Diabetic Retinopathy

What Is Diabetic Retinopathy?

Diabetic retinopathy (DR) is a condition in which high blood sugar from diabetes damages the small blood vessels inside the retina, the light-sensitive tissue at the back of your eye. Over time, these damaged vessels can leak fluid, swell, or close off entirely, starving the retina of the blood supply it needs to function. In advanced stages, the eye grows fragile new blood vessels that bleed easily and can cause severe vision loss.

About one in four people with diabetes has some degree of diabetic retinopathy, making it one of the most common causes of preventable blindness among working-age adults in the United States.

Types and Stages of Diabetic Retinopathy

Diabetic retinopathy is classified into two main types based on how far the disease has progressed. Understanding where you fall helps determine your treatment plan and how closely you need to be monitored.

Non-Proliferative Diabetic Retinopathy (NPDR)

NPDR is the earlier stage. The existing blood vessels in your retina are damaged and may leak, but no abnormal new vessels have formed. It is graded as mild, moderate, or severe based on how much damage is visible. Mild and moderate NPDR often cause no symptoms and are managed with blood sugar control and regular monitoring. Severe NPDR carries a high risk of progressing to the more dangerous proliferative form and requires close follow-up with a retina specialist.

Proliferative Diabetic Retinopathy (PDR)

PDR is the advanced stage. When large areas of the retina lose their blood supply, the eye responds by growing new, abnormal blood vessels on the retinal surface or optic nerve (a process called neovascularization). These new vessels are fragile and prone to bleeding into the vitreous (the gel that fills the eye), causing sudden floaters or vision loss. They can also form scar tissue that pulls on the retina, potentially leading to retinal detachment.

PDR is more vision-threatening and usually requires prompt treatment with laser therapy, injections, or both.

Diabetic Macular Edema (DME)

Diabetic macular edema is a related complication that can occur at any stage of diabetic retinopathy. It happens when damaged blood vessels leak fluid into the macula, the central part of the retina you rely on for reading, driving, and recognizing faces. DME is the most common cause of central vision loss in people with diabetes and is typically treated with anti-VEGF injections

Common Symptoms of Diabetic Retinopathy

In its earliest stages, diabetic retinopathy typically causes no symptoms at all. You can have significant retinal changes and still see clearly, which is why waiting for symptoms before getting an eye exam is risky. As the condition progresses, you may notice:

• A gradual blurring or “fuzziness” in your central vision.
• Straight lines appearing wavy or distorted.
• Difficulty reading, driving, or recognizing faces.
• Colors appearing faded or washed out.
• Dark spots or “holes” in your field of vision.

Symptoms that require immediate attention: A sudden increase in floaters (spots, cobwebs, or strings), a dark curtain or shadow across part of your vision, or sudden severe blurring in one eye may indicate bleeding inside the eye or a retinal detachment. These are urgent and require same-day evaluation.

Causes and Risk Factors

The primary cause of diabetic retinopathy is chronic high blood sugar, which damages the walls of the tiny blood vessels in the retina over time. Both type 1 and type 2 diabetes can lead to DR.

Modifiable risk factors (things you can influence):

• Blood sugar control: Keeping your HbA1c closer to target significantly reduces the risk of developing or worsening retinopathy.
• Blood pressure: Tighter blood pressure control has been shown to reduce retinopathy progression.
• Cholesterol: Elevated blood lipids are associated with increased retinal deposits and a higher risk of macular edema.
• Smoking: Associated with worse blood vessel health and overall vascular outcomes.

Non-modifiable risk factors (things you cannot change):

• Duration of diabetes: The longer you have had diabetes, the higher your risk.
• Type of diabetes: Both type 1 and type 2 carry risk; type 1 patients may develop DR earlier due to longer disease duration.
• Genetics and ethnicity: Family history and certain genetic factors influence susceptibility. Some racial and ethnic groups, including Hispanic/Latino and Black populations, have higher rates of DR.
• Pregnancy: Diabetic retinopathy can worsen during pregnancy, especially in women with pre-existing retinal disease. An eye exam is recommended before conception and during the first trimester.

