Eye Shots Diabetes
- Eye Injections For Diabetics
- Diabetic Retinopathy Injection
- Bloodshot Eyes Diabetes
- Diabetes Eye Symptoms
- New Diabetes Shot Not Insulin
- Eye Injections Diabetic Retinopathy
- Eye Injections Diabetes
Diabetic retinopathy is a major public health problem. Diabetic retinopathy treatment and screening consumes increasing resources year-on-year in most developed countries. This is because diabetic retinopathy is a potentially blinding condition, and is currently the fifth commonest cause of blindness in the world.
One million Americans have advanced diabetic retinopathy, which if untreated, may lead to permanent blindness. Every year, up to 25,000 adult Americans become blind from diabetic retinopathy.
Diabetic retinopathy is caused by diabetes mellitus. Blindness from diabetic retinopathy occurs due to diabetic maculopathy and proliferative diabetic retinopathy. Currently the most important treatment for sight-threatening diabetic retinopathy is retinal laser, such as pan-retinal photocoagulation (PRP).
However, of equal importance is good control of diabetes and blood pressure to prevent advanced retinopathy from developing in the first place, and regular eye screening to detect signs of progression early. The earlier treatment is given, the better the outcomes. Sometimes in special situations, additional retinopathy treatment with intravitreal injections and vitreoretinal surgery are required despite extensive retinal laser.
(Image adapted from the internet)
The various stages of severity of diabetic retinopathy, ranging from normal (top left) to end stage disease with severe scarring (bottom right).
- I had an injection a long time ago in relation to a serious non diabetic eye issue, and as @Jaylee has said, my eye was also anaesthetized first so it didn't hurt at all. For me it was the absolute fearful anticipation of having it done that was by far the worst part - but then I was - and still am - just a daft old biddy!
- The choice between losing eyesight or having a monthly injection directly into your eye is what thousands of diabetic patients face. But new medicine can dramatically reduce the shots and even.
DIABETIC RETINOPATHY TREATMENT - INTRAVITREAL INJECTIONS
If you have diabetic macular edema (DME) or an advanced case of diabetic retinopathy, your doctor may use injections as part of your treatment plan. You may need other treatments, like laser treatments or surgery, in addition to injections. Learn more about diabetic retinopathy and DME When you get injections in your eye, your eye doctor will.
Intravitreal injections are injections of either steroid or anti-Vascular Endothelial Growth Factor (anti-VEGF) medications into the vitreous cavity of the eyeball. This is becoming an increasingly popular treatment option for diabetic macular edema and proliferative diabetic retinopathy. In fact, intravitreal injections are now frequently being used in combination with retinal laser to enhance the retinopathy treatment effect.
Steroid such as triamcinolone and anti-VEGF drugs such as bevacizumab, ranibizumab and aflibercept work in two ways. Firstly, they interfere with chemicals that encourage leakiness of the retinal blood vessels. This helps to stop further leakage of fluid and protein from the blood vessels at the macula. This reduces the amount of fluid in the macula (diabetic macular edema), restores the structural integrity of the macula, and therefore maintains your central vision.
The picture on the left shows successful treatment for diabetic macular edema.
Top (A): Macular swelling and thickening before treatment. Leakage from the retinal blood vessels causes fluid to accumulate in the macula. This disrupts the function of the macula and causes reduced vision.
Bottom (B): The fluid in the macula has now cleared. Notice how the macula has returned to its original thickness and architecture.
(Image adapted from the internet)
Secondly, the anti-VEGF drugs also interfere with chemicals (produced by retinal cells damaged from the diabetes) that stimulate the growth of abnormal new blood vessels. By doing so, abnormal new blood vessels will stop growing and may even regress or disappear completely.
The use of anti-VEGF in proliferative diabetic retinopathy treatment is becoming more widespread and more accepted. It is particularly useful in cases where vitreous hemorrhage has occurred. In these cases, the view of the retina may be too hazy and obscure for effective retinopathy treatment with laser to be performed.
Before the injection, you will be given dilating drops to enlarge your pupil, anesthetic eye drops to numb your eye and antibiotic drops to reduce the risk of infection. A clip will be used to keep your eyelids open. The injection itself takes no more than 5 minutes and shouldn't be painful although you may feel a slight sting or scratch. Your eye may feel slightly sore after the anesthetic effect wears off.
