Diabetic Retinopathy: What Are the Symptoms and Risks?

Diabetes is a condition that leads to an excess of blood sugar levels due to the body’s inability to produce insulin. This often results in high blood pressure and cholesterol problems. Although the condition is commonly associated with heart and kidney problems, diabetes can also cause vision loss from diabetic retinopathy.

In this article, we cover what diabetic retinopathy does, its risk factors, and what treatment options are available.

What is Diabetic Retinopathy?

Diabetic retinopathy is an eye condition that can cause vision loss and blindness in people with diabetes. The condition affects the blood vessels in the retina, which is the light-sensitive layer of tissue in the back of your eye.¹

Having high blood sugar (blood glucose) damages your retina over time. If you have diabetes, it's important to get a complete dilated eye exam at least once a year.

After being diagnosed with diabetes, you may initially not have symptoms of diabetic retinopathy. However, catching it early can help you take steps to protect your eyesight.

Risk Factors of Diabetic Retinopathy

Diabetic retinopathy occurs due to high blood sugar from diabetes. Too much sugar in the blood can cause leaking blood vessels or eye fluid leakage and damage the retina.

Although your eyes can grow new blood vessels to make up for the damage, they won’t work as well and will be prone to leakage.

The risk of developing the disease can increase due to:²

• Having diabetes for a while
• Poor control of your blood sugar level
• Pregnancy
• High blood pressure
• High cholesterol
• Tobacco use
• Being Black, Hispanic, or Native American

What Are the Symptoms of Diabetic Retinopathy?

The early stages of diabetic retinopathy typically don’t present any symptoms. However, some people may begin to notice changes in their vision.

People with diabetic retinopathy may have trouble reading or seeing faraway objects. Potential symptoms of diabetic retinopathy include:²

• Dark spots or strings floating in your vision (floaters)
• Blurred vision
• Fluctuating vision
• Dark areas in your vision
• Vision loss

Your symptoms may vary depending on the stage of the disease since these changes in vision may come and go. Sometimes, the dark spots or strings can clear up on their own.

Contact an eye doctor immediately if you're experiencing any of these symptoms.

Stages of Diabetic Retinopathy

There are two types of diabetic retinopathy: nonproliferative and proliferative. Nonproliferative retinopathy refers to the early stages of the disease, while proliferative retinopathy is its advanced state where symptoms are the most severe.

The disease develops in four stages, which include:

1. Mild Nonproliferative

The earliest stage of diabetic retinopathy is characterized by small swelling or bulges in the blood vessels in the retina. The areas of swelling are known as microaneurysms.

Microaneurysms can cause small amounts of fluid to leak into the retina, triggering swelling of the macula (the back of the retina). However, the stage typically doesn't have any noticeable symptoms.

2. Moderate Nonproliferative

During this stage, tiny blood vessels swell up and block blood flow to the retina, preventing proper nourishment. The most notable sign of this stage is blurry vision. This occurs when blood and other fluids build up in the macula.

3. Severe Nonproliferative

This stage has a high chance of an irreversible loss of vision. During this stage, blockage from large sections of blood vessels in the retina causes a significant decrease in blood flow. The lack of blood causes the body to start growing new blood vessels in the area.

These new blood vessels are thin and fragile, causing retinal swelling. This results in the following symptoms:

• Blurry vision
• Dark spots
• Patches of vision loss

When these blood vessels leak into the macula, you may experience sudden and permanent vision loss.

4. Proliferative

This is the advanced stage of the disease, which causes blood vessels in the retina to bleed into the vitreous (the fluid that fills your eye). The new blood vessels that continue to grow in the retina are weak, thin, and prone to bleeding, causing scar tissue to form inside the eye. The scar tissue can pull the retina away from the macula, resulting in retinal detachment.

This stage of the disease requires urgent treatment.

Complications Caused By Diabetic Retinopathy

Diabetic retinopathy can cause the following vision and eye health complications:²

1. Vitreous Hemorrhage

Diabetic retinopathy causes the growth of abnormal blood vessels in the retina. The abnormal blood vessels may bleed into the clear substance that fills the center of your eye.

If there’s only a small amount of bleeding, you may only see a few floaters. In more severe cases, the blood can completely block your vision.

Vitreous hemorrhage alone does not usually cause permanent vision loss. The blood usually clears from the eye within a few weeks or months, so your vision will likely return to its initial clarity.

