Diabetic retinopathy is a condition that can cause vision loss and blindness in people with diabetes. Over time, high blood sugar damages blood vessels, including those in the retina (the light-sensitive part of the back of the eye). This damage affects one’s ability to see and can lead to permanent vision loss. 

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What Are the Symptoms of Diabetic Retinopathy?

People with diabetic retinopathy may not experience any symptoms at first. In its early stages, you may notice changes to your vision that come and go. These changes can include trouble seeing up close or far away.

As the disease progresses, symptoms can include:

• Dark, floating spots (floaters) or cobweb-like strings in your vision
• Changes in vision, like vision that becomes blurred, then clear, then blurred again
• Blurred vision
• Blank patches or dark spots in your vision
• Flashes of light
• Eye pain or pressure
• Vision loss

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What Causes Diabetic Retinopathy?

Diabetic retinopathy develops in people with diabetes. Diabetes is a disease that makes it harder to control the level of sugar (glucose) in one’s blood.

Over time, high blood sugar damages blood vessels throughout the body, including in the eye. The blood vessels leading to the retina can swell and leak or close up and stop working altogether. Sometimes, new vessels grow to replace them. These vessels can also have problems. Eventually, this can damage vision and may lead to blindness. It can also lead to other conditions that can cause vision problems and blindness, like diabetic macular edema, glaucoma, and retinal detachment. 

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Who’s at Risk for Diabetic Retinopathy?

Anyone who has diabetes can develop diabetic retinopathy. The longer you have diabetes, the more likely you are to develop diabetic retinopathy.

Other risk factors include:

• Uncontrolled blood sugar: The less controlled your blood sugar, the more damage it causes to your blood vessels.
• High blood pressure.
• High cholesterol.
• Smoking.
• Being Black, Hispanic, or Native American: People who are Black, Hispanic, or Native American are at increased risk of developing diabetes and diabetic retinopathy.
• Being pregnant: Women who are pregnant are at greater risk of developing gestational diabetes (diabetes that develops during pregnancy). Women with diabetes who become pregnant are also at higher risk of developing diabetic retinopathy.

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How Is Diabetic Retinopathy Diagnosed?

Your eye doctor will check for signs of diabetic retinopathy during a dilated eye exam. This is an exam in which your eye doctor will use eye drops to open your pupils and get a better view of your eyes. This is sometimes called a diabetic eye exam.

Your doctor will then perform one or a series of tests to check your vision and look at your retina, optical nerve, and other parts of your eye. These include:

• Retinal imaging: Your eye doctor may take a photo of your retina, called a fundus photo. 

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• Optical coherence tomography (OCT): This gives your doctor something akin to a 3D photo of your retina and optic nerve. It allows them to see the different layers of your retina and see if any abnormal blood vessels are growing.

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• Fluorescein angiography: In this test, your eye doctor injects a special dye into your blood. This dye travels throughout the body, including to the eye. It allows your eye doctor to take pictures of the blood vessels in your eyes to see how well they are working based on the diffusion patterns of the dye in the eye.

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How Is Diabetic Retinopathy Treated? 

In its early stages, your eye doctor will check your eyes regularly to monitor their health. Your eye doctor may want to see you as often as every two to four months.

It’s important to stay on top of these exams. This way, your doctor can start treatment as soon as they see signs of the condition progressing. Timely intervention can keep your vision from getting worse.

Managing your diabetes and keeping your blood sugar in range is one of the best ways to slow its progression — and prevent the disease in the first place. Managing high blood pressure and high cholesterol are also important to slowing the disease.

In its later stages, treatment options may include:

• Injecting medication into your eye: Medications called anti-VEGF drugs can stop the growth of new blood vessels, decrease swelling of the macula (part of the retina), and decrease pressure in the eye. Another type of medication, called steroids, can help reduce swelling of the macula. These medicines are injected directly into your eye.
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• Laser treatment: This is also called photocoagulation or focal laser treatment. Laser treatment can shrink and seal off leaking blood vessels and stop them from growing back. This reduces fluid and pressure in the eye.
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• Eye surgery: If you have advanced diabetic retinopathy, your eye doctor may recommend a type of surgery called a vitrectomy. In this procedure, the eye doctor will remove some of the vitreous (the gel-like fluid in the middle of the eye) along with blood that has leaked into this part of the eye. If you also have a lot of scarring from the blood vessels, your doctor will remove some of that tissue as well. This can improve your vision and reduce your risk of retinal detachment.

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Can Diabetic Retinopathy Be Prevented?

Managing your diabetes and keeping your blood sugar within range is the best way to prevent diabetic retinopathy and slow its progression. This includes:

• Follow your diabetes treatment plan. Work with your doctor to set up a plan to manage your diabetes. This includes:
  • Regular blood sugar monitoring
  • Taking any medications as prescribed
  • Eating a nutritious, carb-balanced diet
  • Getting regular physical activity
  • Getting enough sleep each night
  • Managing stress
  • Losing weight if your doctor recommends
  • Keeping up with all of your tests, including your A1c tests and regular foot and eye exams
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• Manage your blood pressure and cholesterol. In addition to following the lifestyle tips above, you may need to take medication.
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• Get your eyes examined regularly. Ask your eye doctor how often you need to be checked.
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• Pay attention to vision changes. If you notice any changes in your vision, contact your eye doctor right away.
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• If you smoke or use tobacco products, ask your doctor for help quitting.

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What If I Already Have Some Vision Loss From Diabetic Retinopathy?

Ask your eye doctor to help you find a low-vision and rehabilitation clinic. Through the use of special devices and eye training, they can help you make the most of your remaining vision. 

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Learn more about how to care for your vision if you have diabetes.