📌 This post is a continuation of our journey. You can read the previous part here: Can You Add Sugar to Borscht with Diabetes? Flavor Secrets Without the Sugar Bowl.
✍ When we faced diabetic retinal edema, the most difficult and worrisome question for us was preserving vision in the long term. It was crucial for us to understand in detail how intravitreal injections (anti-VEGF therapy) work, why diet alone is not enough, and why ophthalmologists recommend laser photocoagulation after injections.
We found out that simply lowering blood sugar is unfortunately not enough to eliminate already formed retinal edema (macular degeneration). Normalizing glucose levels and targeted eye support are two mandatory steps that only work when combined.
Why Blood Sugar Control Alone Isn't Enough
- Sugar is the cause, edema is the result: When we bring blood sugar down to normal levels (for example, targeting an HbA1c around 7.5%), we stop further damage to small blood vessels. Excess glucose stops damaging their walls.
- Fluid is already inside the tissue: However, the blood vessels that were previously damaged have already leaked fluid into the central area of the eye (the macula). This fluid accumulates in the retinal layers like a sponge. It is difficult for the body to drain it independently because damaged capillaries continue to leak slightly.
That is why a proper management scheme is always comprehensive: first, blood sugar levels are stabilized to protect vessels from new damage, and then the ophthalmologist uses targeted treatments to help strengthen the blood vessels and reduce the accumulated fluid.
Can You Get By with Just One Injection?
As medical practice shows, a single injection is usually not enough for a lasting result in diabetic edema.
Specialized medications (VEGF inhibitors) injected directly into the eye act temporarily, usually for 4 to 6 weeks. They block the substance that causes blood vessels to leak fluid, which reduces edema and improves visual clarity. However, as the medication wears off, damaged capillaries may start accumulating fluid again.
- Initial loading dose: The process typically begins with a series of 3 consecutive monthly injections. This helps dry out the macula as much as possible and stabilize the condition.
- Ongoing monitoring: After the initial treatments, the ophthalmologist performs a follow-up optical coherence tomography (OCT) scan. If the retina appears dry and flat, treatment is paused, and regular monitoring is scheduled every 1–2 months.
If blood sugar levels remain well-managed and stable, additional procedures may not be needed for a long time.
Why Do Injections Come Before Laser Treatment?
Detecting the condition in its early stages is the best possible scenario. At this stage, irreversible structural changes have not occurred, giving the best chance to preserve clear central vision. Combining injections with laser therapy is a widely recognized standard in diabetic eye care.
These two approaches perform distinct yet complementary roles:
- Step 1. Injections (anti-VEGF therapy): First, the edema must be cleared. The medication dries out the retinal tissue. Attempting laser treatment on swollen tissue would scatter the laser beam in the fluid, preventing it from reaching its target effectively.
- Step 2. Laser (photocoagulation): Once the retina is dry and thin after injections, laser treatment can be applied. The specialist precisely targets and strengthens the tiny blood vessels that were leaking, helping prevent fluid from reaccumulating in the future.
The laser procedure itself is outpatient, takes about 10–15 minutes with local anesthetic drops, and typically requires only 1 or 2 sessions to secure the retina.
Our main task during this initial phase remains smooth preparation: working with an endocrinologist over 2–3 months to safely lower HbA1c to target values while keeping a daily log and following a gentle diet rich in legumes, fish, and vegetables. Against this well-managed baseline, ophthalmological treatments deliver their best and most durable results 👁️✨
👉 Read the next part: Symptoms of Macular Degeneration, the Amsler Grid Test, and Protecting Mom's Vision