Diabetic retinopathy

If you or a family member have diabetes, you may have been told to watch for diabetic retinopathy. This is a common eye complication of the condition. It develops gradually, so you may not notice changes in your sight at first, but regular eye checks can detect it early and protect your vision.

What is diabetic retinopathy?

Diabetic retinopathy is an eye disease caused by damage to the small blood vessels in the retina (the light-sensitive lining at the back of the eye). High blood sugar over time can weaken or block these vessels, affecting how the retina works.

In the early stages, vision may be normal. As the condition progresses, you might notice blurry eyes, dark patches, or changes in colour vision.

What does diabetic retinopathy look like?

From the outside, the eye usually looks normal. When examined by a specialist, signs may include:

• Tiny areas of bleeding or swelling in the retina
• Abnormal new blood vessels growing on the surface of the retina
• Scarring or pulling on the retina in advanced cases

These are detected using fundoscopy, retinal photography, or optical coherence tomography (OCT).

Symptoms to watch for

For patients, vision with retinopathy can vary:

• Gradual blurring of vision
• Difficulty seeing at night
• Dark or empty areas in your vision
• Sudden changes in sight (which may signal bleeding or retinal detachment)

If you notice a sudden drop in vision, flashes of light, or a curtain across your sight, seek urgent medical advice.

Causes and risk factors

The risk of diabetic retinopathy increases the longer you’ve had diabetes, especially if the condition is not well controlled. Other factors can also make the condition more likely or progress faster:

• High blood pressure or cholesterol: These can put extra strain on blood vessels in the eye
• Pregnancy: Hormonal changes can sometimes make retinopathy progress more quickly
• Smoking: Reduces blood flow and oxygen supply to the retina

Diabetic retinopathy grading

Eye specialists classify the condition based on how far it has progressed:

1. Background (mild): Early changes, often symptom-free
2. Pre-proliferative (moderate): More widespread vessel changes
3. Proliferative (severe): Growth of new, fragile vessels that can bleed
4. Diabetic maculopathy: Swelling at the central retina affecting detailed vision

This classification of diabetic retinopathy helps guide treatment and monitoring.

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How to treat diabetic retinopathy

The right treatment depends on how advanced the retinopathy is and whether the central retina (macula) is affected. Early stages may simply need regular monitoring and good control of diabetes, blood pressure, and cholesterol. Once changes threaten vision, treatment is recommended.

• Laser therapy: Often the first-line treatment for many stages of diabetic retinopathy. It’s used to seal leaking blood vessels, reduce swelling, and prevent abnormal new vessels from forming. In proliferative diabetic retinopathy, laser treatment can significantly reduce the risk of severe sight loss.
• Injections: Usually offered when swelling affects the macula (diabetic macular oedema). These medicines help reduce swelling and stop abnormal blood vessels from growing. Injections may be combined with laser therapy in some cases.
• Vitrectomy surgery: Recommended in advanced stages if there is bleeding (vitreous haemorrhage) or scar tissue pulling on the retina. This procedure clears the blood and scar tissue to restore a clearer path for light to reach the retina.

Your retinal specialist will decide on the best approach based on your classification and imaging results.

Living with the diagnosis

Ongoing management of diabetic retinopathy involves careful attention to overall health. Maintaining stable blood sugar and blood pressure levels can help slow the progression of the condition, while regular eye screening enables early detection of any changes. Any alteration in vision should be reported promptly to your eye specialist for assessment. With consistent care and monitoring, many individuals retain good vision for many years.