Retinopathy in diabetes

Diabetic Retinopathy: Risks, Treatments, Prevention

Retinopathy in diabetes

  • Symptoms
  • Causes
  • Risks
  • Stages
  • Diagnosis
  • Treatment
  • Complications
  • Prevention

Diabetic retinopathy is an eye condition that causes changes to the blood vessels in the part of your eye called the retina. That's the lining at the back of your eye that changes light into images. The blood vessels can swell, leak fluid, or bleed, which often leads to vision changes or blindness. It usually affects both eyes. When left untreated, diabetic retinopathy can scar and damage your retina.

Diabetic retinopathy is the most common cause of vision loss for people with diabetes. It’s the leading cause of blindness for all adults in the U.S.

You might not have any signs of diabetic retinopathy until it becomes serious. When you do have symptoms, you might notice:

  • Loss of central vision, which is used when you read or drive
  • Not being able to see colors
  • Blurry vision
  • Holes or black spots in your vision
  • Floaters, or small spots in your vision caused by bleeding

If your blood glucose level (blood sugar) is too high for too long, it blocks off the small blood vessels that keep your retina healthy. Your eye will try to grow new blood vessels, but they won’t develop well. The blood vessels start to weaken. They can leak blood and fluid into your retina. This can cause another condition called macular edema. It can make your vision blurry.

As your condition gets worse, more blood vessels become blocked. Scar tissue builds up because of the new blood vessels your eye has grown. This extra pressure can cause your retina to tear or detach.

This can also lead to eye conditions glaucoma or cataracts (the clouding of your eye’s lens) that may result in blindness.

If you have any form of diabetes — type 1, type 2, or gestational — you may get diabetic retinopathy. Your chance goes up the longer you have diabetes. Almost half of Americans diagnosed with diabetes have some stage of diabetic retinopathy. And only about half of them know they have this disease.

Other things that can raise your odds of diabetic retinopathy include:

Diabetic retinopathy tends to go through these four stages:

  1. Mild nonproliferative retinopathy. In the disease’s earliest stage, tiny blood vessels in your retina change. Small areas swell. These are called microaneurysms. Fluid can leak them and into your retina.
  2. Moderate nonproliferative retinopathy. As your disease gets worse, blood vessels that should keep your retina healthy swell and change shape. They can’t deliver blood to your retina. This can change the way your retina looks. These blood vessel changes can trigger diabetic macular edema (DME). That’s swelling in the area of your retina called the macula.
  3. Severe nonproliferative retinopathy. In the third stage, many blood vessels get blocked. They can’t deliver blood to your retina to keep it healthy. Areas of your retina where this happens make special proteins called growth factors that tell your retina to grow new blood vessels.
  4. Proliferative diabetic retinopathy (PDR). This is the most advanced stage. New blood vessels grow inside your retina and then into the jelly inside your eyeballs called vitreous humor. Fragile new blood vessels are more ly to leak fluid and bleed. Scar tissue starts to form. This can cause retinal detachment, when your retina pulls away from the tissue underneath. This can lead to permanent blindness.

Your eye doctor can usually tell if you have diabetic retinopathy during your eye exam.

  • Pupil dilation. Your doctor will dilate your pupils to look for any changes in your eye’s blood vessels or see if any new ones have grown. They'll also see if your retina is swollen or detached.
  • Fluorescein angiogram. This test can tell your doctor if you have DME or severe diabetic retinopathy. It shows if any of your blood vessels are leaking or damaged. Your doctor will give you a shot with fluorescent dye into a vein in your arm. When the dye reaches your eyes, your doctor will be able to see images of the blood vessels in your retina and spot any serious problems.

Treatments for diabetic retinopathy include:

Anti-VEGF injection therapy. Drugs that block vascular endothelial growth factor (VEGF), a protein that makes abnormal blood vessels grow in your eye, can reverse the blood vessel growths and lower fluid buildup in your retina. Anti-VEGF drugs include aflibercept (Eylea), bevacizumab (Avastin), and ranibizumab (Lucentis).