(Image adapted from the internet)
After the injection, you may notice the following:
- slight blurriness and swirls in your vision for a few days
- redness, blood and irritation which settle after a few days
- increased watering of the eye
Complications of intravitreal injections are uncommon and occur in less than 1% of the time. If a complication happens to you, treatments are usually available to fix any problems that arise from it. The main complications of this form of retinopathy treatment are raised eye pressure (potentially leading to glaucoma), cataract, retinal detachment and severe infection of the eyeball (infective endophthalmitis).
DIABETIC RETINOPATHY TREATMENT - VITRECTOMY SURGERY
Surgical proliferative diabetic retinopathy treatment is a specialized and complicated operation. Essentially, vitrectomy is surgery to remove the vitreous gel from the vitreous cavity in the eye. You will only need to undergo vitrectomy surgery if you have:
1. Severe vitreous hemorrhage persisting beyond 3 months
2. Tractional retinal detachment that is encroaching on your macula
Vitreous hemorrhage occurs when abnormal new blood vessels bleed into the gel in the vitreous cavity. The blood blocks light that enters the eye from reaching the retina. The amount of sight loss can be mild to severe, and depends on how much blood is in the eye. Your vision will slowly improve as the hemorrhage gradually clears over several months. A vitrectomy will be needed to restore your vision if the blood does not clear up by itself.
(Image adapted from the internet)
The aim of surgery is to remove the blood and scar tissue that has developed within the eye due to the abnormal new blood vessels. Success of surgical proliferative retinopathy treatment depends on whether all sources of the bleeding can be dealt with at the time of surgery. Success is also dependent on having all the scar tissue removed completely.
Often, pan-retinal photocoagulation laser treatment is also performed during surgery. This is because the the view of the extreme retinal periphery is much better when looking through the operating microscope.
This procedure involves removing the vitreous gel from the vitreous cavity and replacing the gel with a clear solution. As much blood and scar tissue within the eye is removed as possible. This is done with special instruments, such as the vitrector (or vitreous cutter) and light pipe. Depending on the circumstances, gas or silicon oil may be inserted into your eye. If so, you may need to follow some stringent positioning instructions after surgery, similar to that after retinal detachment surgery.
(Image adapted from the internet)
Vitrectomy is usually performed as a day case. It can be performed either under local anesthesia (where you are awake) or under general anesthesia (where you are put to sleep). If you opt for local anesthesia, you will need an anesthetic injection (either subtenon or peribulbar) around the eye to numb it. Prior to that, you will be given dilating drops to enlarge your pupil and anesthetic eye drops to provide an initial numbing effect to your eye.
The operation itself can take from 30 minutes to 3 hours, depending on the complexity of the surgery. If gas is inserted into your eye, you should not travel by air for at least 2 months when the gas would have dissipated away. If silicon oil is inserted into your eye, you will not have any travel restrictions. However, you will need to have a second operation to remove the silicon oil.
Eye Injections For Diabetics
Diabetic Retinopathy Injection
You should be able to go home after a short rest following surgery. Do not drive. Make sure there is someone with you for 24 hours after surgery. Your eye will feel uncomfortable, sore and itchy. It will also be sensitive to light and feel as though there is something in the eye. You will be given eye drops (antibiotic to prevent infection and steroid to reduce inflammation) to put in your eye after surgery. Be careful not to accidentally hit or press against the eye. It is best not to swim or engage in strenuous activities while you are still using the eye drops. It is alright to read or watch television.
Although generally a safe procedure, vitrectomy surgery complications can and do occur. However, severe complications causing blindness are uncommon and occur in less than 1% of the time. The major complications of this surgical retinopathy treatment are:
- glaucoma
- cataract
- recurrent retinal detachment (due to incomplete scar tissue removal)
- persistent vitreous hemorrhage
- severe infection of the eyeball (infective endophthalmitis)
Note: When you develop a vitreous hemorrhage, you vision can drop dramatically. It can seem frustrating that your ophthalmologist is only advising you to wait a few months for the blood to reabsorb. And in the meantime, there is nothing you can do apart from waiting and maintaining good sugar and blood pressure control. It is best not to rush into surgery, especially if the bleeding does clear by itself. Your ophthalmologist will want to perform vitrectomy at the time that is most likely to give you the best outcomes.
