At first, you may notice no changes in your vision. But don't let diabetic retinopathy fool you. It could get worse over the years and threaten your good vision. With timely treatment, 90 percent of those with advanced diabetic retinopathy can be saved from going blind.

As the disease progresses, it enters its advanced, or proliferative, stage. Fragile, new blood vessels grow along the retina and in the clear, gel-like vitreous that fills the inside of the eye. Without timely treatment, these new blood vessels can bleed, cloud vision, and destroy the retina.

Back to the Top

Who is at risk for this disease?

All people with diabetes are at risk—those with Type I diabetes (juvenile onset) and those with Type II diabetes (adult onset).

During pregnancy, diabetic retinopathy may also be a problem for women with diabetes. It is recommended that all pregnant women with diabetes have dilated eye examinations each trimester to protect their vision.

What are its symptoms?

These spots are often followed within a few days or weeks by a much greater leakage of blood. The blood will blur your vision. In extreme cases, a person will only be able to tell light from dark in that eye. It may take the blood anywhere from a few days to months or even years to clear from inside of your eye. In some cases, the blood will not clear. You should be aware that large hemorrhages tend to happen more than once, often during sleep.

Back to the Top

How is it detected?

How is it treated?

There are two treatments for diabetic retinopathy. They are very effective in reducing vision loss from this disease. In fact, even people with advanced retinopathy have a 90 percent chance of keeping their vision when they get treatment before the retina is severely damaged. These treatments are:

Laser Surgery: Doctors will perform laser surgery to treat severe macular edema and proliferative retinopathy.

Macular Edema: Timely laser surgery can reduce vision loss from macular edema by half. But you may need to have laser surgery more than once to control the leaking fluid.

During the surgery, your doctor will aim a high-energy beam of light directly onto the damaged blood vessels. This is called focal laser treatment. This seals the vessels and stops them from leaking. Generally, laser surgery is used to stabilize vision, not necessarily to improve it.

Proliferative Retinopathy: In treating advanced diabetic retinopathy, doctors use the laser to destroy the abnormal blood vessels that form at the back of the eye.

Laser surgery is performed in a doctor's office or eye clinic. Before the surgery, your ophthalmologist will: (1) dilate your pupil and (2) apply drops to numb the eye. In some cases, the doctor also may numb the area behind the eye to prevent any discomfort.

The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of bright green or red light. These flashes may eventually create a stinging sensation that makes you feel a little uncomfortable.

You may leave the office once the treatment is done, but you will need someone to drive you home. Because your pupils will remain dilated for a few hours, you also should bring a pair of sunglasses.

For the rest of the day, your vision will probably be a little blurry. Your eye may also hurt a bit. This is easily controlled with drugs that your eye care professional suggests.

Vitrectomy: If you have a lot of blood in the vitreous, you may need an eye operation called a vitrectomy to restore sight. It involves removing the cloudy vitreous and replacing it with a salt solution. Because the vitreous is mostly water, you will notice no change between the salt solution and the normal vitreous.

Studies show that people who have a vitrectomy soon after a large hemorrhage are more likely to protect their vision than someone who waits to have the operation. Early vitrectomy is especially effective in people with insulin-dependent diabetes, who may be at greater risk of blindness from a hemorrhage into the eye.

Vitrectomy is often done under local anesthesia (using drops to numb the eye). This means that you will be awake during the operation. The doctor makes a tiny incision in the sclera, or white of the eye. Next, a small instrument is placed into the eye. It removes the vitreous and inserts the salt solution into the eye.

You may be able to return home soon after the vitrectomy. Or, you may be asked to stay in the hospital overnight. Your eye will be red and sensitive. After the operation, you will need to wear an eyepatch for a few days or weeks to protect the eye. You will also need to use medicated eye drops to protect against infection.

Although laser surgery and vitrectomy are very successful, they do not cure diabetic retinopathy. Once you have proliferative retinopathy, you will always be at risk for new bleeding. This means you may need treatment more than once to protect your sight.

Back to the Top

What research is being done?

The NEI is currently supporting a number of research studies in both the laboratory and with patients to learn more about the cause of diabetic retinopathy. This research should provide better ways to detect, treat, and prevent vision loss in people with diabetes.

For example, it is likely that in the coming years researchers will develop drugs that turn off enzyme activity that has been shown to cause diabetic retinopathy. Some day, these drugs will help people to control the disease and reduce the need for laser surgery.

What can you do to protect your vision?

The NEI urges all people with diabetes to have an eye examination through dilated pupils at least once a year. If you have more serious retinopathy, you may need to have a dilated eye examination more often.

A recent study, the Diabetes Control and Complications Trial (DCCT), showed that better control of blood sugar level slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.

The study found that the group that tried to keep their blood sugar levels as close to normal as possible, had much less eye, kidney, and nerve disease. This level of blood sugar control may not be best for everyone, including some elderly patients, children under 13, or people with heart disease. So ask your doctor if this program is right for you.

National Eye Institute
National Institutes of Health