Focal/grid macular laser surgery. Lasers make tiny burns on the leaky areas of vessels in your macula. You may need anti-VEGF therapy after this surgery.

Corticosteroids. Doctors can implant or inject these medications into your eye. There are both short-term and long-acting types. Steroids can raise your chance of glaucoma or cataracts. Your eye doctor will monitor the pressure in your eye if you take them.

Scatter laser surgery. This treatment makes up to 2,000 tiny burns to treat spots where your retina has detached from the macula. This can shrink abnormal blood vessels. You may need two or more sessions. Laser surgery can save your central vision, but it may lessen your side, color, or nighttime vision. It works best if you get it before those new vessels start to bleed.

Vitrectomy. If blood vessels leak into your retina and vitreous humor and your vision clouds, you may need to have this procedure. It removes the leaked blood so you can see better. This can treat cloudy vision.

Your doctor will tell you if any of these treatments are right for you. They’ll do them in the doctor's office or in the hospital.

Diabetic macular edema (DME) is a serious complication of diabetic retinopathy. A healthy macula gives you sharp vision straight in front of you. This is what you need to drive, read, and see other people’s faces. If your diabetic retinopathy causes fluid buildup and swelling in your macula, you can get DME.

DME is the most common reason people with diabetic retinopathy lose their vision, and about half of people with diabetic retinopathy get DME. You’re more ly to get DME at later stages of diabetic retinopathy, but it can happen at any point.

Sometimes, vision loss from DME can’t be reversed.

Work with your doctor to keep your blood sugar and blood pressure at good levels. This will slow down diabetic retinopathy and maybe even stop it from happening.

Here are more tips to prevent diabetic retinopathy:

  • Make sure you see an eye doctor at least once a year for a complete eye exam.
  • If you have diabetes and are pregnant, have a thorough eye exam during your first trimester.
  • Follow up with your eye doctor during pregnancy. Tell your eye doctor if you develop gestational diabetes.
  • Don’t smoke if you have diabetic retinopathy or diabetes.


National Eye Institute: “Facts About Diabetic Eye Disease,” “How is macular edema treated?”

Cleveland Clinic: “Diabetic Retinopathy.”

American Academy of Ophthalmology: “Diabetic Retinopathy?”

National Eye Institute: Mayo Clinic: “Diabetic retinopathy.”

CDC: “Common Eye Disorders.”

© 2019 WebMD, LLC. All rights reserved.


Diabetic Retinopathy

Retinopathy in diabetes

Diabetic retinopathy is an eye condition that can cause vision loss and blindness in people who have diabetes. It affects blood vessels in the retina (the light-sensitive layer of tissue in the back of your eye).  

If you have diabetes, it’s important for you to get a comprehensive dilated eye exam at least once a year. Diabetic retinopathy may not have any symptoms at first — but finding it early can help you take steps to protect your vision. 

Managing your diabetes — by staying physically active, eating healthy, and taking your medicine — can also help you prevent or delay vision loss.  

Diabetic retinopathy is the most common cause of vision loss for people with diabetes. But diabetes can also make you more ly to develop several other eye conditions: 

  • Cataracts. Having diabetes makes you 2 to 5 times more ly to develop cataracts. It also makes you more ly to get them at a younger age. Learn more about cataracts. 
  • Open-angle glaucoma. Having diabetes nearly doubles your risk of developing a type of glaucoma called open-angle glaucoma. Learn more about glaucoma. 

The early stages of diabetic retinopathy usually don’t have any symptoms. Some people notice changes in their vision, trouble reading or seeing faraway objects. These changes may come and go. 

In later stages of the disease, blood vessels in the retina start to bleed into the vitreous (gel- fluid in the center of the eye). If this happens, you may see dark, floating spots or streaks that look cobwebs. Sometimes, the spots clear up on their own — but it’s important to get treatment right away. Without treatment, the bleeding can happen again, get worse, or cause scarring.

