Diabetes-Related Retinopathy

Overview

Diabetes-related retinopathy is an eye condition that weakens the blood vessels in your retina.

There are two types of diabetes-related retinopathy:

  • Nonproliferative diabetes-related retinopathy (NPDR): In this early disease stage, people have blood vessels which leak in the retina. This manifests with either fluid, hemorrhage, or lipid seen in the retina. Eventually these blood vessels close causing ischemia or poor blood flow.
  • Proliferative diabetes-related retinopathy (PDR): When the disease progresses, abnormal blood vessels grow in response to the ischemia. These abnormal vessels can leak blood into the gel-like substance (vitreous) that fills your eye and cause tractional changes to the surface of the retina detaching it and resulting in severe vision loss in late stages.

What is the retina?

The retina is a tissue in the back of the eye that sends signal to your brain akin to the film in a camera. The retina converts light rays into electrical impulses that communicate with your brain. These impulses are what enable you to see (vision).

Without treatment, diabetes-related retinopathy may lead to vision loss, low vision or blindness.

Anyone who has diabetes can get diabetes-related retinopathy, including people who have:

If you have diabetes, risk factors for diabetes-related retinopathy can include:

  • Pregnancy.
  • Hypertension.
  • Uncontrolled blood sugar.
  • Hyperlipidemia.
  • The duration for which you have had diabetes-related retinopathy.

Symptoms and Causes

Diabetes can cause multiple eye diseases including cataracts, glaucoma, and diabetes-related retinopathy which is defined as damage to the retinal vessels of the eye. These damage vessels can lead to poor blood flow (ischemia), inflammation, and ultimately legal blindness if not treated.

In the early stages, most people experience no signs of diabetes-related retinopathy. You may not experience vision changes until the condition is severe. For some people, symptoms come and go.

Symptoms of diabetes-related retinopathy include:

  • Blurred or distorted vision.
  • New color blindness or seeing colors as faded.
  • Poor night vision (night blindness).
  • Small dark spots (eye floaters) or streaks in your vision.
  • Trouble reading or seeing faraway objects.

Diagnosis and Tests

An eye doctor (ophthalmologist) can diagnose diabetes-related retinopathy during a simple exam.

  • Visual acuity: Acuity refers to how clearly you can see.
  • Intraocular pressure to make sure there are no signs of glaucoma.
  • Eye muscle function: Muscle function refers to how well you can move your eyes.
  • Peripheral vision: Peripheral vision is seeing from the sides of your eyes.
  • Pupil response: This assessment looks at how your pupils react to light.

Then, your eye doctor will put drops into your eyes. The drops dilate (widen) your pupils (centers of the eyes).

During this exam, the doctor looks for:

  • Abnormal blood vessels.
  • Bleeding in the center of your eye.
  • Growth of new blood vessels.
  • Retina swelling.

Management and Treatment

Your healthcare provider will consider several factors when creating a treatment plan, including:

  • Age.
  • Medical history.
  • Extent of retinal damage.
  • Visual acuity.
  • HgbA1c.

In the early stages of the disease, your healthcare provider may use a wait-and-see approach especially in the setting of good vision. During this phase, you have regular eye exams but don’t need further treatment. Some people need eye exams every two to four months.

Other treatment options include:

  • Injections: Your healthcare provider injects medication, such as anti-vascular endothelial growth factor drugs or corticosteroids, into your eye. These medicines help slow down disease progression and improve vision.
  • Laser surgery: Your healthcare provider uses a laser to reduce swelling in your retina and new blood vessel growth. The lasers shrink blood vessels or stop leaking.
  • Vitrectomy: Your healthcare provider may recommend this outpatient eye surgery if you have cloudy vision due to leaking blood vessels. During a vitrectomy, the eye doctor makes a small incision in the eye. The provider can repair the blood vessels and remove scar tissue.

Prevention

If you have diabetes, you can lower your risk of developing diabetes-related retinopathy by:

  • Avoiding smoking.
  • Controlling your blood sugar.
  • Exercising regularly.
  • Having annual eye exams.
  • Keeping your blood pressure within a healthy range.
  • Taking any medications exactly as prescribed.

Outlook / Prognosis

With timely treatment, you can prevent vision loss and delay diabetes-related retinopathy progression. After diabetes-related retinopathy treatment, you will have the best chance of a positive outcome if you manage your diabetes and keep your blood sugar well-controlled.

People with uncontrolled diabetes have a higher risk of developing eye problems that look similar to diabetes-related retinopathy. Some of these conditions include:

Living With

If you have diabetes, it’s important to have an eye exam at least once per year. Pregnant women who have diabetes should schedule an eye exam during their first trimester.

Between eye appointments, call your healthcare provider if you notice:

  • Black spots in your vision.
  • Blurred vision.
  • Flashes of light.
  • Holes in your vision.

Anyone who has diabetes has a risk of developing diabetes-related retinopathy. This serious eye condition needs immediate treatment. Without intervention, it can lead to vision loss and even blindness. But timely treatment can prevent vision loss and stop disease progression. The best way to avoid the disease is by managing your diabetes and controlling your blood sugar. Schedule an appointment with a healthcare provider if you notice any new vision changes.

Last reviewed by a Cleveland Clinic medical professional on 03/22/2021.

References

  • American Academy of Ophthalmology. Diabetic Retinopathy. (https://www.aao.org/eye-health/diseases/what-is-diabetic-retinopathy) Accessed 3/16/2021.
  • American Optometric Association. Diabetic Retinopathy. (https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/diabetic-retinopathy) Accessed 3/16/2021.
  • National Institute of Health: National Eye Institute. Diabetic Retinopathy. (https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy) Accessed 3/16/2021.

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