Table of Contents
Diabetic retinopathy is a type of vision loss caused by high blood sugar and blood vessel damage in the retina, which can occur in people who have any type of diabetes. (Learn More)
You may not notice early symptoms of diabetic retinopathy. Advanced symptoms mean irreversible vision loss. Preventative steps like regular appointments with your doctor and optometrist or ophthalmologist will help you maintain your sight. (Learn More)
A dilated eye exam allows your eye doctor to monitor blood vessel changes at the back of your eye. They may have you take one or two other tests to examine blood vessels in your eyes and the thickness of your retina. (Learn More)
Advanced diabetic retinopathy may require injections of anti-VEGF drugs, corticosteroids, laser surgery, or more invasive surgery. (Learn More) Although there are advances in treating retinal damage, the best step is still to get regular eye exams to monitor potential vision changes. (Learn More)
What Is Diabetic Retinopathy?
Diabetic retinopathy is a vision problem that can occur in people who have diabetes. Blood vessels to the retina (the part of the eye that absorbs light and sends it through the optic nerve to the brain) are damaged by diabetes, which can cause vision loss and even blindness.
About two in five people with diabetes develop diabetic retinopathy. The risk of the condition increases the longer you have diabetes. If you work with your doctor to control diabetes, you can greatly reduce your risk of losing your vision.
People who have diabetes should get an annual comprehensive eye exam, regardless of age. This helps your optometrist or ophthalmologist track any changes in your vision and help you maintain your sight. You may not notice symptoms of diabetic retinopathy on your own until a significant amount of vision loss has already occurred, but your eye doctor will notice changes in the back of your eye, which can lead to an early diagnosis. This helps you preserve your vision longer.
Managing diabetes with lifestyle changes and prescription medication will reduce your risk of diabetic retinopathy. If you develop the condition, work with your doctor to make sure you understand potential treatment options.
Causes & Symptoms of Diabetic Retinopathy
There are three common types of diabetes, all of which can lead to diabetic retinopathy.
- Type 1 diabetes: Also called juvenile or insulin-dependent diabetes, type 1 diabetes occurs when the pancreas fails to produce insulin.
- Type 2 diabetes: This is the most common form of diabetes. It develops in adults who become insulin-tolerant, so their blood glucose (sugar) is not regulated well.
- Gestational diabetes: This is similar to type 2 diabetes, but it only develops in women who are pregnant.
Having too much sugar in your blood because your body cannot manage insulin can cause damage to the retina, as the disease damages blood vessels all over the body. Sugar that is not removed from the blood and metabolized will collect in blood vessels, causing them to bleed or leak. Since these blood vessels fail to deliver enough oxygenated blood to important parts of the body, like your retina, new blood vessels grow.
These new vessels are less effective. They can leak or bleed more easily, and their presence can cause structural damage to organs.
Like many eye diseases, there are few noticeable symptoms in the early stages of diabetic retinopathy. Because of this, annual dilated eye exams are crucial. If you do notice symptoms in the early stages, they may feel more like changes in nearsightedness, farsightedness, or astigmatism. You may have trouble reading up close or seeing signs far away. Problems with vision may come and go, so some people may delay seeing a doctor initially.
Symptoms may include:
- Dark spots or strings in your vision (floaters).
- Blurry vision.
- Fluctuating visual acuity.
- Impaired color vision.
- Dark or dim areas of your vision.
- Empty areas in your vision.
- Vision loss.
Later stages of diabetic retinopathy involve blood vessels leaking blood into the vitreous humor, the gel-like substance that makes up the bulk of the eye and helps the organ to keep its shape. This can lead to floaters, which are dark streaks, spots, or web-like filaments that move across your vision. These spots may come and go, but if they appear suddenly or there are more of them in your vision, you should get treatment as soon as possible.
If blood vessels continue to leak into your eyes, this may eventually lead to significant internal bleeding, damage to the retina from oxygen loss and increased fluid pressure, and scarring in the eye.
Untreated diabetic retinopathy can lead to blindness. The condition can also lead to other eye diseases.
