Medical treatments for my sight loss so far…

Over the years, I have had a lot of laser treatment for my sight loss to both of my eyes, right from that very first bleed in my right eye.  I developed proliferative retinopathy.

  • Laser Treatment
  • Photodynamic Therapy (PDT)
  • Eye Injections

Diabetic retinopathy usually only requires specific treatment when it reaches an advanced stage and there’s a risk to your vision.

1. Laser Treatments for my sight loss

In this condition very small blood vessels grow from the surface of the retina.The retina is the film at the back of your eye , and the tiny blood vessels are capillaries. These growing blood vessels are very delicate and bleed easily. Without laser treatments for my sight loss, the bleeding causes scar tissue that starts to shrink and pull the retina off, and the eye becomes blind. Laser treatment prevents blindness, but often some vision is lost.If you have had diabetes for years your retinae may develop this condition. As the retina is damaged by diabetes, the diseased retina releases special growth chemicals. These chemicals make tiny blood vessels grow: these are called ‘new blood vessels’.The new vessel growth in diabetes only occurs in the retina, nowhere else in the body. When a retina becomes damaged by a higher than normal sugar, over many years, it seems to release special growth hormones.VEGF is one of the main growth hormones; VEGF stands for Vascular Endothelial Cell Growth Factor. It seems to be manufactured and released by ‘sick’ retinal capillaries, and in turn makes other capillaries grow. This seems to be an exaggeration of one of the body’s normal responses…. the retina becomes starved of nutrients, and then the retina makes chemicals that make new blood vessels grow to deliver more nutrients.

The typical pattern of proliferative retinopathy with laser treatments for my sight loss is:
    1. Have diabetes for a number of years
    2. Retinal damage occurs
    3. The retina releases a growth chemical
    4. New Vessels grow
    5. Laser treatment is given
    6. Oxygen and Nutrient flow to the retina improves
    7. The newly formed vessels close up
    8. More diabetic damage to the retina
    9. Even More new vessels grow
    10. More laser treatment is given
    11. New Vessels close up
    12. and the cycle continues until they eventually stop growing

 

The first Laser treatments I had were Argon Green laser . This is a specific wavelength of 350nm.Laser treatment is usually carried out in a darkened room in an out-patient clinic. Anaesthetic drops are dropped into your eye, a contact lens is placed on your eye, and you have to sit at a laser slit lamp. This is virtually the same machine as that used for the regular examination, but a laser has been added on. It is naturally uncomfortable having to keep still whilst a doctor flashes a very bright light into the eye.Each treatment is slightly different, depending on the condition of the eye. Laser is simply a highly focused and powerful light, where the light rays are all of the same type.  Therefore it can be pointed at one spot on the retina very accurately. Each bright flash lasts for about 0.02 seconds. Typocally I would receive 2 to 3000 laser burns per treatment.Treatment can help stabilise the changes in your eyes caused by your diabetes and stop your vision getting any worse, although it won’t usually improve your sight.

Side effects

After treatment, you may have some side effects for a few hours. These can include:

  • blurred vision – you won’t be able to drive until this passes, so you’ll need to arrange for a friend or relative to drive you home, or take public transport
  • increased sensitivity to light – it might help to wear sunglasses until your eyes have adjusted
  • aching or discomfort – over-the-counter painkillers, such as paracetamol, should help

Possible complications

You should be told about the risks of treatment in advance. Potential complications include:

  • reduced night or peripheral (side) vision – some people may have to stop driving as a result of this
  • bleeding into the eye or objects floating in your vision (floaters)
  • being able to “see” the pattern made by the laser on the back of your eye for a few months
  • a small, but permanent, blind spot close to the centre of your vision
The images below show the back of the eye Before and after laser surgery.  All of the dark spots are the laser burns which have caused permanent damage to the peripheral vis
BEFORE LASER
 Back of the eye before laser           
 AFTER L:ASER
 Back of the eye after laser
The most important part of your treatment is to keep your diabetes under control.

In the early stages of diabetic retinopathy, controlling your diabetes can help prevent vision problems developing.

In the more advanced stages, when your vision is affected or at risk, keeping your diabetes under control can help stop the condition getting worse.

2. Photodynamic therapy (PDT) treatments for my sight loss

A treatment that involves the use of light-sensitive medication and a light source to destroy abnormal cells.On their own, the medication and light source are harmless, but when the medication is exposed to the light, it activates and causes a reaction that damages nearby cells.This allows small abnormal areas of tissue to be treated without the need for surgery.
What happens during PDT

PDT is carried out in two stages.

1) Preparation
  • Usually carried out in an out-patients clinic
  • The amount of medication needed is dependant upon your body weight. When the amount has been calculated, it is drawn into a syringe and delivered slowly, through a small cannula into a vein in your hand or arm.
2) Light treatment
  • A very strong light (similar to a laser beam) is focussed very carefully onto the specific area that needs to be treated. This is done through a contact lens and the slit lamp.  The length of time the light is shone onto the area is very specific.
  • The light source activates the medication only in the area that the light is shine onto
After PDT
  • You need to avoid sunlight for 48-72 hours.  The reason for this is that, as the medication is activated by a light source, it is possible that being in direct sunlight will activate the medication where the sunlight hits your body, therefore causing dangerous burns.
Risks and side effects of PDT

PDT is a very safe treatment, although the following side effects are common:

  • a burning or stinging sensation while the light treatment is carried out – this usually passes soon after the treatment finishes
  • if the medication was injected, your skin or eyes being sensitive to sunlight and bright indoor lights.

Other potential side effects depend on the area treated.

  • A very small risk of permanent vision loss.

 

3. Eye injections treatments for my sight loss

In an attempt to decrease the build up of fluid behind my retina, I am now having injections into the eye.  I have had one so far, and am due to have a further two at 4 weekly intervals.  The drug I am being given is called aflibercept (Eylea). This can help stop the problems in my right  eye getting worse, and may also lead to an improvement in my vision.  This is carried out in The Macula Treatment Centre, in their out-patient theatre.

The treatments for my sight loss  involves :
  • Numbing drops are placed onto the eyeball
  • the skin around the eye is cleaned with iodine and covered with a sterile sheet
  • small clips are used to keep the eye open
  • a very fine needle is carefully guided into the eyeball and the injection is given
Risks and side effects

Possible risks and side effects of anti-VEGF injections include:

  • eye irritation or discomfort
  • bleeding inside the eye
  • floaters or a feeling of having something in your eye
  • watery or dry, itchy eyes

There’s also a risk that the injections could cause blood clots to form, which could lead to a heart attack or stroke. Also increased pressure inside the eye.

And that is where I am up to at the moment with treatments for my sight loss ………

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