Diabetic retinopathy can lead to other serious eye conditions: 

  • Diabetic macular edema (DME). Over time, about half of people with diabetic retinopathy will develop DME. DME happens when blood vessels in the retina leak fluid, causing swelling in the macula (a part of the retina). If you have DME, your vision will become blurry because of the extra fluid in your macula.  
  • Neovascular glaucoma. Diabetic retinopathy can cause abnormal blood vessels to grow  the retina and block fluid from draining the eye. This causes a type of glaucoma.
  • Retinal detachment. Diabetic retinopathy can cause scars to form in the back of your eye. When the scars pull your retina away from the back of your eye, it’s called tractional retinal detachment.

Anyone with any kind of diabetes can get diabetic retinopathy — including people with type 1, type 2, and gestational diabetes (diabetes that can develop during pregnancy).   

Your risk increases the longer you have diabetes. More than 2 in 5 Americans with diabetes have some stage of diabetic retinopathy. The good news is that you can lower your risk of developing diabetic retinopathy by controlling your diabetes.  

Women with diabetes who become pregnant — or women who develop gestational diabetes — are at high risk for getting diabetic retinopathy. If you have diabetes and are pregnant, have a comprehensive dilated eye exam as soon as possible. Ask your doctor if you’ll need additional eye exams during your pregnancy. 

Diabetic retinopathy is caused by high blood sugar due to diabetes. Over time, having too much sugar in your blood can damage your retina — the part of your eye that detects light and sends signals to your brain through a nerve in the back of your eye (optic nerve).  

Diabetes damages blood vessels all over the body. The damage to your eyes starts when sugar blocks the tiny blood vessels that go to your retina, causing them to leak fluid or bleed. To make up for these blocked blood vessels, your eyes then grow new blood vessels that don’t work well. These new blood vessels can leak or bleed easily. 

Eye doctors can check for diabetic retinopathy as part of a dilated eye exam. The exam is simple and painless — your doctor will give you some eye drops to dilate (widen) your pupil and then check your eyes for diabetic retinopathy and other eye problems.

If you have diabetes, it’s very important to get regular eye exams. If you do develop diabetic retinopathy, early treatment can stop the damage and prevent blindness.  

If your eye doctor thinks you may have severe diabetic retinopathy or DME, they may do a test called a fluorescein angiogram. This test lets the doctor see pictures of the blood vessels in your retina. 

Managing your diabetes is the best way to lower your risk of diabetic retinopathy. That means keeping your blood sugar levels as close to normal as possible. You can do this by getting regular physical activity, eating healthy, and carefully following your doctor’s instructions for your insulin or other diabetes medicines.  

To help control your blood sugar, you’ll need a special test called an A1c test. This test shows your average blood sugar level over a 3-month period. Talk with your doctor about lowering your A1c level to help prevent or manage diabetic retinopathy.

Having high blood pressure or high cholesterol along with diabetes increases your risk for diabetic retinopathy. So controlling your blood pressure and cholesterol can also help lower your risk for vision loss.

In the early stages of diabetic retinopathy, your eye doctor will probably just keep track of how your eyes are doing. Some people with diabetic retinopathy may need a comprehensive dilated eye exam as often as every 2 to 4 months.  

In later stages, it’s important to start treatment right away — especially if you experience changes in your vision. While it won’t undo any damage to your vision, treatment can stop your vision from getting worse. It’s also important to take steps to control your diabetes, blood pressure, and cholesterol. 

Last updated: August 3, 2019


What is diabetic retinopathy?

Diabetic retinopathy occurs when changes in blood glucose levels cause changes in retinal blood vessels. In some cases, these vessels will swell up (macular oedema) and leak fluid into the rear of the eye.

In other cases, abnormal blood vessels will grow on the surface of the retina.
Unless treated, diabetic retinopathy can gradually become more serious and progress from ‘background retinopathy’ to seriously affecting vision and can lead to blindness.

Diabetic retinopathy includes 3 different types :

  • Background retinopathy
  • Diabetic maculopathy
  • Proliferative retinopathy

What are the symptoms of diabetic retinopathy?

many conditions of this nature, the early stages of diabetic retinopathy may occur without symptoms and without pain. An actual influence on the vision will not occur until the disease advances.

Macular oedema can result from maculopathy and affect vision occurs if leaking fluid causes the macular to swell. New vessels on the retina can prompt bleeding, which can also block vision in some cases.

