Diabetic retinopathy is a diabetes complication that affects eyes. It's caused by damage to the blood
vessels of the light-sensitive tissue at the back of the eye (retina).
At first, diabetic retinopathy may cause no symptoms or only mild vision problems. Eventually, it can
cause blindness.The condition can develop in anyone who has type 1 or type 2 diabetes. The longer you have
diabetes and the less controlled your blood sugar is, the more likely you are to develop this eye
You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses,
diabetic retinopathy symptoms may include:
Spots or dark strings floating in your vision (floaters)
Impaired color vision
Dark or empty areas in your vision
Diabetic retinopathy usually affects both eyes.
When to see a doctor
Careful management of your diabetes is the best way to prevent vision loss. If you have diabetes, see your
eye doctor for a yearly eye exam with dilation — even if your vision seems fine. Pregnancy may worsen
diabetic retinopathy, so if you're pregnant, your eye doctor may recommend additional eye exams throughout
Contact your eye doctor right away if your vision changes suddenly or becomes blurry, spotty or hazy.
There are two types of diabetic retinopathy:
Early diabetic retinopathy.
In this more common form — called nonproliferative diabetic retinopathy (NPDR) — new blood vessels aren't
When you have NPDR, the walls of the blood vessels in your retina weaken. Tiny bulges (microaneurysms)
protrude from the vessel walls of the smaller vessels, sometimes leaking fluid and blood into the retina.
Larger retinal vessels can begin to dilate and become irregular in diameter, as well. NPDR can progress
from mild to severe, as more blood vessels become blocked.
Nerve fibers in the retina may begin to swell. Sometimes the central part of the retina (macula) begins to
swell (macular edema), a condition that requires treatment.
Advanced diabetic retinopathy.
Diabetic retinopathy can progress to this more severe type, known as proliferative
diabetic retinopathy. In this type, damaged blood vessels close off, causing the growth of new, abnormal
blood vessels in the retina, and can leak into the clear, jelly-like substance that fills the center of
your eye (vitreous).
Eventually, scar tissue stimulated by the growth of new blood vessels may cause the
retina to detach from the back of your eye. If the new blood vessels interfere with the normal flow of
fluid out of the eye, pressure may build up in the eyeball. This can damage the nerve that carries images
from your eye to your br7\ain (optic nerve), resulting in glaucoma.
Anyone who has diabetes can develop diabetic retinopathy. Risk of developing the eye
condition can increase as a result of:
Duration of diabetes — the longer you have diabetes, the greater your
risk of developing diabetic retinopathy
Poor control of your blood sugar level
High blood pressure
Being African-American, Hispanic or Native American
Diabetic retinopathy involves the abnormal growth of blood vessels in the retina. Complications can lead
to serious vision problems:
Vitreous hemorrhage. The new blood vessels may bleed into the clear,
jelly-like substance that fills the
center of your eye. If the amount of bleeding is small, you might see only a few dark spots (floaters). In
more-severe cases, blood can fill the vitreous cavity and completely block your vision.
Vitreous hemorrhage by itself usually doesn't cause permanent vision
loss. The blood often clears from the
eye within a few weeks or months. Unless your retina is damaged, your vision may return to its previous
Retinal detachment. The abnormal blood vessels associated with
diabetic retinopathy stimulate the growth
of scar tissue, which can pull the retina away from the back of the eye. This may cause spots floating in
your vision, flashes of light or severe vision loss.
Glaucoma. New blood vessels may grow in the front part of your eye
and interfere with the normal flow of
fluid out of the eye, causing pressure in the eye to build up (glaucoma). This pressure can damage the
nerve that carries images from your eye to your brain (optic nerve).
Blindness. Eventually, diabetic retinopathy, glaucoma or both can
lead to complete vision loss.
You can't always prevent diabetic retinopathy. However, regular eye exams, good control of your blood
sugar and blood pressure, and early intervention for vision problems can help prevent severe vision
If you have diabetes, reduce your risk of getting diabetic retinopathy by doing the following:
Manage your diabetes. Make healthy eating and
physical activity part of your daily
routine. Try to get at least 150 minutes of moderate aerobic activity, such as walking, each week. Take
oral diabetes medications or insulin as directed.
Monitor your blood sugar level. You may need to check and record your
blood sugar level several times a
day — more-frequent measurements may be required if you're ill or under stress. Ask your doctor how often
you need to test your blood sugar.
Ask your doctor about a glycosylated hemoglobin test. The glycosylated
hemoglobin test, or hemoglobin A1C
test, reflects your average blood sugar level for the two- to three-month period before the test. For most
people, the A1C goal is to be under 7 percent.
Keep your blood pressure and cholesterol under control. Eating healthy
foods, exercising regularly and
losing excess weight can help. Sometimes medication is needed, too.
If you smoke or use other types of tobacco, ask your doctor to help
you quit. Smoking increases your risk
of various diabetes complications, including diabetic retinopathy.
Pay attention to vision changes. Contact your eye doctor right away if
you experience sudden vision
changes or your vision becomes blurry, spotty or hazy.
Remember, diabetes doesn't necessarily lead to vision loss. Taking an active role
management can go a long way toward preventing complications.
Treatment, which depends largely on the type of diabetic retinopathy you have and how
severe it is, is geared to slowing or stopping progression of the condition.
If you have mild or moderate nonproliferative diabetic retinopathy, you may not need treatment right away.
However, your eye doctor will closely monitor your eyes to determine when you might need treatment.
Work with your diabetes doctor (endocrinologist) to determine if there are ways to improve your diabetes
management. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the
If you have proliferative diabetic retinopathy or macular edema, you'll need prompt surgical treatment.
Depending on the specific problems with your retina, options may include:
Your doctor may recommend these medications, also called anti-VEGF therapy, as a stand-alone treatment or in
combination with panretinal photocoagulation. While studies of anti-VEGF therapy in the treatment of
diabetic retinopathy are promising, this approach is not yet considered standard.
Surgery often slows or stops the progression of diabetic retinopathy, but it's not a cure. Because diabetes
is a lifelong condition, future retinal damage and vision loss are still possible.