Diabetic retinopathy is a complication of diabetes (type 1 or 2) that damages the retina, a tissue in the back of the eye.1 Elevated blood sugar from diabetes damages the blood vessels and light sensitive parts of the retina.2
It is possible to have diabetic retinopathy without any symptoms. It is also possible for symptoms appear and then resolve. Dilated eye exams are important for people with and without symptoms.3
The visual experience of DR
34.2 million people of all ages - or 10.5% of the US population - has diabetes.
21.4% of people with diabetes do not know they have it.
Diabetes is the leading cause of new cases of blindness among adults age 18 to 65.
Symptoms may include: 5,6
Blurred or double vision
Dark spots, shadows or streaks in vision
Faded color vision
Difficulty with vision at night
Difficulty with low light situations
Recommended Dilated Eye Exams for Patients with Diabetes: 3
|First exam||Follow-up exams|
|Type 1 diabetes||Within 5 years of diabetes diagnosis||Yearly if no signs of retinopathy|
|Type 2 diabetes||At the time of diabetes diagnosis||Yearly if no signs of retinopathy|
|Pregnancy and Diabetes (type 1 & 2)||Early in the first trimester||Follow your eye doctor’s recommendation|
There are four stages of diabetic retinopathy: 7
Stages of DR
A few small blood vessel changes (microaneurysms) are present.
More small blood vessels changes (microaneurysms), bleeding in the retina and other changes are present.
Blood vessel changes (microaneurysms) and/or bleeding in all areas of the retina or other changes are present.
New abnormal blood vessels grow in the eye.
Diabetic macular edema (DME) can develop at any stage of DR. It is swelling in the macula (the center area of the retina) due to leaky blood vessels.7
National Institute of Health (NIH) 8
Know your risk factors for DR
The longer you have had diabetes the more likely you are to develop retinopathy. 9
Know your hemoglobin A1c level (HbA1c). It is a measure of your average blood sugar level over about 3 months. It is recommended that HbA1c be 7% or lower for most patients. 10
Know your cholesterol levels and goals for good control. 11
If you are planning a pregnancy, or if you are pregnant, speak to your primary care provider (PCP) or OB/GYN about goals for your blood sugar. 12
Know your blood pressure numbers and goals for good control. 13
Your PCP or a specialist will monitor and treat your blood sugar, blood pressure and cholesterol levels. It is important for your eye care provider and PCP or specialist to work together to manage diabetic retinopathy.
Things you can do to help control blood sugar, blood pressure and cholesterol include: 14
Taking your medications as directed
Eating a healthy diet and maintaining a healthy weight
Moderate aerobic exercise that gets your heart pumping for a total of 2.5 hours per week
3 myths about diabetic retinopathy
I was just diagnosed with type 2 diabetes; surely it has not caused diabetic retinopathy yet.
About 21% of patients with type 2 diabetes will have diabetic retinopathy at the time of diabetic diagnosis.15
I’m young and have diabetes. I couldn’t have diabetic retinopathy yet.
Type 1 diabetes: After 5 years, approximately 25% of people will have retinopathy, increasing to 60% after 10 years, and 80% after 15 years.3
Type 2 diabetes: The rate of retinopathy after 5 years is higher for those taking insulin (40%) compared to those who do not need it (24%). These rates more than double in patients who have had diabetes for 19 years.3
My eye doctor is managing my diabetes.
Your eye care provider is managing only a portion of your diabetes, specifically the eye disease. It is very important for you to continue to keep your appointments with your PCP and for all your doctors to work together. 3 Your diabetic care team will include your PCP, your eye care provider and specialists that may include a retina specialist, low vision specialist, endocrinologist, registered dietician or nutritionist, diabetic health educator, dentist, pharmacist and podiatrist.
Maintaining healthy eyes and vision
Taking an active role in in your diabetes management can help prevent diabetic retinopathy.
Get a yearly eye examination with dilating eye drops, even if you do not have symptoms 3
Contact your eye doctor if you experience vision changes
Don’t delay treatment: The better your vision is prior to treatment, the better your vision will be after treatment 16
Stop smoking 17
If you have already been diagnosed with diabetic retinopathy, know how often your doctor wants to see you for follow up and stick to the schedule
Monitor your blood sugar levels and know your hemoglobin A1c level 10
Take your medications as prescribed
Commonly used treatments
Not all diabetic retinopathy needs treatment, but when it does, it is tailored specifically for each patient. 3 Treatment for diabetic retinopathy has been found to be effective in preventing severe vision loss. 18
Stages and Treatments:
Mild and moderate stages of diabetic retinopathy will be monitored with frequent follow up appointments with your eye doctor. 3
Severe or proliferative retinopathy and diabetic macular edema (DME) will likely require prompt treatment. 3
Types of treatment:
Panretinal photocoagulation (PRP): A laser is used to make many small burns in the retina to reduce the formation of new leaky blood vessels. 19
Focal Laser: A laser used to make one or a few small burns in the retina to treat leaky blood vessels. 20
Anti-VEGF medication: This medication is injected into the eye to prevent blood vessels from leaking and prevent abnormal blood vessel growth.21 It is also used to decrease swelling from diabetic macular edema (DME). 22
Corticosteroid medication: This medication is injected into the eye to reduce inflammation and swelling in the retina. 3
Barriers to eye care
Knowledge: Not all patients with diabetes are not aware of the importance of annual eye dilated examinations.23 Dilated eye exams are important even if there are no symptoms.
