New Treatment Options for Diabetic Eye Disease.
Despite some significant advances in managing diabetic eye disease with new modes of treatment it is generally still the case the argon laser treatment remains central to helping to modify the course of this serious condition.
The effectiveness of argon laser photocoagulation has been established for over thirty years ! For many patients with diabetic eye disease argon laser treatment expertly applied will be sufficient to ameliorate the course of the condition. As already outlined in the previous sections argon laser treatment can be applied for diabetic macular oedema and/or for general retinopathy when it reaches certain well defined criteria.
Below we outline the important points about laser treatment for diabetic eye diease and also the more recent options that can be considered too.
- Argon Laser Treatment for Macular Oedema
Argon laser treatment for macular oedema from diabetes is a well established treatment. Trials have shown that treatment can lower the risk of eyesight deterioration from diabetic macular oedema by around 50%.
The aim of treatment is stabilisation of vision however a small percentage of patients may experience a modest improvement in eyesight (around 5-10%).
- Argon Laser Treatment for Proliferative Diabetic Retinopathy
Also referred to as pan retinal laser photo-coagulation (PRP). This is also a long established form of treatment and remains very much the core treatment to manage the more severe proliferative diabetic retinopathy.
Treatment typically involves an initial phase of between one to three individual treatment sessions spread out over 4-6 weeks.
Each session of PRP laser treatment involves applying around 800-1000 tiny laser pulses onto the retina. PRP treatment is aimed at the peripheral retina with great care taken to avoid the optic nerve and the central macula area in particular.
Treatment can sometimes be a little uncomfortable – but this varies enormously from person to person and indeed session to session too. It normally takes around 15-20 minutes for each session to be administred and is normally carried out on an outpatient basis with eyedrops to numb the front part of the eye.
The ultimate aim of PRP is stabilising vision. It is not expected to improve your eyesight.
Studies suggest that PRP treatment can lower the risk of serious eyesight deterioration occuring over a two year period by around 50%. The effect of treatment will be closely monitored and further treatment after the initial phase of treatment will be carefully considered at subsequent follow up visits.
One of the major risks of PRP is constriction of the field of vision – our experience is that this tends to affect around 10% of people treated with PRP and is more common with extended phases of treatment than with the first phase of treatment. In some cases the impact of a reduced field of vision is that is can lead to a field insufficient to pass DVLA criteria for driving.
Its therefore very important for all people who are undergoing any type of laser treatment for diabetic retinopathy to let the DVLA authorities know about this.
- Lucentis (Ranibizumab) Eye Injections for Macular oedema
Recent research has suggested that diffuse DMO in particular may respond better to Lucentis eye injections than to argon laser. Its also possible that combining argon laser with Lucentis eye injections may provide some added benefit for patients with this form of DMO.
The National Institute of Health & Care Excellence (NICE) have now released their appraisal of this form of therapy for DMO. The result of this guidance is that patients who have DMO with a measured central macular thickness of 0.4mm or more (normal is 0.25mm) ought to be able to access Lucentis injections on NHS funding. This is great news for those patients who are in the unfortunate position of suffering from severe DMO and where argon laser is either not working or not going to work.
The guidance is welcomed by Bettersight Eye Consultancy but we do remain concerned that patients with a measured thickness of just under 0.4mm could struggle to access this therapy even if their specialist feels Lucentis would be beneficial.
- Fluocinolone (Iluvein) Implant for Macular oedema
luvein is a newly released medical device designed to be inserted into the vitreous cavity of the eye where it very slowly releases a type of steroid called fluocinolone acetonide. It has been thought to be a additive therapy to be considered in DMO cases that have not responded to other treatments such as argon laser or Lucentis eye injections. One of the major advantages of Iluvein is the potential for a treatment effect lasting up-to 3 years.
NICE have recently provided an update on their previous view about Iluvein’s cost effectiveness – thankfully Iluvien has now been approved for use on NHS funding but within fairly tightly defined criteria.
In these cases the results from clinical investigations suggest that upto 40% of patients could show a significant vision improvement over a 2-3 year period compared to around 18% in people who weren’t treated with Iluvein.
We at Bettersight feel that in cases where other treatments have failed to work effectively in treating DMO alternative treatments such as Iluvein ought to be more widely available for all patients not just for those patients who are able to afford privately funded care