2. Blindness

Diabetic retinopathy, glaucoma, macular edema, or a combination of these issues can result in complete vision loss. This is especially true if a person doesn’t manage their diabetes properly.

3. Diabetic Macular Edema (DME)

About one in 15 people with diabetes will develop DME.¹ DME occurs when blood vessels in the retina leak fluid into the macula.

The macula is part of the retina. It’s necessary for sharp, central vision. This leak causes blurry vision.

4. Neovascular Glaucoma

Glaucoma is a group of eye diseases that cause vision loss and blindness. Diabetic retinopathy can cause abnormal blood vessels to develop in the retina. This blocks fluid from draining out of the eye and leads to neovascular glaucoma.

5. Retinal Detachment

Diabetic retinopathy can cause scars to develop in the back of your eye. Tractional retinal detachment is when the scars pull your retina away from the back of your eye.

A detached retina can lead to:

• A reduced field of vision
• Blurriness
• Permanent blindness

When to See an Eye Doctor for Diabetic Retinopathy

If you have diabetes, visit your eye doctor annually for an eye exam with dilation. You should take precautions even if your vision seems fine.²

Speak to your doctor immediately if your vision changes suddenly or becomes:

• Blurry
• Spotty
• Hazy

If you’re pregnant, your eye doctor may suggest additional eye exams during pregnancy. Having or developing diabetes during pregnancy can increase your risk for diabetic retinopathy.

How is Diabetic Retinopathy Diagnosed?

Eye doctors can check for diabetic retinopathy during a dilated eye exam. The eye exam is simple and painless.

Your doctor will provide you with some eye drops to dilate your pupil. Then, they will check your eyes for the condition and any other eye problems.

If your eye doctor believes you may have severe diabetic retinopathy or DME, they are likely to perform a fluorescein angiogram. This test allows the doctor to see pictures of the blood vessels in your retina and areas of fluid leakage.¹

If you are diagnosed with diabetic retinopathy, early detection and treatment can reduce future damage and prevent blindness.

How Can You Prevent Diabetic Retinopathy?

You can't always prevent diabetic retinopathy since diabetes is a lifelong condition. However, there are some steps you can take to prevent and reduce severe vision loss.

You can reduce your risk of developing diabetic retinopathy by doing the following:²

• Manage your diabetes. This involves eating healthy, exercising, and taking oral diabetes medicines or insulin. Try to complete at least 150 minutes of moderate aerobic activity each week.
• Regular eye exams. Visiting your doctor regularly can help detect the signs of diabetic retinopathy and other vision problems. This can provide early intervention and increase your chance of preventing eye diseases.
• Monitor your blood sugar levels. Record your blood glucose levels several times a day, more if you're feeling stressed or sick. Ask your doctor about a glycosylated hemoglobin test and how often you should get one.
• Lose excess weight. Managing your weight with diet and exercise can help control your cholesterol and blood pressure levels.
• Quit smoking. Smoking increases your risk of diabetes complications. This includes diabetic retinopathy.
• Pay attention to vision changes. Speak with your eye doctor immediately if your vision changes.

Diabetes does not always lead to vision loss. Taking an active role in diabetes management can help prevent its various complications.

Treatment Options for Diabetic Retinopathy

In the early stages of the condition, your eye doctor will likely assess how your eyes are doing. Some patients with diabetic retinopathy may require a complete dilated eye exam every two to four months.

In its later stages, it’s essential to begin treatment immediately. Treatment can stop your vision from worsening and, in many cases, results in visual improvement.

Treatment options for diabetic retinopathy include:¹

• Eye injections. Medications called anti-VEGF drugs can slow down or reverse the condition. Other injections, called corticosteroids, can also help.
• Laser treatment. Eye doctors can use lasers to reduce swelling in your retina. This makes the blood vessels shrink and stop leaking.
• Eye surgery. If your retina is bleeding a lot or there are a lot of scars in your eye, your doctor may recommend vitrectomy surgery.

Summary

Diabetic retinopathy is a type of diabetic eye disease that affects the blood vessels in the retina. Over time, the damage causes blurry vision, dark spots, and even irreversible blindness.

There are two types of diabetic retinopathy: nonproliferative and proliferative. The disease progresses into four stages, and your symptoms may vary depending on the condition’s stage.

The earliest stage of diabetic retinopathy may not show any symptoms. Because of this, it's important to visit your eye doctor regularly to prevent future complications. Early detection and treatment can prevent vision problems that may develop.