What is diabetic retinopathy?
Diabetic retinopathy is damage to the small blood vessels of the retina caused by chronically elevated blood sugar. Over time, the walls of these vessels weaken — some leak fluid and blood into the retina; others close off and stop delivering oxygen. One common consequence is swelling of the macula — the central part of the retina responsible for sharp, detailed vision — which is called diabetic macular edema (DME) and is a frequent cause of vision loss in patients with diabetes.
The retina also responds to chronically poor blood flow by trying to grow new blood vessels, but these new vessels are abnormal — fragile, prone to bleeding, and capable of causing scarring. Advanced disease can lead to retinal detachment and, ultimately, blindness if untreated.
Symptoms
Early diabetic retinopathy often produces no symptoms at all. This is the single most important thing to understand about the disease — significant damage can be present in an eye that still sees 20/20. The only way to detect early disease is a dilated eye exam.
When symptoms do develop, they may include blurred or fluctuating vision, dark or empty areas in your vision, a sudden shower of floaters (which can mean bleeding inside the eye), or sudden, painless vision loss. If you have diabetes and notice any sudden change in vision, you should be evaluated promptly.
How we diagnose diabetic retinopathy
A complete evaluation includes a dilated examination, optical coherence tomography (OCT) imaging to measure macular swelling, and — when indicated — fluorescein angiography or OCT angiography to map the retinal blood flow and identify areas of leakage or non-perfusion.
Treatment options
Treatment depends on the stage of disease and whether macular edema is present. Options include observation with systemic optimization for early disease, intravitreal injections for macular edema and more advanced retinopathy, panretinal photocoagulation laser for proliferative disease, focal laser for select cases of macular edema, and vitrectomy surgery for advanced complications such as non-clearing vitreous hemorrhage or tractional retinal detachment.
Active clinical trials
We may have ongoing enrollment for clinical trials in diabetic macular edema and non-proliferative diabetic retinopathy. If you have either condition, you may qualify. View our active trials →
Working with your primary care doctor
Diabetic retinopathy is one piece of a larger picture. Improving blood sugar control, managing blood pressure and cholesterol, and stopping smoking all reduce the risk of progression. We share our findings with your primary care doctor and any other physicians involved in your diabetes care, so that everyone is working with the same information.