Symptoms may only become noticeable once the disease advances, but the typical symptoms of retinopathy to look out for include:

  • Sudden changes in vision / blurred vision
  • Eye floaters and spots
  • Double vision
  • Eye pain

Read more about the symptoms of diabetic retinopathy

How is diabetic retinopathy caused?

Diabetic retinopathy is caused by prolonged high blood glucose levels Over time, high sugar glucose levels can weaken and damage the small blood vessels within the retina.

This may cause haemorrhages, exudates and even swelling of the retina.

This then starves the retina of oxygen, and abnormal vessels may grow. Good blood glucose control helps to lower diabetes retinopathy risks.

Am I at risk from diabetic retinopathy?

Diabetic retinopathy risk factors include the following.

If any of the below affect you it’s worth having an retinopathy screening examination as quickly as possible.

  • Poor blood glucose control
  • Protein in urine
  • High blood pressure
  • Prolonged diabetes
  • Raised fats (triglycerides) in the blood

Anyone suffering from diabetes faces the risk of developing diabetic retinopathy and other diabetes complications

The longer a person has diabetes, the greater the risk of developing diabetic retinopathy becomes. However, keeping blood glucose levels well controlled can help to significantly slow down the development of retinopathy.

People with diabetes should, however, be aware that a rapid improvement in blood glucose levels can lead to a worsening of retinopathy. A rapid improvement in blood glucose levels in this case is defined as a drop in HbA1c of 30 mmol/mol or 3%.

Retinopathy occurs when blood vessels in the back of the eye, the retina, become damaged. When the blood vessels become damaged they can leak and these leaks can cause dark spots on our vision.

The main causes of retinopathy tend to be sustained high blood glucose levels and high blood pressure as well. Retinopathy can progress over years or decades depending on how good your blood glucose control is.

The good news is that because it takes a long time to develop, it can be spotted before it becomes too serious.

The symptoms of retinopathy tend to come on once retinopathy has been developing for some time. The symptoms present themselves as dark patches on your vision. You may not notice them at first but can be more noticeable if retinopathy is not picked up.

It’s important therefore that you attend your retinopathy screening each year.

People with diabetes should be screened in the UK once each year for retinopathy. A photograph is taken of the eye which allows the specialists to spot any signs of damage that may be present.

Screening appointments mean that the signs can be spotted well in advance of symptoms developing. In the early stages of retinopathy, no treatment is needed but it’s recommended that patients keep good control of their blood sugar levels.

If retinopathy develops laser surgery may be needed. Laser targets the problem blood vessels to prevent them from leaking. Other treatments for advanced retinopathy can include injections or vitrectomy surgery.

Download a FREE eye health guide for your phone, desktop or as a printout.

Are there any ways to prevent diabetic retinopathy?

Long-term good blood glucose level management helps to prevent diabetes retinopathy and lower the risk of developing it. Heart disease risk factors also affect retinopathy risk and include stopping smoking, having regular blood pressure and cholesterol checks and undergoing regular eye check-ups.

The risk of developing diabetic retinopathy can be lessened through taking the following precautions:

Can diabetic retinopathy be treated?

Laser surgery is often used in the treatment of diabetic eye disease, but each stage of diabetic retinopathy can be treated in a different way.

Background retinopathy has no treatment but patients will need regular eye examinations.
Maculopathy is usually treated with laser treatment (tiny burns that help to prevent new blood vessel growth and improve the nutrient and oxygen supply to the retina).

This is usually painless and has no side effects, but can influence night driving and peripheral vision.

This type of laser treatment for diabetic retinopathy will not improve vision, but it can prevent deterioration. Proliferative retinopathy is also treated with lasers, with a scattering over the whole retina. This destroys the starved area of the retina.
Serious diabetes retinopathy cases may require eye surgery.

This is usually diagnosed due to bleeding in the eye, late-stage proliferative retinopathy or ineffective laser treatment. This type of diabetic retinopathy eye surgery is called vitrectomy.