- Diabetic macular edema (DME): About half of people with diabetic retinopathy eventually develop diabetic macular edema. This occurs when retinal blood vessels leak fluid, which causes swelling in the macula. The macula is the central part of the retina, and it is associated with central vision.DME causes blurry vision because of the extra fluid retained in this area of the eye.
- Neovascular glaucoma: Not only can blood vessels around the retina leak fluid, but new ones can grow, causing a fluid blockage and increased pressure on the retina. Increased fluid pressure can damage that area and become glaucoma.
- Tractional retinal detachment: When the retina is damaged by blood loss and high pressure, it can detach due to more scarring at the back of the eye.
First Line of Diabetic Retinopathy Treatment: Regular Eye Exams
The best approach to treating diabetic retinopathy is to have a full eye exam once per year. Your eye doctor will dilate your pupils so they can see into the back of your eye. This is the most effective way for them to monitor blood vessel growth or leakage at the back of your eye.
If your eye doctor thinks you have advanced retinopathy or a related condition like DME, they may also perform an exam called a fluorescein angiogram. This test uses a dye called fluorescein to help your doctor see the blood vessels in your eye.
Sometimes, your ophthalmologist may perform an optical coherence tomography (OCT) exam, which creates cross-sectioned images of your retina to determine the area’s thickness. This helps your doctor understand if fluid has leaked into the retina and surrounding tissue.
You must follow your physician’s advice on necessary prescription medications to help you manage your diabetes and make lifestyle changes to keep yourself healthy overall. Your physician will also examine your blood sugar levels with an A1C test, which looks at your average blood sugar over a three-month period. If you have high blood sugar, high blood pressure, or high cholesterol, your chances of developing diabetic retinopathy are higher.
These are the most highly recommended lifestyle changes to manage diabetes:
- Get regular exercise, ideally on a daily basis.
- Eat a diet that focuses on healthy, low-sugar foods.
- Manage your body weight.
- Find ways to reduce stress.
Treating Advanced Diabetic Retinopathy Requires Medication or Surgery
Treating advanced diabetic retinopathy helps to slow down vision loss or changes in vision. A variety of treatments are available.
- Injections: Either corticosteroids or anti-VEGF medications can decelerate the growth of new blood vessels, which slows down vision loss. The VEGF protein in the eye is associated with blood vessel problems and swelling in the macula. Medications injected into the eye can block this protein’s action. Corticosteroids, in contrast, reduce overall swelling so they can reduce tissue inflammation at the back of the eye.
- Laser procedures: By using laser treatments, like those used for some types of glaucoma, your doctor can reduce how much fluid is in your eye. Scatter laser surgery, sometimes called panretinal photocoagulation, shrinks blood vessels at the back of the eye. Focal or grid photocoagulation targets specific spots near your retina to remove blood vessels and reduce scarring.
- Surgery: A vitrectomy will help to manage bleeding and scarring on your retina by removing the vitreous humor, which can become cloudy as blood leaks into it.
Medical Studies Examine Potential Future Treatments
In some patients, aggressive treatment of advanced diabetic retinopathy has reversed a little vision loss. However, once your retina is damaged, that vision almost never returns. This is why early diagnosis of diabetic retinopathy, along with full-body treatment of diabetes, will help you keep your vision if you do develop this eye disease.
Some medical researchers are examining whether photoreceptor cells in the macula and retina can be replaced. A few small studies have examined the regenerative properties of these cells, but no larger-scale trials have attempted surgery to replace damaged parts of the retina yet.
Eating more antioxidant-rich foods and adding antioxidant supplements to the diets of laboratory rats was found to reduce some diabetic retinopathy damage, suggesting that lifestyle changes could help humans too.
Still, the best approach to treatment for a chronic condition like diabetes is to work closely with your doctor to control your blood sugar. This reduces your risk of developing additional complications like diabetic retinopathy.
Early diagnosis of diabetes is imperative to avoiding long-term issues, including diabetic retinopathy. If you have risk factors for diabetes, visit your doctor regularly to have your blood sugar levels monitored.
There are two types of medications that may be injected as part of treating diabetic retinopathy damage.
