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Diabetic Eye Disease

If you have diabetes, it’s important for you to get a comprehensive dilated eye exam at least once a year. Diabetes can cause problem with the health of your eyes. Diabetic retinopathy is an eye condition that can cause vision loss and blindness in people who have diabetes. It affects blood vessels in the retina (the light-sensitive layer of tissue in the back of your eye).

Diabetic retinopathy may not have any symptoms at first — but finding it early can help you take steps to protect your vision.

Managing your diabetes — by staying physically active, eating healthy, and taking your medicine — can also help you prevent or delay vision loss.

Diabetic Retinopathy
Diabetic retinopathy is caused by high blood sugar due to diabetes. Over time, having too much sugar in your blood can damage the blood vessels in your retina — the part of your eye that detects light and sends signals to your brain through a nerve in the back of your eye (optic nerve).
Diabetes damages blood vessels all over the body. The damage to your eyes starts when sugar damages the tiny blood vessels that go to your retina, causing them to leak fluid or bleed. To make up for these blocked blood vessels, your eyes then grow new blood vessels that don’t work well. These new blood vessels can leak or bleed easily.

Diabetic retinopathy can lead to other serious eye conditions:

Diabetic macular edema (DME)
Over time, about half of people with diabetic retinopathy will develop DME. DME happens when blood vessels in the retina leak fluid, causing swelling in the macula (a part of the retina). If you have DME, your vision will become blurry because of the extra fluid in your macula.

Neovascular glaucoma
Diabetic retinopathy can cause abnormal blood vessels to grow out of the retina and block fluid from draining out of the eye. This causes a type of glaucoma.

Retinal detachment
Diabetic retinopathy can cause scars to form in the back of your eye. When the scars pull your retina away from the back of your eye, it’s called tractional retinal detachment.

Other types of diabetic eye disease
Diabetic retinopathy is the most common cause of vision loss for people with diabetes. But diabetes can also make you more likely to develop several other eye conditions:

  • Cataracts – Having diabetes makes you 2 to 5 times more likely to develop cataracts. It also makes you more likely to get them at a younger age. 
  • Open-angle glaucoma – Having diabetes nearly doubles your risk of developing a type of glaucoma called open-angle glaucoma. 

Symptoms of Diabetic Retinopathy

The early stages of diabetic retinopathy usually don’t have any symptoms. Some people notice changes in their vision, like trouble reading or seeing faraway objects. 
In later stages of the disease, blood vessels in the retina start to bleed into the vitreous (gel-like fluid in the center of the eye). If this happens, you may see dark, floating spots or streaks that look like cobwebs. Sometimes, the spots clear up on their own — but it’s important to get treatment right away. Without treatment, the bleeding can happen again, get worse, or cause scarring.

Risk Factors for Diabetic Retinopathy

Anyone with any kind of diabetes can get diabetic retinopathy — including people with type 1, type 2, and gestational diabetes (diabetes that can develop during pregnancy).

  • Duration of Diabetes – Your risk increases the longer you have diabetes. More than 2 in 5 Americans with diabetes have some stage of diabetic retinopathy.
  • Diabetes Control – The good news is that you can lower your risk of developing diabetic retinopathy by controlling your diabetes. Keeping your HbA1c less than 6.5% reduces the risk of developing retinopathy and can slow the progression in those who already have retinopathy.
  • Women with diabetes who become pregnant — or women who develop gestational diabetes — are at high risk for getting diabetic retinopathy. If you have diabetes and are pregnant, have a comprehensive dilated eye exam as soon as possible. Ask your doctor if you’ll need additional eye exams during your pregnancy.
  • High Blood Pressure – Controlling your blood pressure can also reduce the risk of retinopathy.

Preventing Diabetic Retinopathy

  • Managing your diabetes is the best way to lower your risk of diabetic retinopathy.
  • Regular visit with your Primary Care Physician.
  • Keeping your blood sugar levels as close to normal as possible.
  • Knowing how well your blood sugar is controlled. 
  • Getting a HbA1c test.  This test shows your average blood sugar level over a 3-month period.
  • Getting regular physical activity.
  • Healthy eating habits.
  • Following your doctor’s instructions for your insulin or other diabetes medicines.
  • Controlling your blood pressure and cholesterol.
  • Having a dilated eye examination at least once every year.

 

Diagnosing Diabetic Retinopathy

Eye doctors can check for diabetic retinopathy as part of a dilated eye exam. The exam is simple and painless — your doctor will give you some eye drops to dilate (widen) your pupil and then check your eyes for diabetic retinopathy and other eye problems.

  • Dilated Eye Examination – Dilating the pupils allows a better view of the retina and optic nerve.
  • Fundus Photography – If you have retinopathy, photos of your retina can be used for future comparison to evaluate for progression.
  • Optical Coherence Tomography – These scans of the retina can show diabetic macular edema.
  • Fluorescein Angiography – This test allows the doctor to see the flow of blood in your retina and can highlight leaking or abnormal blood vessels. It can be used to guide laser treatment.

If you have diabetes, it’s very important to get regular eye exams. If you do develop diabetic retinopathy, early treatment can stop the damage and prevent blindness.

Treating Diabetic Retinopathy

In the early stages of diabetic retinopathy, your eye doctor will probably just keep track of how your eyes are doing. Some people with diabetic retinopathy may need a comprehensive dilated eye exam as often as every 2 to 4 months.

In later stages, it’s important to start treatment right away — especially if you experience changes in your vision. While it won’t undo any damage to your vision, treatment can stop your vision from getting worse. It’s also important to take steps to control your diabetes, blood pressure, and cholesterol.

Injections
If you have diabetic macular edema (DME) or an advanced case of diabetic retinopathy, your doctor may use injections as part of your treatment plan. You may need other treatments, like laser treatments or surgery, in addition to injections.

Anti-VEGF drugs
If you have diabetic retinopathy or DME, a protein called VEGF increases problems like leaking blood vessels and swelling in the macula (a part of the retina). Medicines called anti-VEGF drugs block this protein and help improve vision.
Common anti-VEGF drugs include:
Avastin (bevacizumab)
Lucentis (ranibizumab)
Eylea (afilibercept)
Most people who get anti-VEGF injections will need injections once a month for at least the first 3 months. Over time, you may need injections less often. Some people can eventually stop getting the injections, but others need to keep getting injections to protect their vision.

Corticosteroids
DME causes swelling in the macula. Medicines called corticosteroids can help reduce this swelling and make your vision clearer.
You can get corticosteroids as eye drops or injections, or your doctor can put a special device called an implant in your eye. The implant gives you regular small doses of the medicine over time. People who get the implant may be able to stop getting monthly injections.
Common corticosteroid implants include:

  • Ozurdex (dexamethasone) for short-term use
  • Iluvien (fluocinolone acetonide) for long-term use

Corticosteroids can increase your risk for cataracts and glaucoma. If you get corticosteroid injections for DME, it’s important to get regular eye exams to check for signs of these problems.

Laser treatment
Scatter laser surgery (sometimes called panretinal photocoagulation) can help treat advanced cases of diabetic retinopathy. Your doctor will use lasers to shrink blood vessels in your eye that are causing vision problems.

Eye surgery
If your retina is bleeding a lot or you have a lot of scars in your eye, your eye doctor may recommend a type of surgery called a vitrectomy. This procedure removes the gel that fills the eye (the vitreous). Along with the vitreous, blood can be removed and a retinal detachment can be repaired.

Get the latest news on NEI-supported diabetic eye disease research