  • Read more on treating retinopathy

Background retinopathy

Background retinopathy, also known as simple retinopathy, involves tiny swellings in the walls of the blood vessels.

Known as blebs, they show up as small dots on the retina and are usually accompanied by yellow patches of exudates (blood proteins).

Background diabetic retinopathy requires regular monitoring by an ophthalmologist. It is therefore important to attend regular retinopathy screening appointments.

Diabetic maculopathy

The macula is the most well used area of the retina and provides us with our central vision. Maculopathy refers to a progression of background retinopathy into the macular.
This can cause vision problems such as difficulty with reading and or seeing faces in the centre of your vision.

Proliferative retinopathy

Proliferative retinopathy is an advanced stage of diabetic retinopathy in which the retina becomes blocked causing the growth of abnormal blood vessels.

These can then bleed into the eyes, cause the retina to detach, and seriously damage vision. If left untreated, this can cause blindness. If proliferative retinopathy is regularly monitored and treated, the development of retinopathy can help be limited and more severe damage may be prevented.


Diabetic retinopathy: Causes, symptoms, and treatments

Retinopathy in diabetes

Diabetic retinopathy is damage to the retina caused by complications of diabetes mellitus.

The condition can lead to blindness if left untreated. Early blindness due to diabetic retinopathy (DR) is usually preventable with routine checks and effective management of the underlying diabetes.

  • Diabetic retinopathy (DR) is blood vessel damage in the retina that happens as a result of diabetes.
  • It is the leading cause of blindness in the United States (U.S.).
  • Symptoms include blurred vision, difficulty seeing colors, floaters, and even total loss of vision.
  • People with diabetes should have their vision checked at least once annually to rule out DR.
  • There are retinal surgeries that can relieve symptoms, but controlling diabetes and managing early symptoms are the most effective ways to prevent DR.

Share on PinterestDiabetic retinopathy is a complication of diabetes that can lead to total blindness without treatment.

DR is a complication of diabetes and a leading cause of blindness in the United States (U.S.).

The retina is the membrane that covers the back of the eye. It is highly sensitive to light.

It converts any light that hits the eye into signals that can be interpreted by the brain. This process produces visual images, and it is how sight functions in the human eye.

Diabetic retinopathy damages the blood vessels within the retinal tissue, causing them to leak fluid and distort vision.

There are two types of DR:

  • Non-proliferative diabetic retinopathy (NPDR): This is the milder form of diabetic retinopathy and is usually symptomless.
  • Proliferative diabetic retinopathy (PDR): PDR is the most advanced stage of diabetic retinopathy and refers to the formation of new, abnormal blood vessels in the retina.

Approximately 5.4 percent of people in the U.S. aged over 40 years have DR.

Worldwide, one-third of the estimated 285 million people with diabetes show signs of DR.

Diabetic retinopathy typically presents no symptoms during the early stages.

The condition is often at an advanced stage when symptoms become noticeable. On occasion, the only detectable symptom is a sudden and complete loss of vision.

Signs and symptoms of diabetic retinopathy may include:

  • blurred vision
  • the impairment of color vision
  • floaters, or transparent and colorless spots and dark strings that float in the patient’s field of vision
  • patches or streaks that block the person’s vision
  • poor night vision
  • sudden and total loss of vision

DR usually affects both eyes. It is important to make sure that the risk of vision loss is minimized. The only way people with diabetes can prevent DR is to attend every eye examination scheduled by their doctor.


Possible complications associated with diabetic retinopathy include the following:

Vitreous hemorrhage: A newly formed blood vessel leaks into the vitreous gel that fills the eye, stopping light from reaching the retina. Symptoms include loss of vision and sensitivity to light, or floaters in milder cases. This complication can resolve itself if the retina remains undamaged.

Detached retina: Scar tissue can pull the retina away from the back of the eye. This usually causes the appearance of floating spots in the individual’s field of vision, flashes of light, and severe vision loss. A detached retina presents a significant risk of total vision loss if left untreated.

Glaucoma: The normal flow of fluid in the eye may become blocked as new blood vessels form. The blockage causes a buildup of ocular pressure, or pressure in the eye, increasing the risk of optic nerve damage and vision loss.

