Diabetic Retinopathy: Protecting Your Vision
Understanding Diabetic Retinopathy
Diabetic retinopathy is a condition where high blood sugar levels damage the tiny blood vessels inside the retina. Over time, these damaged blood vessels can swell and leak fluid. In some cases, the blood vessels close off entirely, cutting blood flow to parts of the retina. When the retina does not get enough blood, it can trigger the growth of new, abnormal blood vessels that are fragile and prone to bleeding.
This process is driven by chronic high blood sugar, which causes oxidative stress and inflammation in the eye. These changes lead the body to overproduce a protein called vascular endothelial growth factor, or VEGF. VEGF promotes the growth of abnormal blood vessels and increases leaking from damaged ones.
Diabetic retinopathy progresses through two main stages. The first stage is called non-proliferative diabetic retinopathy (NPDR). During this stage, the walls of the blood vessels in the retina weaken. Tiny bulges may form in the vessel walls, and fluid or blood may leak into the retina. This can cause the retina to swell, a condition known as diabetic macular edema.
The second and more advanced stage is called proliferative diabetic retinopathy (PDR). In this stage, damaged blood vessels close off, and the retina responds by growing new, abnormal blood vessels on its surface. These new vessels are weak and can bleed into the vitreous (the clear gel that fills the eye). This bleeding can cause severe vision loss and may lead to retinal detachment if left untreated.
Unlike age-related macular degeneration, which is linked to aging, diabetic retinopathy is directly caused by diabetes. It can affect people at any age, including younger adults and even adolescents with diabetes. The condition can also lead to other complications, such as diabetic macular edema and tractional retinal detachment, which require different treatment approaches.
Who Is Affected and Risk Factors
Diabetic retinopathy is widespread among people with diabetes. Approximately 26.43% of adults with diabetes in the United States, or about 9.60 million people, had diabetic retinopathy in 2021 (JAMA Ophthalmology, 2023). Of those, an estimated 1.84 million people had vision-threatening diabetic retinopathy (JAMA Ophthalmology, 2023). Over time, more than half of all people with diabetes will develop some form of diabetic retinopathy (National Eye Institute).
Several factors increase the likelihood of developing diabetic retinopathy. Understanding these risk factors can help you and your retina specialist monitor your eye health more effectively.
- Duration of diabetes: The longer you have had diabetes, the higher your risk.
- Poor blood sugar control: Consistently high blood sugar levels accelerate damage to retinal blood vessels.
- High blood pressure: Elevated blood pressure puts additional stress on the blood vessels in the eye.
- High cholesterol: Abnormal cholesterol levels contribute to blood vessel damage throughout the body, including the retina.
- Kidney disease: Diabetes-related kidney problems are closely linked with worsening diabetic retinopathy.
Certain populations face a higher risk of diabetic retinopathy. Nearly half of all adult Hispanic and Latino individuals in the United States with diabetes have some form of diabetic retinopathy (National Eye Institute). African American adults with diabetes also face an elevated risk. These disparities may be related to differences in access to healthcare, rates of diabetes management, and genetic factors.
Pregnancy can increase the risk of developing or worsening diabetic retinopathy. Women who develop gestational diabetes also have a higher risk of developing type 2 diabetes later in life, which carries its own risk for retinopathy. Puberty may accelerate the progression of diabetic retinopathy in younger patients with diabetes. Rapid changes in blood sugar control, even when improving glucose levels quickly, can sometimes cause a temporary worsening of retinopathy.
Signs and Symptoms
One of the most important things to understand about diabetic retinopathy is that you can have it without knowing it. In its early stages, the condition often causes no noticeable vision changes. Damage to the retinal blood vessels may be occurring silently. This is why regular eye exams are critical for anyone with diabetes, even if your vision seems fine.
As diabetic retinopathy progresses, you may begin to notice changes in your vision. These symptoms can develop gradually or appear suddenly, depending on the type and severity of damage occurring in the retina.
- Seeing spots, floaters, or dark streaks that look like cobwebs
- Blurred or fluctuating vision
- A dark or empty spot in the center of your vision
- Difficulty seeing well at night
- Colors appearing faded or washed out
- Vision changes that seem to come and go
Certain vision changes require immediate medical attention. If you experience a sudden increase in floaters, flashes of light, a shadow or curtain across your vision, or sudden vision loss in one or both eyes, see a retina specialist or go to the emergency room immediately. These symptoms could indicate a serious complication such as a vitreous hemorrhage or retinal detachment, both of which require prompt treatment to preserve your vision.
