If You’re Living With Diabetes, Here’s What You Need to Know About Diabetic Retinopathy
Key takeaways:
Diabetic retinopathy is a condition that affects the blood vessels in the back of the eye and can lead to permanent vision loss.
People with diabetes can develop diabetic retinopathy over time if their blood sugar levels are frequently high. Keeping blood sugars in a healthy range can prevent diabetic retinopathy.
There’s no way to reverse diabetic retinopathy. But there are treatments that can help slow down vision loss.
Diabetic retinopathy is an eye condition that affects people living with Type 1 or Type 2 diabetes. If you’re living with diabetes, you already know that maintaining your blood sugar in a healthy range can keep you safe from the long-term complications of diabetes.
Heart disease or strokes are the first things that jump to mind when thinking about diabetes complications. But, without proper treatment, diabetes can lead to eye problems, too. Diabetic retinopathy is one of these eye problems and it’s very common. Experts estimate that nearly half of all people living with diabetes will develop diabetic retinopathy. And diabetic retinopathy can be serious — it’s the leading cause of blindness among young and middle-aged adults.
If you’re living with diabetes, here’s what you need to know about diabetic retinopathy and how to protect your vision.
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How does diabetes cause retinopathy?
Over time, high blood sugar levels damage blood vessels throughout the body. Damaged blood vessels can’t supply tissues and organs with oxygen. Without oxygen, organs stop working properly.
This is how diabetes can lead to kidney failure, vascular disease, heart disease, and stroke. It’s also how diabetes causes retinopathy.
The retina is the back part of the eye that sends visual signals to the brain.
There are many blood vessels bringing blood to the retina. But these blood vessels are some of the smallest blood vessels in the body. Because they’re so small, they’re some of the first to get damaged by high blood sugar levels from diabetes.
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Damaged blood vessels can swell, leak, or even close off completely. This cuts off the oxygen supply to the retina. Swelling from leaky blood vessels also puts pressure on the retina. These two things damage the retina so it can’t work properly. Without working retinas, people start to experience vision changes and permanent vision loss.
How can I find out if I’m at risk for retinopathy?
If you have diabetes, you’re at risk for developing diabetic retinopathy. Some people with diabetes are more likely to develop retinopathy though. You’re more likely to develop retinopathy if:
You’ve had diabetes for a long time.
You have high blood sugar levels.
You experience difficulty managing diabetes and improving blood sugar levels.
You smoke.
Since anyone with diabetes can develop retinopathy, experts recommend that people with diabetes get a dilated eye exam every year. A dilated eye exam can catch retinopathy early, when it’s easier to treat.
What are the symptoms of diabetic retinopathy?
At first, people with diabetic retinopathy don’t have any symptoms.
But over time, as damage continues, people start noticing trouble seeing and other symptoms like:
Blurred vision
Large floaters
Dark spots or cobwebs in their vision
Changes in color perception
Without treatment, these symptoms get worse over time and people develop permanent vision loss.
Can diabetic retinopathy be reversed?
No.
Diabetic retinopathy cannot be reversed or cured. But there are treatments that can stop diabetic retinopathy from getting worse. These treatments can protect your eyes so that you can maintain the vision you still have and prevent blindness.
In some cases, treatment can help improve people’s vision, too. But for many people, vision changes from diabetic retinopathy are permanent.
How is diabetic retinopathy treated?
During the early stages of diabetic retinopathy, treatment focuses on improving blood sugar levels. That might mean starting new diabetes medications, diet changes, and exercise. In some cases, maintaining blood sugar levels in target ranges can improve vision. People also need regular eye exams by an ophthalmologist to make sure their retinopathy isn’t getting worse.
Advanced diabetic retinopathy requires additional treatment. Treatment may not restore vision but it can keep vision from getting worse. Your ophthalmologist may recommend some or all of the following treatments.
Anti-VEGF eye injections
Anti-VEGF medications stop blood vessels from growing inside the retina. Since normal blood vessels in the retina are damaged, the body tries to grow new ones. But these new blood vessels are more prone to breaking and leaking, so they make diabetic retinopathy worse instead of better. Anti-VEGF medications tell the body to stop trying to grow new blood vessels. These medications are injected directly into the eye and are also used to treat other eye conditions like diabetic macular edema and macular degeneration.
Steroid eye injections
Steroid eye injections are also injected directly into the eye. They calm inflammation and can help ease pressure on the retina. They’re also used to treat diabetic macular edema.