Anybody with diabetes is at risk of developing diabetic retinopathy. However, there is a greater risk if the person:

  • does not correctly control blood sugar levels
  • experiences high blood pressure
  • has high cholesterol
  • is pregnant
  • smokes regularly
  • has had diabetes for a long time

Damage to the network of blood vessels that nourish the retina is the key cause of diabetic retinopathy.

High glucose levels damage these vessels and restrict the flow of blood to the retina. The problems with the blood vessels can be as mild as tiny bulges in the vessel wall that occasionally leak blood without affecting vision.

However, in the advanced stages of the condition, these blood vessels may become completely blocked. The eye then produces new, less stable blood vessels. The new vessels break easily and leak into the vitreous gel of the eye. The bleeding causes blurred and patchy vision by further blocking the retina.

This bleeding, on occasion, forms scars that can separate the retina and the eye, leading to a detached retina. As symptoms develop, a person with DR becomes increasingly ly to experience complete vision loss.

Share on PinterestDiabetic retinopathy may be diagnosed using an optical coherence tomography (OCT) scan.

Diabetic retinopathy generally starts without any noticeable change in vision. However, an ophthalmologist, or eye specialist, can detect the signs.

It is crucial for people with diabetes to have an eye examination at least once or twice annually, or when recommended by a physician.

The following methods are commonly used to diagnose diabetic retinopathy:

Dilated eye exam

The doctor administers drops into the patient’s eyes. These drops dilate the pupils and allow the doctor to view the inside of the eye in a more detailed way.

Photographs are taken of the interior of the eye. During the eye examination, the doctor can detect the presence of:

  • abnormalities in the blood vessels, optic nerve, or retina
  • cataracts
  • changes in eye pressure or overall vision
  • new blood vessels
  • retinal detachment
  • scar tissue

These drops may sting, and the bright lights of the photographs can startle the person receiving the test. In high-risk individuals, the eye drops may cause an increase in ocular pressure.

Fluorescein angiography

Drops are used to dilate the pupils, and a special dye called fluorescein is injected into a vein in the patient’s arm. Pictures are taken as the dye circulates through the eyes. The dye may leak into the retina or stain the blood vessels if the blood vessels are abnormal.

This test can determine which blood vessels are blocked, leaking fluid, or broken down. Any laser treatments can then be accurately guided. For around 24 hours after the test, the skin may turn yellowish, and urine dark orange, as the dye exits the body.

Optical coherence tomography (OCT)

This noninvasive imaging scan provides high-resolution cross-sectional images of the retina, revealing its thickness. After any treatments, scans may be used later to check how effective treatment has been.

OCT is similar to ultrasound testing but uses light rather than sound to produce images. The scan can also detect diseases of the optic nerve.

Treating DR depends on several factors, including the severity and type of DR, and how the person with DR has responded to previous treatments.

With NPDR, a doctor may decide to monitor the person’s eyes closely without intervening. This is known as watchful waiting.

Individuals will need to work with their doctor to control diabetes. Good blood sugar control can significantly slow the development of DR.

In most cases of PDR, the patient will require immediate surgical treatment. The following options are available:

Focal laser treatment, or photocoagulation

The procedure is carried out in a doctor’s office or an eye clinic. Targeted laser burns seal the leaks from abnormal blood vessels. Photocoagulation can either stop or slow down the leakage of blood and buildup of fluid in the eye.

People will usually experience blurry vision for 24 hours following focal laser treatment. Small spots may appear in the visual field for a few weeks after the procedure.

Scatter laser treatment, or pan-retinal photocoagulation

Scattered laser burns are applied to the areas of the retina away from the macula, normally over the course of two or three sessions. The macula is the area at the center of the retina in which vision is strongest.

The laser burns cause abnormal new blood vessels to shrink and scar. Most patients require two or three sessions for the best results.

Individuals may have blurry vision for 24 hours following the procedure, and there may be some loss of night vision or peripheral vision.


