How is diabetic retinopathy treatment performed?
The most widely available form of treatment is a retinal laser. This can be used to treat proliferative diabetic retinopathy, in other words, get rid of the abnormal blood vessels. That form of laser is essentially destructive on purpose. It delivers high-energy laser to the areas of damaged retina and stops them from sending signals that result in the formation of these abnormal blood vessels.
One of the side effects of such treatment apart from pain at the time of treatment is that patients describe sometimes difficulties managing in the dark. If treatment occurs in both eyes it can result in the loss of a driving licence. Most patients can undergo successful laser treatment for proliferative diabetic retinopathy without losing their driving licence. But it is difficult to predict to which extent they will need treatment.
Certainly, after undergoing such a laser you are obliged to tell the DVLA you’ve had such treatment and they will assess you as necessary. The treatment of diabetic maculopathy is where some of the most exciting advances that have occurred in the last few years. Currently, the main treatment method in the NHS is still laser and a laser is very effective in preventing visual loss. Certainly, if there was a small area of leakage from diabetic retinopathy a laser would be perfectly indicated.
NHS vs. Private Treatment
A laser is not safe to use when the swelling involves the very centre and is greater than a certain degree. In the NHS, any macular oedema at less than 400 microns is treated with laser, even if it involves the centre.
Over 400 microns and a patient will be classified for treatment with the high-cost drugs such as Lucentis or Eylia. We know that injections are incredibly safe and can reverse visual loss in the early stages of diabetic macula oedema.
What’s exciting is that they may actually modify the course of diabetic macula oedema for the better. With early treatment and prompt, frequent treatment at the start of their disease, this may result in fewer injections in the subsequent for years.
For patients who are not eligible to receive Lucentis and Eylia as a treatment on the NHS, we are able to offer them alternative drugs such as steroid implants which include Ozurdex or Iluvien. These are also very effective at treating macular oedema, but they do come with side effects, such as rises in eye pressure and the formation of cataracts. In the NHS, it can only be used in patients who have had cataract surgery.
Advantages of Private Treatment
One of the advantages of treatment in the independent sector is that it does allow a greater degree of flexibility about the choice of drug that can be used. For example, my preference for any centre involving oedema would be either Avastin, Eylia or Lucentis. We are not restricted to treating patients who have 400 microns of thickness, which is considered to be the most advanced form of diabetic macula oedema. Also earlier treatment is considered to be beneficial overall.