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By Jackie Young, Alexander Wolf, and Nicole Kofman
Twitter Summary:Dr. Ivan Suñer gives us a closer look at diabetic retinopathy and how to prevent this “silent” complication
The diaTribe team recently interviewed leading ophthalmologist and retinal surgeon Dr. Ivan Suñer about a common diabetes complication called diabetic retinopathy (DR). Between 40% and 45% of Americans with diabetes have some stage of diabetic retinopathy, a condition that often presents no symptoms at all until it has progressed to the point of severe loss of vision. During our conversation with Dr. Suñer, he shared valuable advice on DR screening, tips on how people can prevent DR, and a glimpse of the future of DR treatments. In addition to interviewing Dr. Suñer, we spoke with Mr. Mike Ellis, a person who was diagnosed with DR at age 63. He shared with us key takeaways from his experience.
What is diabetic retinopathy?
Diabetic retinopathy is a complication of diabetes that occurs when blood vessels in the retina of the eye are damaged or swollen, or begin to grow irregularly. DR has four stages: mild, moderate, severe, and proliferative retinopathy. At first, diabetic retinopathy may cause no symptoms. If left untreated, DR can cause severe vision loss or even blindness.
As Dr. Suñer explained, DR also typically reveals the presence of other diabetes-related complications that may be occurring elsewhere in the body. For instance, a study by the American Diabetes Association indicates that people with DR are twice as likely to develop coronary heart disease and three times as likely to suffer from fatal coronary heart disease as people with type 2 diabetes with no DR.
What causes diabetic retinopathy, and who is at risk?
Anyone with type 1 or type 2 diabetes is at risk of developing DR, which is caused by high average blood glucose over time, typically many years. Persistently high blood sugar can lead to the damage and blockage of the tiny blood vessels in the retina. When blood supply is cut off, the eye develops new blood vessels, but these new blood vessels don’t develop properly and can easily leak, causing vision loss. Additionally, the longer a person lives with diabetes, the more likely he or she is to develop DR.
How can people prevent diabetic retinopathy?
Dr. Suñer stressed the importance of monitoring and controlling blood sugar, blood pressure, and cholesterol to prevent DR. Specifically, the American Diabetes Association (ADA) demonstrates that A1c has a direct relationship with risk of developing DR, with an A1c of <6.5 being associated with a decreased risk of DR. Regular exercise also decreases risk of DR and long-term complications. He also pointed out that limited research suggests smoking cigarettes increases one’s risk for DR.
The most urgent piece of information Dr. Suñer shared was that people with all stages of DR often have no symptoms until they are at extremely high risk for vision loss. Thus, he strongly emphasized the importance of regular DR screening with a comprehensive eye examination.
Our conversation with Mr. Mike Ellis, a person diagnosed with DR, taught us the same lesson. He hadn’t seen a doctor in years when he started losing his vision, and only when he started having trouble doing the things he loved, including fly fishing and working on cars, did he see a doctor. His physician diagnosed him with type 2 diabetes and DR at the same appointment. He had no reason to believe that he had diabetes – while a majority of people with type 2 diabetes are overweight, he had always been fit and active his entire life. Thus, the number one piece of advice he wanted to share with diaTribe readers is to see a doctor regularly and receive screening for DR.
Where and when should you receive DR screening?
Early detection of diabetic retinopathy is crucial to prevent vision loss. Patients should be screened through a dilated eye exam by an ophthalmologist or optometrist. An exam done by a primary doctor, without eye dilation, is not a substitute for a full exam done by an ophthalmologist or optometrist.
It is recommended that anyone with type 1 diabetes above the age of 10 receive an initial dilated examination within five years of the onset of diabetes. For people with type 2 diabetes, it is recommended that any newly diagnosed patients receive a dilated eye exam immediately after diagnosis, as 21% of type 2 patients have some level of DR at the time of diagnosis, as did Mr. Ellis. The recommended frequency of DR screening depends on the stage of retinopathy, and can range from once a year for very mild retinopathy, to every four to six weeks for severe DR.