Diagnosis and Testing
The most important step in diagnosing diabetic retinopathy is a comprehensive dilated eye exam. During this exam, a retina specialist uses eye drops to widen your pupils. This allows a clear view of the retina and the blood vessels inside the eye. The specialist will look for signs of swelling, leaking, abnormal blood vessel growth, and other changes. This exam is painless and typically takes about 30 minutes.
Optical coherence tomography, or OCT, is an imaging test that creates detailed cross-section pictures of the retina. It uses light waves to capture images of the retinal layers. OCT can detect swelling in the macula (the central part of the retina responsible for sharp vision) even before it affects your eyesight. This test is quick, non-invasive, and helps your retina specialist monitor changes over time.
Fluorescein angiography is a test that shows how blood flows through the retinal blood vessels. A special yellow dye is injected into a vein in your arm. As the dye travels through the blood vessels in your eye, a camera takes rapid photos. This test reveals areas where blood vessels are leaking, closed off, or growing abnormally. It helps guide treatment decisions for more advanced stages of diabetic retinopathy.
Artificial intelligence (AI) screening tools are becoming increasingly available for the early detection of diabetic retinopathy. These systems can analyze images of the retina and flag signs of the condition without requiring a specialist to be present at the screening location. AI screening may be offered in primary care offices or community health settings, helping to identify people who need a referral to a retina specialist for further evaluation.
Treatment Options
Anti-VEGF medications are a primary treatment for diabetic retinopathy, especially when it involves diabetic macular edema (swelling of the central retina). These medications block the VEGF protein that drives abnormal blood vessel growth and leakage. They are delivered as intravitreal injections, which are small injections of medication directly into the vitreous cavity of the eye.
Several anti-VEGF medications are used to treat diabetic retinopathy. Eylea (aflibercept) is one of the most commonly used, typically given every 4 to 8 weeks after an initial loading period. Lucentis (ranibizumab), the first anti-VEGF medication approved for eye use, is given approximately every 4 weeks. Vabysmo (faricimab), a newer bispecific antibody, can be given every 4 to 16 weeks depending on how well the eye responds. Avastin (bevacizumab) is also widely used, typically every 4 to 6 weeks, though it is important to note that Avastin is FDA-approved for cancer and is used off-label for eye conditions.
Laser photocoagulation (thermal laser treatment applied to the retina) has been a proven treatment for diabetic retinopathy for decades. In this procedure, a retina specialist uses a focused beam of light to seal leaking blood vessels or to reduce abnormal blood vessel growth. Panretinal photocoagulation, also called scatter laser, treats wider areas of the retina and is commonly used for proliferative diabetic retinopathy. Focal laser treatment targets specific areas of leakage near the macula.
Vitrectomy (a surgery to remove the gel inside the eye) may be necessary in advanced cases of diabetic retinopathy. This procedure is typically recommended when there is significant bleeding into the vitreous or when scar tissue on the retina causes a tractional retinal detachment. During vitrectomy, a retina specialist removes the vitreous gel and any blood or scar tissue, then replaces it with a clear solution or gas bubble to help the retina heal.
A newer treatment option is Susvimo (ranibizumab injection), the first and only continuous delivery treatment approved by the FDA for diabetic macular edema. This small implant is placed in the eye and releases medication steadily over time. It was approved in February 2025 for diabetic macular edema and in May 2025 for diabetic retinopathy. Susvimo may help maintain vision with treatments needed only once every nine months, reducing the burden of frequent injections (FDA, 2025).
Researchers are developing new treatments that target pathways beyond VEGF. These include gene therapies that use specially designed viruses (AAV vectors) to deliver corrective genes to retinal cells. Nanotechnology-based drug delivery systems are being studied to provide longer-lasting medication release inside the eye. Scientists are also investigating microRNA-targeted therapies, which aim to regulate the genes involved in blood vessel damage at a molecular level. While these therapies are still in development, they represent promising future directions.
What to Expect
If your retina specialist recommends anti-VEGF injections, the procedure is performed in a clinical setting. The eye is numbed with anesthetic drops, and the area around the eye is cleaned. A very thin needle is used to inject the medication into the vitreous cavity. Most patients report brief pressure or mild discomfort rather than sharp pain. The injection itself takes only seconds. You may notice temporary floaters or mild redness afterward.
Treatment typically begins with a series of monthly injections called loading doses. After this initial phase, your retina specialist will evaluate your response and may extend the time between injections. Some patients require ongoing treatment for months or years to maintain their results.
