Different treatment options for diabetic eye disease

“In our clinic, a typical patient, Mrs X, was first seen with a visual acuity of 6/9, a few macular exudates, and proliferative disease. The treatment plan followed the textbook recommendation of doing focal laser for the maculopathy first. The patient then missed two appointments and pan-retinal photocoagulation (PRP) was delayed by about two months. When PRP was finally given, the intention was to give it in the recommended multiple sessions. However, due to further missed appointments, the interval between laser sessions was over a month. This allowed fibrovascular proliferation to continue. It was six months from the time of presentation before laser was completed. By then, tractional retinal detachment involving the macula had developed and vitrectomy was required. Mrs X’s final visual acuity was counting fingers at three metres.”

There are clearly established treatment plans in theory but in practice they require working closely with the patient.

Many patients are very anxious about having laser treatment and an adequate explanation of the process is essential. Most patients characterise the “pain” of laser treatment as brief, intermittent, sharp or piercing. Pain is also often described as being worse during re-treatment. It is important to manage patient’s anxiety throughout treatment and encourage them with the benefit of preventing long term vision loss.

Anti VEGF may not a suitable option for all patients or all settings.

As you watch this video, consider what can be practically done to ensure patient adherence to treatment plans?