Diabetes Can Affect Your Vision- Early Detection Matters
Comprehensive diabetic eye exams help identify changes in your eyes before vision problems develop.
What is Diabetic Retinopathy?
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Diabetes is a condition which affects the body's ability to use and store sugar. Incidence of the disease is reaching epidemic proportions in our country—increasing six-fold in the last 30 years. Medical achievements have enabled those suffering from diabetes to better control their disease. However, as the lifespan of diabetics has increased, so has the incidence of related circulatory problems that can develop over time, including the sight-robbing complication known as diabetic retinopathy—a leading cause of blindness in Americans under age 65.
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With diabetes, high blood sugar levels can weaken blood vessels in the eye, causing them to leak blood or fluid. This causes the retina to swell and form deposits that can lead to vision loss. Blood sugar fluctuations can also promote the growth of new, fragile blood vessels on the retina, which can sometimes leak blood into the vitreous (the clear, jelly-like substance that fills the eyeball). This retinal blood vessel damage, or “retinopathy,” can blur vision and lead to permanent impairment.
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Of the more than 30 million Americans diagnosed with diabetes, it is estimated that up to 45 percent have some degree of retinopathy. Diabetic retinopathy is the leading cause of blindness in Americans under age 65.
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Types of Diabetic Retinopathy.
Blood sugar-related changes cause
the retinal blood vessels to leak.
Symptoms
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Background or Non-Proliferative Diabetic Retinopathy (NPDR)​
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Typically, there is no pain or redness, and symptoms include blurred or distorted vision of varying extent. Only when deposits or fluid involve the macular area is decreased vision actually noted. Thus, some patients with significant background diabetic retinopathy may still have excellent vision if the macula is spared.
Regular diabetic eye exams are essential for detecting and treating this condition early.
​Background or Non-Proliferative Diabetic Retinopathy (NPDR)
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Background diabetic retinopathy is the most common form of the disease, accounting for 80 to 90 percent of all cases. Although it rarely leads to total blindness, 5 to 20 percent of patients with the condition may become legally blind (20/200 or less vision) within five years.
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Background diabetic retinopathy occurs when small blood vessels in the retina become damaged due to diabetes. These tiny vessels may become blocked or swollen, forming small bulges called microaneurysms.
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Damaged blood vessels can leak fluid, blood, and fatty deposits into the retina, which may cause the retina to become swollen and function less effectively.
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Macular Edema
When swelling affects the macula—the central part of the retina responsible for clear, straight-ahead vision—it is called macular edema.
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Macular edema may affect both eyes, although not always to the same degree.
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Common characteristics include:
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Usually no pain or redness
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Blurred or distorted vision
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Vision changes that can vary in severity
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Many patients with background diabetic retinopathy may still have normal or excellent vision, especially if the macula is not affected. However, when fluid or deposits reach the macula, vision loss can occur.
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Why Regular Eye Exams Matter
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Because early diabetic retinopathy may not cause noticeable symptoms, regular diabetic eye exams are essential for detecting changes early and protecting long-term vision.
Blood sugar-related changes cause
new abnormal retinal blood vessels to grow.
Blood sugar-related changes
cause the retinal blood vessels to leak.
​​Symptoms ​​
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Proliferative Diabetic Retinopathy (PDR)
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For most people with proliferative retinopathy, there are no early symptoms. There is no pain, blurriness or inflammation. Patients may have good (or near normal) vision until the onset of vitreous hemorrhage or another serious problem causes symptoms. Others may, however, notice a change in their central and/or color vision as a result of macular edema (the leaking of blood vessels onto the central retina, or macula). This can often be treated if detected early.
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Because of the lack of and/or variation in symptoms, it is vital for ALL diabetics to schedule regular comprehensive eye exams.
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Proliferative Diabetic Retinopathy (PDR)
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Proliferative diabetic retinopathy is the most severe vision-related complication of diabetes, often leading to blindness if left untreated. It develops in 10 to 15 percent of diabetics.
Proliferative diabetic retinopathy is an advanced stage of diabetic eye disease. It develops when the retina does not receive enough oxygen and nutrients. In response, the eye begins to grow abnormal new blood vessels on the retina or optic nerve.
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These vessels are fragile and can lead to serious vision problems if left untreated.
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Possible Complications
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Vitreous Hemorrhage
Fragile blood vessels may rupture and bleed into the vitreous (the clear gel inside the eye). This can cause sudden blurred vision, dark spots, or floating shapes that resemble spider webs.
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Retinal Detachment
Repeated bleeding may form scar tissue that pulls the retina away from the back of the eye. This may cause flashes, floaters, or a curtain-like shadow in vision and can lead to severe vision loss.
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Rubeosis
Abnormal blood vessels may grow on the iris (the colored part of the eye).
