Diabetic Retinopathy
Also known as DR, Diabetic Eye Disease, Nonproliferative Diabetic Retinopathy, NPDR, Proliferative Diabetic Retinopathy, PDR
Bottom Line
Diabetic retinopathy is damage to the tiny blood vessels in the back of the eye from high blood sugar. It is the leading cause of blindness in working-age adults, but early treatment can prevent most vision loss.
Diabetic retinopathy is the most common eye complication of diabetes. About 1 in 3 people with diabetes have some form of it, and about 1 in 10 have a vision-threatening form 1.
Over years, high blood sugar weakens the tiny blood vessels (capillaries) in the back of the eye (retina). The vessels can leak fluid or blood, swell up, or close off. In the worst stage, abnormal new vessels grow on the retina and can cause sudden, severe vision loss 2.
Most early diabetic retinopathy has no symptoms. The only way to find it is a dilated eye exam. Good blood sugar and blood pressure control, plus modern treatments — injections, lasers, or surgery — can prevent most vision loss 3.
Symptoms & Warning Signs
Most early diabetic retinopathy has no symptoms. By the time you notice changes, the disease may already be advanced. Warning signs include:
- Blurry or wavy central vision — often from diabetic macular edema
- New floaters or dark strings — from a small bleed
- Sudden, severe vision loss — from a large vitreous bleed
- A dark curtain or shadow over part of your vision — can mean a retinal detachment
- Trouble seeing at night or in dim light
- Colors that look faded
Can You Prevent Diabetic Retinopathy?
You cannot fully prevent diabetic retinopathy if you have diabetes, but you can lower your risk and slow it down a lot 3:
- Keep your A1C as close to your target as possible. For many adults, that is under 7%, but your doctor will set the right number for you.
- Keep your blood pressure under control. High blood pressure speeds up retinopathy.
- Do not smoke. Smoking damages blood vessels everywhere in the body.
- Get a dilated eye exam every year if you have type 1 or type 2 diabetes, even if your vision feels fine.
- If you are pregnant or planning pregnancy with diabetes, get an eye exam before and during pregnancy. Retinopathy can get worse fast.
Treatment
The right treatment depends on the stage of retinopathy:
- No retinopathy or mild changes: No eye treatment yet. Focus on blood sugar, blood pressure, cholesterol, and yearly eye exams.
- Diabetic macular edema: Injections of anti-VEGF drugs (aflibercept, ranibizumab, bevacizumab, faricimab) into the eye. These shots dry up the swelling and improve vision in most people 2.
- Proliferative diabetic retinopathy: Either scatter (panretinal) laser treatment, anti-VEGF injections, or both. Laser leaves small scars on the side of the retina to stop new vessels from growing.
- Vitreous bleeding that does not clear: Vitrectomy surgery removes blood from the gel inside the eye.
- Tractional retinal detachment: Vitrectomy with peeling of scar tissue to flatten the retina.
Modern eye injections work very well. About 1 in 3 people gain 3 lines of vision on the eye chart, and most keep their vision stable for years 4.
Common Questions About Diabetic Retinopathy
Next Steps
- 1Book a dilated eye exam if you have diabetes and have not had one in the past year.
- 2Ask for your most recent A1C, blood pressure, and cholesterol numbers and write them down.
- 3Tell your eye doctor about any new floaters, blurry vision, or shadows in your vision.
- 4If you are pregnant or planning pregnancy, get an eye exam before and early in the pregnancy.
- 5If you smoke, talk with your doctor about quitting — smoking speeds up diabetic eye damage.
- 6Get same-day retina care if you have sudden vision loss, many new floaters with flashes, or a curtain over your vision. Go to the emergency room if a retina specialist is not reachable today.
Find specialists for Diabetic Retinopathy
Board-certified ophthalmologists who treat Diabetic Retinopathy.
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