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Diabetic Retinopathy

How to treat this progressive condition—and avoid vision loss.
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Written by
Daniel Choi, MD.
Emergency Medicine Resident, Massachusetts General Hospital
Last updated March 15, 2021

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What is diabetic retinopathy?

Diabetic retinopathy is damage to your retina. It’s one of many possible complications of diabetes and is the most common reason working-age people in the United States go blind.

Your retina is the inner lining at the back of the eye. It captures light and signals to your brain that you’re seeing something.

The retina is filled with small blood vessels. High blood sugar levels from diabetes can make these blood vessels bleed and leak fluid. This damages the retina, and can cause you to lose your vision.

If you have diabetes, see an eye doctor regularly and try to keep blood sugar levels under control to prevent diabetic retinopathy.

Most common symptoms

Pro Tip

Unlike other eye conditions that are limited in time, this is a chronic disease that requires a good relationship with your ophthalmologist. —Dr. Daniel Choi

The main symptom of diabetic retinopathy is blurred vision. This can include trouble seeing both up close and far away.

Another common sign is having a sudden change in your eyeglass prescription. Some people get floaters (little specks that float in front of your eyes). And some people suddenly can’t see at all.

Main symptoms

Next steps

If you are diagnosed with type 2 diabetes, see an optometrist to check if you have any signs of diabetic retinopathy. Your doctor will put drops in your eyes to widen (dilate) your pupils, which lets them examine your retina and optic nerve. Dilating drops make your vision blurry and light sensitive, but only for a few hours.

A laser retina scan is another way for your doctor to examine your retina, but people with diabetes still need a dilated eye exam as well.

If you have type 1 diabetes, you should have a dilated eye exam within the first 5 years of being diagnosed.

If you start to lose your vision or your vision gets worse very quickly, call your doctor.

Diabetic retinopathy causes

When you have diabetes, high levels of blood sugar circulate throughout your body. This can damage the inner lining of your blood vessels in the eye. It can make those vessels bleed (vitreous hemorrhage), and cause your retina to swell (macular edema), according to The National Institute of Diabetes and Digestive and Kidney Diseases.

If the damage has been around for long enough, it can put tension on the retina and cause it to detach.

Risk factors

Diabetes that is not well controlled is the main risk factor for diabetic retinopathy. Your risk is also greater if you’ve had diabetes for a long time.

Other risk factors are those that are bad for your overall cardiovascular (heart) health. These factors can cause damage to blood vessels all over your body, including those in your eyes. These include:

  • Smoking
  • Not exercising
  • Drinking a lot of alcohol
  • High cholesterol
  • High blood pressure

Diabetic retinopathy treatment

Dr. Rx

The treatment and management of diabetic retinopathy has progressed over the years, but there is no better treatment than healthy lifestyle choices that lower hemoglobin A1C levels—blood sugar levels. Changes in diet, exercise, and smoking have a dramatic impact on preserving your vision. —Dr. Choi

Doctors try to prevent diabetic retinopathy so that treatment doesn’t become necessary. Getting your diabetes under control is the first step. It’s also important to treat your cardiovascular risk factors, like high blood pressure or high cholesterol.

If you have diabetic retinopathy, your eye doctor will try and figure out what stage you’re in. Early stages don’t need any in-office or surgical treatment. But once your retinal blood vessels start leaking fluid or bleeding, your doctor will have to take steps to control the progression.

Usually this is done by injecting medications called “anti-VEGF” antibodies (such as bevacizumab, ranibizumab, and aflibercept) into your eye. These target the signals in the retina that make your diabetic retinopathy get worse. Sometimes, your doctor may inject steroid medications instead.

Some people might need laser treatment (“focal laser” or “pan retinal photocoagulation (PRP)”). And if bleeding gets out of control (vitreous hemorrhage) or causes scar tissue to form (tractional retinal detachment), you might need surgery to repair the retina and clear the bleeding.

Follow up

Most people with diabetes need at least an annual eye exam. Depending on how bad your diabetic retinopathy is, you might need to see your eye doctor several times a year. If you have advanced retinopathy, your doctor will send you to a medical retina specialist or vitreoretinal surgeon for ongoing care.

Preventative tips

Pro Tip

With good diabetic control, you can avoid almost all complications of diabetic retinopathy for many years. —Dr. Choi

The number one prevention for diabetic retinopathy is getting your diabetes under control. That means making changes to your diet and taking any medications your doctor prescribes.

It’s also important to reduce your risks for heart disease. Keep your blood pressure and cholesterol levels under control by following a healthy diet, exercising regularly, and not smoking.

Getting an eye exam once a year can help catch diabetic retinopathy in an early stage.

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Emergency Medicine Resident, Massachusetts General Hospital

Dr. Choi received his medical degree from Boston University School of Medicine, and is a graduate of Dartmouth College with a BA in Religion. He is currently an Emergency Medicine resident at Massachusetts General Hospital & Brigham and Women's Hospital. He is actively involved in both the residency and hospital wide physician wellness committees, and has a large interest in addressing resident burnout. He was born and raised in Queens, NY and during his free time, he enjoys watching football and basketball and movies.

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