Laser eye surgery
Laser eye surgery is used to destroy abnormal blood vessels that are growing near the retina. While anti-VEGF injections stop the body from making more of these blood vessels, laser eye surgery removes the ones that have already developed. Destroying blood vessels before they have a chance to leak prevents further retina damage.
Vitrectomy
A vitrectomy is a type of eye surgery that removes the vitreous humor. The vitreous humor is a gel-like substance in the back of the eye. Once the vitreous is removed, the ophthalmologist can remove scar tissue from the back of the eye. They can also look for any active bleeding and stop it. Some people with diabetic retinopathy can develop a retinal detachment. During a vitrectomy, the ophthalmologist can also try to repair a retinal detachment.
Can diabetic retinopathy be prevented?
Yes.
If you have diabetes, you’re at risk for developing diabetic retinopathy. But that doesn’t mean you’ll definitely develop it. You can take steps to prevent diabetic retinopathy from starting and keep your vision safe. Here’s how you can prevent diabetic retinopathy.
Keep your blood sugar in a healthy range
Keeping your blood sugar in a healthy range is the best way to prevent diabetic retinopathy. Studies show the risk of developing diabetic retinopathy goes up dramatically once people’s HbA1c levels go above 6.6%.
Landmark research trials show that people who maintain blood sugar levels in a healthy range are less likely to develop diabetic retinopathy. And in people who already have diabetic retinopathy, maintaining blood sugar in target ranges keeps diabetic retinopathy from getting worse.
Work with your care team to make sure you’re on the best possible treatment for your diabetes. That might include different types of medications, insulin delivery methods, glucose monitoring devices, diet, and exercise.
Get treatment for high blood pressure and high cholesterol
Landmark studies show that high blood pressure and high cholesterol can increase people’s risk of developing diabetic retinopathy. If you have either of these conditions, talk with your healthcare provider about your treatment options. Medications and diet changes can help you control your blood pressure and your cholesterol levels.
Consider quitting smoking
If you smoke, consider quitting.
Smoking makes it harder for you to manage your diabetes. Studies show that people with diabetes need more insulin to lower their blood sugar if they smoke. So smoking can undo all the hard work you put into your diet, exercise routine, and medication management.
The good news is that quitting smoking can have a huge impact on your diabetes. Studies show that in as little as 8 weeks, people who quit smoking had better responses to insulin. If you have a hard time managing your blood sugar levels and you smoke, quitting smoking could be enough to bring your blood sugar levels within the target range.
Get a yearly eye exam
Make sure you get a yearly dilated eye exam. This is the only way to find out if you have diabetic retinopathy. People can start treatment for diabetic retinopathy before they start experiencing vision changes. In these cases, treatment can keep people from experiencing any vision loss.
The bottom line
People living with diabetes are at risk for diabetic retinopathy, an eye condition that can lead to vision changes and blindness. There are treatments that can help diabetic retinopathy from getting worse — like anti-VEGF eye injections, steroid eye injections, and laser eye surgery. But there’s no cure for the condition. If you’re living with diabetes, you can lower your risk of developing diabetic retinopathy by keeping your blood sugars in a healthy range, getting a yearly eye exam, and quitting smoking.
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References
American Diabetes Association. (2022). Eye health: Why you should schedule your annual diabetes eye exam. Focus on Diabetes.
Boyd, K., et al. (2022). Diabetic retinopathy: Causes, symptoms, treatment. American Academy of Ophthalmology.
Bryl, A., et al. (2022). The effect of hyperlipidemia on the course of diabetic retinopathy — literature review. Journal of Clinical Medicine.
Centers for Disease Control and Prevention. (n.d.). Smoking and diabetes. Surgeon General’s Report on Smoking and Health.
Centers for Disease Control and Prevention. (2022). Diabetes and vision loss.
Centers for Disease Control and Prevention. (2022). Smoking and diabetes.
Diabetes Control and Complications Trial Research Group, et al. (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine.
Klein, R., et al. (2002). Blood pressure control and diabetic retinopathy. British Journal of Ophthalmology.
National Eye Institute. (2022). Diabetic retinopathy.
National Eye Institute. (2022). Injections to treat eye conditions.
National Eye Institute. (2022). Vitrectomy.
Setareh, J., et al. (2022). Can the level of HbA1C predict diabetic retinopathy among type II diabetic patients? BioMed Central Ophthalmology.
Wong, T. Y., et al. (2016). Diabetic retinopathy. Nature Reviews Disease Primers.
