Symptoms of diabetic retinopathy

Early diabetic retinopathy usually has no symptoms at all, which is why routine dilated exams matter. As it progresses, patients may notice:

Blurry or fluctuating vision, especially with drastic changes in blood sugar
New floaters or dark strings drifting through your vision
Dark or empty areas in your field of vision

A landscape seen through dark blotches and haze, simulating vision with diabetic retinopathy — What diabetic retinopathy can look like: dark blotches and haze from bleeding into the vitreous gel.

Causes & risk factors

Years of elevated blood sugar cause damage to the retina’s small blood vessels. In the earlier stage, called nonproliferative retinopathy, vessels leak fluid and blood into the retina, causing small spots of bleeding and areas of swelling within the retina. When fluid collects in the macula, it is called diabetic macular edema and can cause blurring of the central vision.

In the advanced stage, called proliferative diabetic retinopathy, fragile and unhealthy blood vessels grow like weeds from the retina into the vitreous gel. These abnormal blood vessels can bleed, causing blurry vision, and can pull on the retina, causing the retina to detach.

How we diagnose diabetic retinopathy

Diabetic retinopathy is diagnosed with a dilated eye exam, and often with retina photographs or other advanced imaging techniques such as OCT to better visualize areas of swelling or angiography to determine areas of blood vessel damage or abnormal blood vessel growth.

How is diabetic retinopathy treated?

Treatment depends on the stage of diabetic retinopathy and whether swelling is present in the macula:

Anti-VEGF injections

The main treatment for diabetic macular edema, and often used to treat proliferative diabetic retinopathy. Intravitreal injections, which are injections of medicine through the white part of the eye and into the vitreous gel, reduce leakage and swelling from abnormal blood vessels and cause abnormal vessels to regress. Various anti-VEGF medications can be used, with the most common being Avastin, Lucentis, Eylea, or Vabysmo.

Laser treatment

Focal laser is often performed in the macula, but sparing the fovea, and decreases blood vessel leakage and retinal swelling. Panretinal laser photocoagulation, also known as PRP laser, treats advanced proliferative disease to prevent bleeding and retinal detachment.

Vitrectomy surgery

For eyes with bleeding that will not clear with time or with anti-VEGF injections, or if scar tissue forms that causes retinal detachment, vitrectomy surgery removes the vitreous gel and the hemorrhage mixed in with the gel, and may also relieve the traction from the abnormal blood vessels and scar tissue. PRP laser is often performed during vitrectomy surgery.

Partnership with your care team

We will send a report to your regular eye doctor and to your primary care provider and/or endocrinologist, to keep them updated as to your treatments and prognosis.

What to expect

Vision loss from diabetes is largely preventable with regular exams and timely treatment. Even advanced retinopathy can usually be stabilized. The patients who do best are the ones whose disease is caught before they notice anything wrong.

Common questions

How often should I have my eyes examined if I have diabetes?

At least once a year for most people with diabetes, and more often if retinopathy is present. Early disease has no symptoms, so the exam schedule should not depend on how your vision feels.

Can diabetic retinopathy be reversed?

Swelling and bleeding can often be reversed with treatment, and abnormal vessels can be made to regress. Damage from long-standing untreated disease is harder to undo, which is why timing matters.

Will I need injections forever?

Not necessarily. Many patients need a series of injections while the disease is active, then fewer as it stabilizes, especially when blood sugar control improves.

Why do I have diabetic retinopathy if my a1c is normal and my diabetes is well-controlled?

Diabetic retinopathy reflects years of history and can even progress temporarily as control improves. We encourage you to keep your exam schedule regardless of your latest A1c.

Sources & review

This page is educational and is not a substitute for an examination. Content follows guidance from the American Academy of Ophthalmology and the American Society of Retina Specialists.