Definition

Diabetic retinopathy is damage to blood vessels in the retina. The retina is tissue in the back of the eye.

This condition can happen with Type 1 or Type 2 diabetes.

There are two types of diabetic retinopathy:

• Non-proliferative (early stage)—blood vessels in the retina weaken and may leak. Vision may become blurry.
• Proliferative (late stage) —new blood vessels form in the retina and back of the eye. They can leak and make vision cloudy. If left untreated, it can lead to loss of eyesight and blindness.

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Causes

Diabetes causes high levels of sugar in the blood. Over time, excess blood sugar can damage small blood vessels in the body. This includes blood vessels in the retina.

High blood sugar causes swelling and leaking in the blood vessels of the retina. Some vessels may close off. New, weaker blood vessels can form. They also bleed or leak fluid into the eye or create scarring. This can cause problems with eyesight.

Risk Factors

Things that raise the risk of diabetic retinopathy are:

• Poorly-controlled diabetes
• Having diabetes for 20 years or longer
• High blood pressure
• Recent cataract surgery
• Kidney disease
• Pregnancy and puberty
• High cholesterol levels

Symptoms

Early diabetic retinopathy may not cause any symptoms. Over time, symptoms may be:

• Blurred or double vision
• Lower vision or loss of vision—in one or both eyes
• Spots or what looks like floating objects—in one or both eyes
• Eye pressure or pain
• Problems seeing in dim light
• Seeing flashing lights or rings around lights
• Sudden blindness (rare)

Diagnosis

The doctor will ask about symptoms and past health.

An eye doctor will do an eye exam and vision test. Diagnosis is based on an exam of the retina.

Images of the eyes will be taken with:

• Fundus photography—a digital photo of the retina
• Optical coherence tomography—light waves are used to take pictures of the retina

Treatment

Early stages of the disease may not need treatment. However, it is important to manage blood sugar, cholesterol, and blood pressure. This can slow or stop more damage. The eye doctor will check the condition.

If eye treatment is needed, options are:

• Medicines injected into the eye to slow or stop damage, such as:
  • Anti-vascular endothelial growth factor (Anti-VEGF)—to reduce swelling in the eye
  • Steroids—to reduce swelling and inflammation in the eye
• Surgery to slow the condition or keep if from getting worse, such as:
  • Laser treatment—to shrink abnormal blood vessels or to stop or slow leaks
  • Vitrectomy—blood vessels and/or scar tissue are removed

Prevention

To help lower the risk of getting diabetic retinopathy:

• Manage blood sugar, blood pressure, and cholesterol levels.
• Have regular eye exams.
• Follow a healthy diet and lifestyle.