Cost of care: Ask your eye doctor or primary care doctor what programs are available to reduce your cost.
Fear of treatment: Speak with your doctor before your appointment if fear is may prevent you from going to the appointment. Pain with eye injection is mild for the majority of people.24 There are medications to control pain when treatment with PRP laser is needed. 25
Meet Marcos, who explains his experience with anti-VEGF injections for DR
1 Abcouwe SF, Gardner TW. Diabetic retinopathy: loss of neuroretinal adaptation to the diabetic metabolic environment. Ann N Y Acad Sci. 2014; 1377:174-190.
2 Shah AR, Garder TW. Diabetic retinopathy: research to clinical practice. Clin Diabetes Endocrinology 2017;3:9.
3 Flaxel CJ, Adelman RA, Bailey ST, et al. Diabetic Retinopathy Preferred Practice Pattern. Ophthalmology. 2020;127(1): PP66-PP145.
4 Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2020.
5 Diabetic Retinopathy. NIH: National Eye Institute. 2019 (Cited: December 27,2020). Available from: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy
6 Boyd K. What is diabetic retinopathy? American Academy of Ophthalmology. 2020 (Cited: December 27, 2020). Available from:
7 Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs- an extension of the modified Airlie House classification. ETDRS report 10. Ophthalmology. 1991;98:786-806.
8 National Institutes of Health (NIH). National Eye Institute. Animation: Diabetic Retinopathy. Feb 21, 2014. Accessed December 29, 2020. Available from: https://www.youtube.com/watch?v=X17Q_RPUlYo
9 Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin Study of Diabetic Retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmology. 1984;102(4):520-526.
10 Ferris FL III, Nathan DM. Editorial. Preventing Diabetic Retinopathy Progression. Ophthalmology. 2016; 123 (9): P1840-P1842.
11 Shi R, Zhao L, Wang F, et al. Effects of lipid-lowering agents on diabetic retinopathy: a Meta-analysis and systematic review. Int J Ophthalmol. 2018;11(2):287-295.
12 Diabetes Control and Complications Trial Research Group. Diabetes Care. 2000;23(8):1084-1091.
13 UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. BMJ. 1998; 317(7160): 703-713.
14 Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6): 393-403.
15 Fong DS, Aiello L, Gardner TW, et al. Retinopathy in Diabetes. Diabetes Care 2004;27(supp1) s84-s87.
16 Sophie R, Lu N, Campochiaro PA. Predictors of functional and anatomical outcomes in patients with diabetic macular edema treated with ranibizumab. Ophthalmology. 2015;122 (7):1395-1401.
17 Omae T, Nagaoka T, Yoshida A. Effects of Habitual Cigarette Smoking on Retinal Circulation in Patients with Type 2 Diabetes. Investigative Ophthalmology & Visual Science. 2016; 57: 1345-1351.
18 Ferris FL III. How effective are treatments for diabetic retinopathy? JAMA. 1993;269(10)1290-1291.
19 The Diabetic Retinopathy Study Group. Indications for photocoagulation treatments of diabetic retinopathy: Diabetic Retinopathy Study Report no. 14. Int Ophthalmology Clin. 1987;27(4):239-253.
20 Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinic guidelines for photocoagulation of diabetic macular edema. ETDRS study report number 2. Ophthalmology. 1987;94:761-774.
21 Writing Committee for the Diabetic Retinopathy Clinic Research Network. Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinic trial. JAMA. 2015;314:2137-2146.
22 Mitchell P, Bandello F, Schmidt Erfurth U, et al. The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology. 2011;188:615-625.
23 Lu Y, Serpas L, Genter P, et al. Divergent perceptions of barriers to diabetic retinopathy screening among patients and care providers, Los Angeles, California, 2014-2015. Prev Chronic Dis. 2016; 13
24 Shiroma, H.F., Takaschima, A.K.K., Farah, M.E. et al. Patient pain during intravitreal injections under topical anesthesia: a systematic review. Int J Retin Vitr. 2017;3 (23).
25 Wu, WC., Hsu, KH., Chen, TL. et al. Interventions for relieving pain associated with panretinal photocoagulation: a prospective randomized trial. Eye. 2006; 20, 712–719.