Diabetic Retinopathy

How can diabetes affect the eyes?

Diabetes, especially when it’s not well controlled, can impair the eyes and cause serious vision loss. Eye diseases related to diabetes include:

  • Diabetic retinopathy, which can cause blood vessels in the retina to leak fluid or bleed, distorting vision. It is the most common cause of vision loss in people with diabetes and a leading cause of visual impairment and blindness in working-age adults.
  • Diabetic macular edema (DME) is a complication of diabetic retinopathy in which there is a buildup of fluid in the macula, the central part of the retina.

About 40 to 45 percent of Americans with diabetes have some degree of diabetic retinopathy, but only about half know it. People with all types of diabetes are at risk: types 1 and 2 as well as gestational diabetes. People with diabetes also have an increased risk of:

What causes diabetic eye diseases?

Blood sugar that remains chronically high and not well controlled can damage the tiny blood vessels in the retina, leading to retinopathy. When these damaged blood vessels leak, fluid can accumulate in the macula, causing DME. In the most advanced stage of diabetic retinopathy—proliferative diabetic retinopathy—new abnormal blood vessels increase in number on the surface of the retina, which can produce scarring and loss of retina cells.

What are the symptoms of diabetic retinopathy and DME?

In the early stages, there are no symptoms. As damage to blood vessels in the eyes progresses and bleeding occurs in the retina, you may experience “floating” spots and, in the case of DME, blurred vision.

How are diabetic retinopathy and DME diagnosed?

An eye care professional can perform a comprehensive dilated eye exam to look for changes in the blood vessels in the retina, swelling of the macular, changes in the lens, and damage to nerve tissue.

Are diabetic eye diseases preventable?

The best way to reduce your risk of diabetic retinopathy, DME, and other complications of diabetes is to control your blood sugar and keep it in a normal range. Take your diabetes medications as prescribed, monitor your blood sugar regularly, and get a comprehensive dilated eye exam at least once a year.

How are DME and diabetic retinopathy treated?

You may receive one or more of these therapies:

  • Anti-VEGF injections. Therapies that target a protein called “vascular endothelial growth factor” (VEGF)—such as aflibercept, bevacizumab, or ranibizumab—inhibit abnormal blood vessel growth. These treatments are injected into the eye. Anti-VEGF therapies can slow vision loss and even improve vision in some people. Repeated treatments are needed to achieve the most benefit.
  • Focal/grid macular laser surgery for DME. Your doctor can use a laser to make small burns to blood vessels in areas of the macula where edema is present, slowing fluid leakage and reducing swelling. This treatment is sometimes used in combination with anti-VEGF injections.
  • Scatter laser surgery for diabetic retinopathy. Also called panretinal laser surgery or panretinal photocoagulation, this treatment applies tiny laser burns to abnormal blood vessels, causing them to shrink. 
  • Corticosteroid injections. Some patients receive corticosteroid injections or implants in the eye to suppress DME.
  • Vitrectomy. People who have severe bleeding in the vitreous, the gel-filled area in the center of the eye, may have the vitreous surgically removed and replaced with a saline solution.

If you have vision loss from diabetic retinopathy or DME, there are low vision aids you can use to maximize the use of your remaining vision. Examples include handheld lenses, electronic reading machines, and closed circuit video magnification systems.