of growth signals the body sends to generate new blood vessels.Your doctor may recommend these medications, also called anti-VEGF therapy, as a stand-alone treatment or in combination with panretinal photocoagulation. While studies of anti-VEGF therapy in the treatment of diabetic retinopathy are promising, this approach is not yet considered standard.Surgery often slows or stops the progression of diabetic retinopathy, but it’s not a cure. Because diabetes is a lifelong condition, future retinal damage and vision loss are still possible.

Even after treatment for diabetic retinopathy, you’ll need regular eye exams. At some point, additional treatment may be recommended.

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