- Corticosteroids: While these are not the primary form of treatment for diabetic retinopathy, corticosteroid injections may be used in place of anti-VEGF medications if the preferred treatment is not effective enough. The main side effect of corticosteroid injections is the risk of increased pressure inside the eye, which may lead to glaucoma.
- Anti-VEGF drugs: These are drugs injected directly into your eye to prevent new blood vessels from forming in the back of your eyes, so normal blood flow can return to your retina. There are two primary anti-VEGF medicines: Lucentis (ranibizumab) and Eylea (aflibercept).Possible side effects of anti-VEGF drugs include eye irritation, discomfort, bleeding inside the eye, watery or itchy eyes, feeling that the eyes are dry, and developing floaters inside the eye.
When you go in for an injection treatment, you can expect the process to include steps like these:
- The skin around your eyes is thoroughly cleaned.
- The area around your eyes is covered in a sheet to protect it during the procedure.
- Small clips are attached to your eyelids to keep your eyes open.
- Local anesthetic eyedrops are applied to numb your eyes.
Many people get these injections once per month until their vision begins to stabilize. Then, the ophthalmologist will determine an appropriate schedule for regular treatments and follow-up appointments.
This is a new approach to managing blood vessel development at the back of the eye, with targeted lasers that kill new, malformed, and leaking blood vessels that can damage the retina. Laser treatments are recommended only for advanced diabetic retinopathy, but it can help slow down the progression of vision loss for people who have a significant number of new blood vessels blocking their vision.
Similar in some ways to LASIK, you will prepare for this laser treatment with numbing eye drops and special drops that widen your pupils. Unlike LASIK, special contact lenses will be used to hold your eyelids open to focus the laser onto your retina, which is at the back of your eye. The process takes between 20 and 40 minutes per eye, and you can return home, with help, on the same day as the procedure.
You may have some side effects, like aching or discomfort, increased sensitivity to light, and blurry vision, but these will go away after your treatment has finished. However, you may need a few rounds of treatment to remove enough blood vessels.
If other treatments fail, surgery may be required to stop damage from diabetic retinopathy. Vitreoretinal surgery removes some of the vitreous humor from inside the eye; this is the watery, jelly-like substance that mostly keeps the eye in its round shape, but it also serves as an organ to stabilize and clean the inside of the eye.
Surgery to remove some of this substance is considered a last resort in the event that:
- A lot of blood has collected in the eye, and this has increased the internal pressure to a dangerous level.
- Scar tissue has formed around the retina to the point that it causes retinal detachment.
Like other eye surgeries, you will receive a local anesthetic so you don’t feel any of the procedure. Typically, you will be able to go home the same day as the operation.
You may need to wear an eye patch over your eye for a few days after vitrectomy. Even after you remove the patch, you may have some areas of blurry vision for several months. This will improve gradually. Your ophthalmologist will monitor that everything is healing appropriately via your regular eye exams.
Diabetic Retinopathy. (August 2019). National Eye Institute.
Diabetic Retinopathy Treatment. (October 2019). American Academy of Ophthalmology (AAO).
Diabetic Eye Problems. MedlinePlus.
Watch Out for Diabetic Retinopathy. (November 2018). Centers for Disease Control and Prevention.
Diabetic Retinopathy. John Hopkins Medicine.
Diabetic Retinopathy: Understanding Diabetes-Related Eye Disease and Vision Loss. (January 2020). Harvard Health Publishing, Harvard Medical School.
My Patient Has Diabetic Retinopathy… Now What? (May 2019). Review of Optometry.
Diabetic Retinopathy Diagnosis. (October 2019). American Academy of Ophthalmology (AAO).
Injections to Treat Diabetic Retinopathy and Diabetic Macular Edema. (May 2019). National Eye Institute.
Laser Treatment for Diabetic Retinopathy. (May 2019). National Eye Institute.
Diabetic Retinopathy and Diabetic Macular Edema. (2016). Developments in Ophthalmology.
Vitrectomy. (June 2019). National Eye Institute.
Current Advances in Pharmacotherapy and Technology for Diabetic Retinopathy: A Systematic Review. (January 2018). Journal of Ophthalmology.
Treatment: Diabetic Retinopathy. (October 2018). National Health Service (NHS).