Treating Proliferative Retinopathy
When abnormal blood vessels start to grow on the retina and other parts of the eye, it’s called proliferative retinopathy. The key is to treat right away—before additional problems develop. While the future of proliferative retinopathy may include anti-VEGF inhibitor therapy, which is currently used to treat people with macular edema alone and people with both macular edema and proliferative retinopathy, for now, lasers and surgery are the mainstays of treatment.
The primary treatment for proliferative diabetic retinopathy is laser therapy as soon as abnormal blood vessels start to grow. The doctor scatters 1,000 to 2,000 laser burns around the retina to shrink the abnormal blood vessels. Ideally, you would have the procedure before the blood vessels start to bleed or the scar tissue causes detachment of the retina. “This tends to make it less likely that [blood vessels] would bleed, less likely that it would detach the retina,” says Neil Bressler, MD, professor of ophthalmology and chief of the Retina Division at Johns Hopkins University School of Medicine. “But it doesn’t work all of the time.”
The Process: You’ll start surgery with dilated eyes. Numbing drops help prevent pain, though you may feel an uncomfortable stinging sensation during the procedure. You will see flashes of light—that’s the laser doing its job. Once the procedure is over, you will need someone to drive you home, as your vision may be a bit blurry for the rest of the day.
The Timeline: Two or more sessions are usually needed to complete the treatment.
The Cost: The cost for a scatter laser surgery is about $500, says Raj Maturi, MD, associate professor of clinical ophthalmology at Indiana University School of Medicine and partner at the Midwest Eye Institute in Indianapolis.
When laser therapy fails to work, a surgery called a vitrectomy may be necessary. This procedure involves the removal of the gel-like substance that normally fills the eye—what’s known as the vitreous humor or, simply, the vitreous. Microscopic incisions are made into the white part of the eye, and tiny instruments are inserted to remove the vitreous, along with blood and scar tissue. During the surgery, the doctor may also need to repair a detached retina. “We literally have to remove the blood or remove scar tissue to get the retina to reattach,” says Bressler. Scar tissue can be removed only with this surgery.
The Process: A vitrectomy can be done under local or general anesthesia, so depending on your specific situation, you may be awake with a numbed eye, sedated, or unconscious during surgery. When the doctor removes the vitreous, it is replaced with a salt solution, which appears no different than the normal vitreous when it comes to vision. If there is also a retinal detachment, the doctor will reattach it. Most people head home after surgery, but some stay overnight in the hospital. Your eye will be red and sensitive, and you will need to wear an eye patch for a few days or weeks to protect it. You will also have to temporarily apply eye drops to prevent infection.
The Timeline: If you need a vitrectomy in both eyes, they will be done several weeks apart so you will have the use of one eye as the other heals.
The Cost: Maturi puts the total cost at about $3,000. This includes a $1,000 surgeon fee and $2,000 for the surgery center and anesthesia.