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What Is Diabetic Retinopathy?
Diabetic retinopathy is diabetes-related damage to the retina, the light-sensitive tissue at the back of the eye. Persistently high blood glucose can weaken and damage the retina’s small blood vessels, causing them to leak or become blocked. It affects people with diabetes, including both type 1 and type 2 diabetes. Early disease may cause no symptoms, which is why regular eye examinations are important.
Symptoms
Symptoms of Diabetic Retinopathy
- Blurred vision can make near or distant objects look unclear.
- Floaters may appear as spots, threads, or cobweb-like shapes moving across your vision.
- Dark spots or empty areas may develop in part of your field of vision.
- Difficulty seeing at night may make it harder to navigate in dim light.
- Colors may look faded or less vivid than usual.
- Vision loss can occur as retinal damage becomes more advanced.
Causes
Causes of Diabetic Retinopathy
Over time, high blood glucose can weaken the tiny blood vessels that supply the retina. This vascular damage is the main reason retinopathy and diabetes are closely linked. The longer blood glucose remains above the recommended range, the greater the chance of retinal injury.
Describe How Retinal Damage Progresses
Damaged vessels may leak fluid or blood into the retina and may reduce blood flow and oxygen delivery. Swelling can affect the macula, the area responsible for sharp central vision. In response to poor oxygen supply, the eye may grow fragile, abnormal vessels that can bleed and threaten vision.
Risk Factors
Risk Factors for Diabetic Retinopathy
- Having diabetes for a longer period increases the opportunity for retinal damage to develop.
- Persistently high blood glucose increases the risk of diabetic eye disease.
- High blood pressure can add stress to retinal blood vessels.
- Abnormal cholesterol levels may contribute to blood-vessel damage.
- Pregnancy with diabetes can increase the need for close eye monitoring.
- Kidney disease is associated with a higher risk of retinopathy and diabetes-related complications.
- Smoking can worsen blood-vessel health and increase eye risks.
- Delayed or missed eye examinations can allow retinal changes to progress unnoticed.
Complications
Complications of Diabetic Retinopathy
- Diabetic macular edema is swelling in the macula that can reduce central vision.
- Vitreous hemorrhage occurs when abnormal blood vessels bleed into the gel inside the eye.
- Tractional retinal detachment occurs when scar tissue pulls the retina away from its normal position.
- Neovascular glaucoma can develop when abnormal vessels interfere with fluid drainage and raise eye pressure.
- Cataracts can cloud the eye’s lens and reduce clear vision.
- Permanent vision loss can result from severe or untreated retinal damage.
Proliferative diabetic retinopathy is an advanced form in which fragile abnormal blood vessels grow on the retina or nearby structures. These vessels can leak or bleed, and scar tissue may pull on the retina. As a result, this stage carries a higher risk of severe diabetic eye problems and vision loss.
Diagnosis
How Diabetic Retinopathy Is Diagnosed
- A dilated eye examination allows an eye professional to inspect the retina and optic nerve.
- Visual acuity testing measures how clearly you see at different distances.
- Retinal photography creates images that can document and monitor retinal changes.
- Optical coherence tomography uses detailed scans to look for retinal or macular swelling.
- Fluorescein angiography may be used when indicated to assess leakage and retinal blood flow.
Clinicians use examination and imaging findings to classify disease from mild nonproliferative changes through proliferative diabetic retinopathy. They also check for macular edema, reduced blood flow, bleeding, and abnormal vessel growth. These findings help determine the appropriate follow-up and treatment plan.
Treatment & Management
Diabetic Retinopathy Treatment and Management
| Approach | What it addresses | When it may be considered |
|---|---|---|
| Diabetes and blood-pressure control | Reduces ongoing stress on retinal blood vessels | For everyone with diabetes and related risk factors |
| Observation with follow-up | Monitors retinal changes before treatment is needed | For mild or stable disease under an eye specialist’s care |
| Anti-VEGF injections | Reduces abnormal vessel growth and macular swelling | When macular edema or proliferative changes threaten vision |
| Corticosteroid treatment | Helps reduce retinal or macular inflammation and swelling | When appropriate for selected cases |
| Laser photocoagulation | Treats leaking areas or reduces abnormal retinal vessel growth | For selected macular edema or proliferative disease |
| Vitrectomy | Removes blood or scar tissue from inside the eye | For selected advanced bleeding or tractional retinal complications |
Diabetic retinopathy treatment can often slow progression and protect remaining vision, especially when started before severe damage develops. Established retinal damage may not be fully reversed, so an eye specialist determines the plan based on the findings, symptoms, and stage of disease.
Prevention & Screening
Prevention and Screening for Diabetic Retinopathy
- Manage blood glucose with the plan developed with your diabetes care team.
- Monitor and treat high blood pressure.
- Keep cholesterol within the target range recommended by your clinician.
- Avoid smoking and seek support to quit if needed.
- Stay physically active as advised for your health and fitness level.
- Keep scheduled dilated eye examinations even when your vision seems normal.
Who Needs Screening and How Often
People with type 1 diabetes generally need their first comprehensive dilated eye examination within several years of diagnosis, while people with type 2 diabetes should be examined soon after diagnosis. Children and teenagers with diabetes may follow a different schedule based on their age and diabetes type. During pregnancy, people with diabetes may need an examination before pregnancy or early in pregnancy and additional follow-up as advised. The schedule may be more frequent when retinopathy is present or previous findings are concerning, so ask your diabetes clinician or eye specialist for a personalized plan.
Outlook and Prognosis
Outlook and Prognosis
Diabetic retinopathy may remain stable, progress, or recur after treatment, depending on the amount of retinal damage and how well diabetes, blood pressure, and other conditions are controlled. The stages can range from early nonproliferative changes to proliferative diabetic retinopathy, which has a greater risk of serious complications. Early detection and ongoing care improve the chance of protecting vision.
When Should You See a Doctor
When Should You See a Doctor?
- Arrange care if you have diabetes but do not have a current eye-examination plan.
- Contact an eye specialist about new blurred vision.
- Arrange an evaluation for new floaters or dark spots.
- Tell a clinician if you develop trouble seeing at night.
- Seek assessment if your vision is worsening, even gradually.
SEEK URGENT CARE
Sudden vision changes need prompt evaluation
Sudden vision loss, a sudden increase in floaters, flashes of light, or a curtain-like shadow may signal a serious retinal problem. Seek prompt emergency eye assessment rather than waiting for a routine appointment.