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Neovascular Glaucoma
These abnormal vessels can block fluid drainage in the eye, raising eye pressure and leading to a severe form of glaucoma that can permanently damage vision.
Why Early Detection Matters
Proliferative diabetic retinopathy can occur in people with both type 1 and type 2 diabetes, but it is more common in patients who have had diabetes for many years. Without treatment, the condition can lead to significant vision loss.
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Regular diabetic eye exams are essential for detecting and treating this condition early.
Risk Factors​
All people with Type 1 or Type 2 diabetes are at risk for developing diabetic retinopathy. Diabetes also increases the risk of cataracts and glaucoma.
Several factors can increase the likelihood and severity of diabetic eye disease:
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Duration of diabetes: Risk increases the longer you have diabetes.
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Poor blood sugar control
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High blood pressure
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High cholesterol
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Smoking
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Being overweight
Managing these factors and maintaining regular dilated eye exams can help protect your vision.
Detection & Monitoring
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Diabetic eye disease is detected through a comprehensive eye exam, which typically includes dilation of the pupil. Dilating the eyes with special drops allows the doctor to clearly examine the retina and identify early signs of diabetic retinopathy.
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Several advanced diagnostic tools may be used to detect and monitor the condition.
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Ophthalmoscopy
An instrument called an ophthalmoscope allows the doctor to closely examine the retina and identify early signs of diabetic retinopathy, such as microaneurysms—tiny bulges in the retinal blood vessels that may leak fluid or blood.
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Ultrasonic Testing
If bleeding in the eye makes it difficult to see the retina, ultrasound imaging may be used. This test helps determine whether bleeding or scar tissue has caused a retinal detachment.
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Optical Coherence Tomography (OCT)
Optical Coherence Tomography (OCT) is an advanced imaging technology used to diagnose and monitor diabetic retinopathy. Similar to a CT scan, OCT creates detailed cross-sectional images of the retina, allowing doctors to measure swelling known as macular edema with exceptional accuracy.
The OCT scan is fast, painless, and noninvasive. During the test, patients simply focus on a light while a safe scanning laser captures detailed images of the retina in seconds.
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OCT imaging allows doctors to detect and monitor diabetic eye disease and other conditions—including glaucoma and macular degeneration—often before noticeable vision loss occurs. Follow-up scans help track changes and guide treatment decisions such as medications, laser therapy, or surgery to help protect vision.
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Your Medical History Matters
During your exam, it is important to share a complete medical history with your doctor, including:
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Current medications
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Vision symptoms or concerns
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Family history of eye disease
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Other health conditions such as diabetes or hypertension
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Providing accurate information helps ensure the most effective monitoring and treatment plan for your eye health.
Managing and Treating Diabetic Retinopathy
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Although diabetic retinopathy cannot be completely prevented or cured, early diagnosis, careful monitoring, and timely treatment can significantly reduce the risk of vision loss. Managing diabetes and maintaining regular eye care are key steps in protecting your vision.
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Managing Diabetes and Protecting Your Vision
Blood Sugar Control
Maintaining healthy blood sugar levels through medication, diet, and exercise can significantly reduce the risk of developing diabetic retinopathy and slow the progression of existing disease.
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Healthy Lifestyle
A healthy lifestyle plays an important role in protecting vision. Patients with diabetes should focus on maintaining a balanced diet, exercising regularly, controlling blood pressure, and avoiding smoking. These steps can help reduce complications related to diabetic eye disease.
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Regular Eye Exams
Even if your vision seems normal, diabetic retinopathy can progress without noticeable symptoms. Regular comprehensive eye exams—including dilated retinal examinations—allow doctors to detect changes early and begin treatment before significant vision loss occurs.
Treatment Options for Diabetic Retinopathy​
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Treatment depends on the type and severity of diabetic retinopathy. Your doctor will determine the most appropriate approach based on your individual condition.
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Injection Therapy
Medications known as anti-VEGF treatments (including Avastin, Eylea, Lucentis, and Vabysmo) may be injected directly into the eye to reduce swelling and slow the growth of abnormal blood vessels. These injections are commonly used to treat diabetic macular edema and other complications of diabetic retinopathy.
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The procedure is quick and performed in the office with numbing drops. Many patients experience stabilization of vision and, in some cases, improvement.
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Laser Treatment
Laser treatment, known as laser photocoagulation, can help seal leaking blood vessels or prevent the growth of abnormal new vessels in the retina. The goal of laser therapy is typically to stabilize the disease and prevent further vision loss.
Laser treatment is usually performed in the office or outpatient surgery center using local anesthesia.​​​​​​​​​​
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Surgical Treatment
In advanced cases, a surgical procedure called a vitrectomy may be necessary. This procedure removes blood and scar tissue from the vitreous (the gel inside the eye) and replaces it with a clear solution. Vitrectomy may be recommended if complications such as persistent bleeding or retinal detachment occur.
