Diabetic retinopathy
Diabetic retinopathy is a diabetic eye disease that happens when high blood glucose levels damage the blood vessels behind the retina at the back of the eye.
Diabetic retinopathy can ultimately lead to sight loss if it goes undiagnosed and untreated. However, there is less chance of this happening if your diabetes is well managed and your blood sugar levels, blood pressure, and cholesterol are under control. If you have diabetes, you'll have regular eye screening with the NHS to check for the condition.
A diagram of a healthy eye with labels.
A diagram of an eye with diabetic retinopathy. The diagram shows the changes that can occur at the back of the eye including ‘cotton wool’ spots, microaneurysms, and haemorrhages.
Symptoms of diabetic retinopathy
In the early stages, it's common not to experience symptoms. That's why attending diabetic eye screening appointments is important, to detect changes before symptoms occur. At a screening test, you will have a dilated eye examination, a detailed look at the back of your eye, and images will be taken.
In later stages, diabetic retinopathy can lead to vision loss. The retina, a light-sensitive layer at the back of the eye, sends light signals to the brain, creating the images we see. When the blood vessels behind the retina are damaged, as happens with diabetic retinopathy, this can cause vision problems.
Late symptoms can include blurred vision, seeing floaters, seeing flashing lights, and sight loss.
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Stages of diabetic retinopathy
Diabetic retinopathy usually develops slowly and progresses in stages. You may not experience vision loss until the very late stages of the disease and being diagnosed at an early stage doesn’t necessarily mean you’ll go on to develop later stages.
Managing your diabetes can help limit the risk of the disease progressing, and regular diabetic eye screening helps detect diabetic retinopathy changes as early as possible. Anyone over the age of 12 with diabetes should have diabetic eye screening appointments at least once a year.
At your appointment:
- You'll have an eyesight test and a dilated eye examination. You'll be given eye drops to dilate your pupils. Detailed pictures are taken of the back of your eyes, which can show changes to the retina before you have any other symptoms.
- You might have a test called optical coherence tomography (OCT) when a special camera is used to create a detailed image of the retina. It's not an invasive test; you just look into the machine for a few seconds.
- Sometimes you may also need another test called fluorescein angiography. A dye is injected into your arm, which then shows in the small blood vessels of your eye. Images are taken of changes to the blood vessels caused by diabetic retinopathy.
Diabetic retinopathy treatment
Keeping your diabetes well managed is advisable at all stages of diabetic retinopathy. This is the best way to limit its progression and the risk to your sight.
At more advanced stages, you might have treatment to help prevent sight loss or limit further sight loss. Treatments include:
- Laser surgery - this can help with proliferative retinopathy and maculopathy
- Anti-VEGF eye injections - for some cases of maculopathy
- Vitrectomy (eye surgery) - for advanced diabetic retinopathy
Causes of diabetic retinopathy
People with type 1 diabetes or type 2 diabetes are at risk of developing diabetic retinopathy. The condition is caused by sustained high blood sugar levels weakening and damaging the blood vessels at the back of the eye. The risk of diabetic retinopathy is higher if:
- You have had diabetes for a long time
- You have high blood pressure
- You have high cholesterol
- You have gestational diabetes in pregnancy
- You have sustained high blood glucose levels
- You are of Asian or Afro-Caribbean background
Managing the risks of diabetic retinopathy
There are ways to lower your risk of diabetic retinopathy, which can also help prevent it from getting worse.
It’s important to follow the advice of your diabetes care team, and manage your blood glucose levels, cholesterol, and blood pressure.
It’s also a good idea to following healthy living advice. This includes:
- Having a healthy balanced diet. There is lots of healthy diet advice , and you can speak to your GP or diabetes nurse for support.
- Keeping to a healthy weight. Find out more from the NHS.
- Being active and getting regular exercise. There are lots of activities that count, and finding something you enjoy doing makes it easier.
- Getting support to stop smoking. There's some evidence that smoking can make diabetic retinopathy worse (Source: Patient).
Some people also need to take medicine to help manage their diabetes.
Other ways to help manage the risk of getting diabetic retinopathy include:
- Monitoring your blood sugar levels.
- Going for your regular diabetic eye screening appointment.
- Getting help straight away if you notice any changes to your vision.
When to get medical advice
If you have diabetes, you'll be invited for regular diabetic eye screening. These eye exams will monitor your eyes for early signs of diabetic retinopathy before you experience vision problems. You may have more frequent appointments with a specialist if you develop later stages of the condition.
Medically reviewed by: The Royal College of Ophthalmologists on 18/10/2022
Edited by: Nick Astbury FRCS FRCOphth FRCP
Clinical Associate Professor
LSHTM
The Royal College of Ophthalmologists champions excellence in the practice of ophthalmology and is the only professional membership body for medically qualified ophthalmologists. The RCOphth is unable to offer direct advice to patients. If you’re concerned about the health of your eyes, you should seek medical advice from your GP, optometrist or ophthalmologist.