The silver lining of Mr. Ellis’ diagnosis with DR and diabetes at the age of 63 was that it served as a “wakeup call” to his younger siblings. After he was diagnosed with DR, he encouraged them all to get screened for diabetes. It turned out that they all had blood sugar in the prediabetes range. This information gave them the opportunity to proactively change their lifestyles, preventing the onset of type 2 diabetes and its complications.
How is diabetic retinopathy treated?
Treatment options depend largely on the severity of DR. Mild or moderate DR may not require immediate treatment, and maintaining control of one’s blood sugar can usually slow the progression of the condition.
For people with more advanced stage DR, treatment options include:
Drug Treatments
VEGF-inhibitors, such as Lucentis and Eylea, are useful drugs for those earlier in their progression who do not yet need surgery. These drugs inhibit a protein that causes damage to blood vessels in the eye and are administered by a health care provider as a monthly eye injection. According to Dr. Suñer, as many as 40% of people with DR see significant improvements after using these drugs.Focal Laser Treatment
For patients who do not improve after drug treatment, focal laser treatment allows doctors to shrink abnormal blood vessels through a laser procedure. According to the National Eye Institute, focal laser treatments can reduce risk of vision loss by 50%.Vitrectomy
If blood vessels in the eye have significant bleeding, a surgical procedure called a vitrectomy may be performed, during which vitreous gel containing leaked blood is removed from the eye as well as any scar tissue. Laser treatment is also performed to help prevent recurrence of abnormal blood vessels and bleeding.
In November 2015, an NIH-funded clinical trial found that Lucentis is highly effective in treating proliferative diabetic retinopathy, compared with laser treatment. After two years of treatment, the group receiving Lucentis injections had vision improvements of about half a line on an eye chart, compared with no improvement in the laser group. Additionally, there was little change in side vision for those receiving Lucentis, while those receiving laser treatment experienced a substantial loss of side vision.
When Mr. Ellis was diagnosed with DR, he started receiving injections of the VEGF-inhibitor Lucentis as a treatment. Fortunately, and amazingly, these injections have helped him regain his vision within a year. He has regained the ability to do all the activities he loves again, including fishing and tutoring children at his local church. According to his doctor, he likely would have lost his vision completely had he not caught the symptoms when he did, and if this treatment hadn’t been available to him. Although he said it’s certainly not comfortable to get injections in his eyeballs every month, it’s a small price to pay for maintaining his vision.
Surgical interventions like focal laser treatment and vitrectomy often slow or stop the progression of diabetic retinopathy, but they are not cures. Regular eye exams are thus necessary to continue monitoring DR.
Bloodshot Eyes Diabetes
What does the future of DR treatments look like?
Dr. Suñer gave us a glimpse into new research being done on DR treatments. These include:
New Drugs
New drugs such as fenofibrate, a drug traditionally used to lower cholesterol, are currently undergoing clinical trials.Implant Devices
Researchers are investigating implant devices that release a drug (e.g. Lucentis) over a prolonged period of time. Instead of regular and frequent injections, the goal is that patients would need to refill the device less frequently (i.e., potentially every six or eight months).Combination Therapies
Other researchers are investigating the effectiveness of combining multiple therapies for DR early on in the treatment plan (i.e., giving a drug therapy in combination with laser therapy at the start of treatment, rather than beginning with a drug treatment and then performing surgery later on). While this research is in its early stages, Dr. Suñer has seen promising results that this combination therapy can lead to better outcomes and fewer treatments down the road.
Diabetes Eye Symptoms
Our main takeaway from our conversations with Dr. Suñer and Mr. Ellis is that being screened for diabetes and diabetic retinopathy is the most important action that a person can take to prevent this complication from causing severe vision loss and blindness. Maintaining good control of one’s blood sugar by getting ample exercise and controlling one’s diet can prevent DR and reverse it in its early stages, but one can only know if they are at risk for it if they frequently visit their doctor and get their eyes checked.
New Diabetes Shot Not Insulin
Special thanks to Mallika Tamboli, Katherine Weltzien, and Lillian Ackley for their research and contribution to this piece.