Diabetic retinopathy is one of the most significant and potentially sight-threatening complications of diabetes. It develops gradually when high blood sugar levels begin to damage the tiny blood vessels supplying the retina — the light-sensitive tissue at the back of the eye. In its early stages, the condition may cause no symptoms at all, making it easy to overlook. However, as it progresses, diabetic retinopathy can lead to severe visual impairment or even permanent sight loss if it is not identified and treated in time.
As a consultant ophthalmologist specialising in cataract and glaucoma surgery, I frequently meet patients who could have benefitted enormously from earlier diagnosis. Understanding the condition, recognising the signs and knowing how to reduce your risk are vital steps in protecting your long-term vision.
What Is Diabetic Retinopathy?
Diabetic retinopathy occurs because high blood sugar levels gradually weaken the delicate blood vessels in the retina. As these vessels become damaged, they can leak fluid or blood, become blocked, or trigger the growth of abnormal new vessels. Over time, these changes interfere with the retina’s ability to function, affecting the quality of vision.
There are two main stages of diabetic retinopathy. In the early stage, known as non-proliferative diabetic retinopathy (NPDR), the blood vessels in the retina begin to lose their normal structure and may start to leak small amounts of blood or fluid. This stage can vary in severity and may involve areas of swelling or tiny bulges in the vessel walls. Although vision may still appear normal, the foundations for future problems are being laid.
If the disease progresses to the advanced stage — proliferative diabetic retinopathy (PDR) — the damage becomes more significant. The retinal blood vessels may close entirely, prompting the eye to create new, fragile vessels in an attempt to restore oxygen supply. These new vessels tend to bleed easily and can cause extensive scarring. As scar tissue forms, it can pull on the retina, increasing the risk of retinal detachment. Pressure within the eye may also rise, potentially leading to glaucoma.
Another related condition is diabetic maculopathy, which affects the macula — the central part of the retina responsible for sharp, detailed vision. When fluid leaks into this area, the central vision becomes blurred or distorted, making everyday activities such as reading, driving and recognising faces more difficult.
Who Is at Risk?
Anyone with Type 1 or Type 2 diabetes can develop diabetic retinopathy, but some individuals are more vulnerable than others. The risk increases the longer someone has lived with diabetes, especially if their blood sugar levels have been difficult to control over time. Elevated blood pressure and high cholesterol can also accelerate the damage. Smoking further harms the blood vessels and increases the rate of progression. Pregnant women with diabetes, and individuals of Asian or Afro-Caribbean heritage, also have a higher tendency to develop retinal complications.
Recognising the Symptoms
One of the greatest challenges with diabetic retinopathy is that it often develops silently. In its earliest stages, there may be no noticeable symptoms at all. As the condition advances, however, you may start to become aware of subtle changes. These might include blurred or fluctuating vision, difficulty seeing colours clearly, or patchy and distorted areas in your sight. Some people begin to see floaters — small dark shapes drifting across their field of vision — or develop sudden changes in their eyesight. In more severe cases, significant bleeding or retinal detachment can cause sudden, dramatic loss of vision.
For individuals living with diabetes, any unusual change in vision should be investigated promptly. Early assessment is far better than waiting for symptoms to worsen.
How Diabetic Retinopathy Is Diagnosed
Diagnosis usually begins with a comprehensive dilated eye examination. Special drops are used to widen the pupils, allowing the ophthalmologist to examine the back of the eye in detail. During this examination, the doctor assesses the health of the retina and optic nerve, looking for any signs of vessel leakage, swelling, scar tissue, or abnormal new vessels. Retinal photographs or advanced imaging techniques such as OCT (optical coherence tomography) may be used to obtain detailed views of the retina.
Depending on what is found, your ophthalmologist may also check for related conditions such as glaucoma or cataracts, both of which can occur more commonly in people with diabetes.
Treatment Options
Treatment for diabetic retinopathy varies depending on how advanced the condition is. In the earliest stages, improving overall diabetes control is often the most important step. Maintaining stable blood sugar levels, managing blood pressure and cholesterol, and adopting a healthy lifestyle can significantly slow the progression of retinal damage.
When the disease becomes more severe, further treatment may be required. Laser therapy known as photocoagulation can be used to seal leaking vessels or treat areas of the retina deprived of oxygen. This helps to prevent abnormal vessel growth and stabilise the condition.
In some cases, injections of anti-VEGF medication into the eye can help to reduce swelling and prevent the formation of new, fragile vessels that threaten vision. These injections may need to be repeated over several months depending on the response.
If a large amount of bleeding or severe scarring has occurred, surgery known as vitrectomy may be necessary. This procedure removes blood or scar tissue from the inside of the eye and helps to restore a clearer path for light to reach the retina.
Understanding Your Screening Results
In the UK, people with diabetes aged 12 and over are invited for yearly diabetic eye screening. The results will indicate whether there is no retinopathy, early signs of background retinopathy, or more serious changes that require referral or closer monitoring. Early detection through screening is one of the most effective ways to prevent sight-threatening complications.
Reducing Your Risk
Protecting yourself from diabetic retinopathy begins with good diabetes management. Keeping blood glucose within target range, controlling blood pressure and cholesterol, avoiding smoking, and maintaining a healthy diet all play a crucial role. Regular exercise and attending your screening appointments should also be part of your routine. Paying attention to even minor changes in vision and reporting them early can make a significant difference to long-term outcomes.
Diabetic retinopathy is a serious condition, but with early detection and appropriate management, many people are able to preserve their vision for life. The key is taking an active role in your eye health and working closely with your healthcare team.
If you are living with diabetes and have any concerns about your vision or if you’d like a thorough assessment please feel free to get in touch and book an appointment with Gurjeet Jutley.