This involves the removal some of the vitreous from within the eyeball. The surgeon replaces the clouded gel with a clear liquid or gas. The body will eventually absorb the gas or liquid. This will create new vitreous to replace the clouded gel that has been removed.

Any blood in the vitreous and scar tissue that may be pulling on the retina is removed. This procedure is performed in a hospital under general or local anesthetic.

The retina may also be strengthened and held in position with tiny clamps.

After surgery, the patient may have to wear an eye patch to gradually regain use of their eye, which can tire after a vitrectomy.

If gas was used to replace the removed gel, the patient should not travel by plane until all gas has been absorbed into the body. The surgeon will tell the patient how long this should take. Most patients will have blurry vision for a few weeks after surgery. It can take several months for normal vision to return.

Surgery is not a cure for diabetic retinopathy. However, it may stop or slow the progression of symptoms. Diabetes is a long-term condition, and subsequent retinal damage and vision loss may still occur despite treatment.


For the majority of people with diabetes, DR is an inevitable consequence.

However, patients with diabetes who successfully manage their blood sugar levels will help to prevent the onset of a severe form of DR.

High blood pressure, or hypertension, is another contributing factor. Patients with diabetes need to control their blood pressure by:

  • eating a healthy and balanced diet
  • regularly exercising
  • maintaining a healthy body weight
  • smoking cessation
  • strictly controlling alcohol intake
  • taking any antihypertensive measures according to their doctor’s instructions
  • attending regular screenings

Early detection of symptoms increases the effectiveness of the treatment.

Written by Christian Nordqvist


Diabetic retinopathy

Retinopathy in diabetes

Diabetic retinopathy is a condition that may occur in people who have diabetes. It causes progressive damage to the retina, the light-sensitive lining at the back of the eye. Diabetic retinopathy is a serious sight-threatening complication of diabetes.

Diabetes interferes with the body's ability to use and store sugar (glucose). The disease is characterized by too much sugar in the blood, which can cause damage throughout the body, including the eyes. Over time, diabetes damages small blood vessels throughout the body, including the retina.

Diabetic retinopathy occurs when these tiny blood vessels leak blood and other fluids. This causes the retinal tissue to swell, resulting in cloudy or blurred vision. The condition usually affects both eyes. The longer a person has diabetes, the more ly they will develop diabetic retinopathy.

If left untreated, diabetic retinopathy can cause blindness.

Symptoms of diabetic retinopathy include:

  • Seeing spots or floaters
  • Blurred vision
  • Having a dark or empty spot in the center of your vision
  • Difficulty seeing well at night

When people with diabetes experience long periods of high blood sugar, fluid can accumulate in the lens inside the eye that controls focusing. This changes the curvature of the lens, leading to changes in vision.

 However, once blood sugar levels are controlled, usually the lens will return to its original shape and vision improves.

Patients with diabetes who can better control their blood sugar levels will slow the onset and progression of diabetic retinopathy.

According to a 2018 American Eye-Q® Survey conducted by the AOA, nearly half of Americans didn't know whether diabetic eye diseases have visible symptoms (often which the early stages of diabetic retinopathy does not).

The same survey found that more than one-third of Americans didn't know a comprehensive eye exam is the only way to determine if a person's diabetes will cause blindness, which is why the AOA recommends that everyone with diabetes have a comprehensive dilated eye examination at least once a year.

Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy.

Treatment of diabetic retinopathy varies depending on the extent of the disease. People with diabetic retinopathy may need laser surgery to seal leaking blood vessels or to discourage other blood vessels from leaking. Your doctor of optometry might need to inject medications into the eye to decrease inflammation or stop the formation of new blood vessels.

People with advanced cases of diabetic retinopathy might need a surgical procedure to remove and replace the gel- fluid in the back of the eye, called the vitreous. Surgery may also be needed to repair a retinal detachment. This is a separation of the light-receiving lining in the back of the eye.

If you are diabetic, you can help prevent or slow the development of diabetic retinopathy by:

  • Taking your prescribed medication
  • Sticking to your diet
  • Exercising regularly
  • Controlling high blood pressure
  • Avoiding alcohol and smoking

What causes diabetic retinopathy?