Recovery from laser photocoagulation is usually quick. You may experience mild discomfort, blurred vision, or sensitivity to light for a day or two. Most people can return to normal activities within a few days. After vitrectomy surgery, recovery takes longer. You may need to maintain a specific head position for several days if a gas bubble was placed in the eye. Your retina specialist will provide detailed recovery instructions and schedule follow-up visits to monitor healing.
Diabetic retinopathy is a chronic condition that requires ongoing monitoring. Even after successful treatment, the underlying diabetes continues to affect your eyes. Regular follow-up visits with a retina specialist are essential to detect any recurrence or progression. The frequency of these visits depends on the severity of your condition and your response to treatment.
Living with Diabetic Retinopathy
The most effective way to slow the progression of diabetic retinopathy is to manage your diabetes carefully. Keeping blood sugar levels within your target range reduces the risk of damage to retinal blood vessels. Work with your primary care doctor or endocrinologist to develop a plan that includes regular blood sugar monitoring, a balanced diet, physical activity, and medication as prescribed.
High blood pressure and high cholesterol both contribute to the progression of diabetic retinopathy. Monitoring and managing these conditions through lifestyle changes and medication, when needed, can help protect your retinal blood vessels. Regular checkups with your primary care provider are an important part of a comprehensive approach to eye health.
Because diabetic retinopathy can develop without symptoms, regular dilated eye exams are essential. The American Academy of Ophthalmology recommends that people with type 1 diabetes have their first eye exam within five years of diagnosis. People with type 2 diabetes should have an eye exam at the time of diagnosis. After that, most people with diabetes should have a dilated eye exam at least once a year, or more often if their retina specialist recommends it.
Living with a chronic eye condition can be stressful. It is normal to feel anxious about your vision or frustrated by frequent medical appointments. Talk to your healthcare team about any concerns. Low vision rehabilitation services can help if your vision has been affected. Support groups and counseling may also be beneficial for coping with the emotional aspects of managing diabetes and diabetic retinopathy.
When to See a Retina Specialist
If you have type 1 or type 2 diabetes, schedule regular eye exams with a retina specialist even if your vision feels normal. Early detection of diabetic retinopathy gives you the best chance of preserving your sight. Your retina specialist can detect changes in your retina before they cause any noticeable symptoms.
Seek immediate care from a retina specialist or go to the emergency room if you experience a sudden increase in floaters, flashes of light, a curtain or shadow over part of your vision, or sudden vision loss. These symptoms may indicate a serious complication that needs prompt treatment. Do not wait for your next scheduled appointment if any of these symptoms occur.
If you have recently been diagnosed with type 2 diabetes, schedule a comprehensive dilated eye exam as soon as possible. Diabetic retinopathy may already be present at the time of diagnosis, since type 2 diabetes can go undetected for years. Early baseline testing establishes a reference point for monitoring any future changes in your retina.
Questions and Answers
In some cases, treatment can reduce swelling, stop leaking, and improve vision. However, diabetic retinopathy is a chronic condition tied to diabetes, and damage that has already occurred to retinal blood vessels cannot be fully undone. The primary goals of treatment are to slow progression, prevent further vision loss, and in some cases improve vision. Consistent diabetes management is essential to achieving the best possible outcomes.
The frequency of anti-VEGF injections varies depending on your specific condition and how your eye responds to treatment. Many patients start with monthly injections for the first few months. After that, your retina specialist may extend the intervals between injections. Some newer treatments, such as Vabysmo (faricimab), may allow dosing every 8 to 16 weeks. Susvimo (ranibizumab injection) offers continuous delivery that may require treatment only once every nine months. Your retina specialist will create a personalized treatment schedule for you.
Diabetic retinopathy can affect one or both eyes. It is common for the condition to be present in both eyes, though the severity may differ between them. Regular exams allow your retina specialist to monitor both eyes and adjust treatment as needed.
While there is no guaranteed way to prevent diabetic retinopathy, you can significantly reduce your risk. Maintaining good blood sugar control, managing blood pressure and cholesterol, staying physically active, and attending regular dilated eye exams are all important steps. Research consistently shows that people who manage their diabetes well have a lower risk of developing severe retinopathy.
Diabetic macular edema (DME) is a specific complication that can occur as part of diabetic retinopathy. While diabetic retinopathy refers to the overall damage to retinal blood vessels caused by diabetes, DME specifically involves swelling in the macula, the central area of the retina responsible for detailed vision. DME can occur at any stage of diabetic retinopathy and is one of the most common causes of vision loss related to diabetes. Treatment for DME typically involves anti-VEGF injections, and sometimes laser treatment or steroid implants.