Diabetic retinopathy results from the damage diabetes causes to the small blood vessels located in the retina. These damaged blood vessels can cause vision loss:

  • Fluid can leak into the macula, the area of the retina responsible for clear central vision. Although small, the macula is the part of the retina that allows us to see colors and fine detail. The fluid causes the macula to swell, resulting in blurred vision.
  • In an attempt to improve blood circulation in the retina, new blood vessels may form on its surface. These fragile, abnormal blood vessels can leak blood into the back of the eye and block vision.

Diabetic retinopathy is classified into two types:

  1. Non-proliferative diabetic retinopathy (NPDR) is the early stage of the disease in which symptoms will be mild or nonexistent. In NPDR, the blood vessels in the retina are weakened. Tiny bulges in the blood vessels, called microaneurysms, may leak fluid into the retina. This leakage may lead to swelling of the macula.
  2. Proliferative diabetic retinopathy (PDR) is the more advanced form of the disease. At this stage, circulation problems deprive the retina of oxygen. As a result, new, fragile blood vessels can begin to grow in the retina and into the vitreous, the gel- fluid that fills the back of the eye. The new blood vessels may leak blood into the vitreous, clouding vision.

Other complications of PDR include detachment of the retina due to scar tissue formation and the development of glaucoma. Glaucoma is an eye disease in which there is progressive damage to the optic nerve.

In PDR, new blood vessels grow into the area of the eye that drains fluid from the eye. This greatly raises the eye pressure, which damages the optic nerve. If left untreated, PDR can cause severe vision loss and even blindness.

Risk factors for diabetic retinopathy include:

  • Diabetes. People with type 1 or type 2 diabetes are at risk for developing diabetic retinopathy. The longer a person has diabetes, the more ly he or she is to develop diabetic retinopathy, particularly if the diabetes is poorly controlled.
  • Race. Hispanics and African Americans are at greater risk for developing diabetic retinopathy.
  • Medical conditions. People with other medical conditions, such as high blood pressure and high cholesterol, are at greater risk.
  • Pregnancy. Pregnant women face a higher risk for developing diabetes and diabetic retinopathy. If a woman develops gestational diabetes, she has a higher risk of developing diabetes as she ages.

How is diabetic retinopathy diagnosed?

Diabetic retinopathy can be diagnosed through a comprehensive eye examination. Testing, with emphasis on evaluating the retina and macula, may include:

  • Patient history to determine vision difficulties, presence of diabetes, and other general health concerns that may be affecting vision
  • Visual acuity measurements to determine how much central vision has been affected
  • Refraction to determine if a new eyeglass prescription is needed
  • Evaluation of the ocular structures, including the evaluation of the retina through a dilated pupil
  • Measurement of the pressure within the eye

Supplemental testing may include:

  • Retinal photography or tomography to document the current status of the retina
  • Fluorescein angiography to evaluate abnormal blood vessel growth

How is diabetic retinopathy treated?

Laser treatment (photocoagulation) is used to stop the leakage of blood and fluid into the retina. A laser beam of light can be used to create small burns in areas of the retina with abnormal blood vessels to try to seal the leaks.

Treatment for diabetic retinopathy depends on the stage of the disease.

The goal of any treatment is to slow or stop the progression of the disease.

In the early stages of non-proliferative diabetic retinopathy, regular monitoring may be the only treatment.

Following your doctor's advice for diet and exercise and controlling blood sugar levels can help control the progression of the disease.

Injections of medication in the eye are aimed at discouraging the formation of abnormal blood vessels and may help slowdown the damaging effects of diabetic retinopathy.

If the disease advances, the abnormal blood vessels can leak blood and fluid into the retina, leading to macular edema. Laser treatment (photocoagulation) can stop this leakage.

A laser beam of light creates small burns in areas of the retina with abnormal blood vessels to try to seal the leaks.

Widespread blood vessel growth in the retina, which occurs in proliferative diabetic retinopathy, can be treated by creating a pattern of scattered laser burns across the retina. This causes abnormal blood vessels to shrink and disappear. With this procedure, some side vision may be lost in order to safeguard central vision.