How Is Diabetic Retinopathy Diagnosed?

At Retina Vision Consultants, we use advanced imaging to detect diabetic retinopathy at its earliest stages, often before you notice any changes in your vision.

• Dilated Eye Exam: Your doctor uses special drops to widen your pupils and carefully examines the retina for signs of damage such as microaneurysms, hemorrhages, or abnormal vessel growth.
• Optical Coherence Tomography (OCT): A non-invasive scan that produces high-resolution cross-sectional images of your retina, allowing us to measure retinal thickness and detect even small amounts of macular swelling. OCT is essential for diagnosing and monitoring diabetic macular edema.
• Fluorescein Angiography: A dye is injected into your arm and photographs are taken as it travels through the retinal blood vessels. This reveals areas of leakage, poor blood flow, and abnormal vessel growth, and helps guide laser treatment planning.
• OCT-Angiography (OCTA): A newer, dye-free imaging technique that maps the retinal blood vessels in fine detail, detecting early areas of vessel dropout without requiring an injection.
• Fundus Photography: High-detail digital photographs of the retina used to document your baseline and track changes over time.

Treatment Options at RVC

Treatment depends on the type and stage of your diabetic retinopathy. In early stages, careful monitoring combined with tight blood sugar, blood pressure, and cholesterol management may be all that’s needed. For more advanced disease, we have several highly effective treatments to stabilize and often improve your vision.

Anti-VEGF Injections (For DME and PDR)

Anti-VEGF medications (such as Eylea®, Vabysmo®, Lucentis®, or Avastin®) are injected directly into the eye to block the protein that causes abnormal blood vessel growth and leakage. They are the first-line treatment for diabetic macular edema with vision loss and are also used for proliferative disease. Treatment typically begins with monthly injections, then transitions to longer intervals as the eye responds. Many patients see their vision stabilize or improve.

Panretinal Photocoagulation (PRP) Laser

For proliferative diabetic retinopathy, hundreds of small laser burns are applied to the peripheral retina to reduce the oxygen demand that drives abnormal vessel growth. PRP has been the gold standard for preventing severe vision loss from PDR for decades and is often combined with anti-VEGF injections. Side effects can include some reduction in peripheral and night vision, but these are generally outweighed by the protection against severe vision loss.

Focal/Grid Laser

Targeted laser treatment for specific areas of leakage in diabetic macular edema. While anti-VEGF injections have largely replaced laser as first-line therapy for center-involving DME, focal laser remains useful as a supplementary treatment to reduce the number of injections needed over time.

Corticosteroid Implants

For patients with DME who do not respond adequately to anti-VEGF therapy, slow-release steroid implants (such as Ozurdex®) can be placed inside the eye to reduce swelling for several months. These require monitoring for potential side effects including increased eye pressure and cataract progression.

Vitrectomy Surgery

When proliferative disease causes bleeding that does not clear on its own, or when scar tissue pulls the retina out of position (tractional retinal detachment), surgery may be needed. During a vitrectomy, the vitreous gel is removed along with blood or scar tissue, and laser is applied directly to the retina.

Living With Diabetic Retinopathy: What to Expect

Will I lose my vision? With early detection and consistent treatment, most people with diabetic retinopathy can maintain functional vision for life. Patients who keep their blood sugar, blood pressure, and cholesterol well controlled, attend regular eye exams, and follow their treatment plan have the best outcomes. Anti-VEGF therapy and laser treatment have dramatically reduced the rate of severe vision loss from diabetic eye disease.

However, if diabetic retinopathy is left untreated, it can progress to stages that cause permanent, significant vision loss. This is why regular screening is so important, even when your vision feels fine.

How often will I need to be seen? Your monitoring schedule depends on severity: yearly for no retinopathy or mild NPDR, every 6–9 months for moderate NPDR, every 3–4 months for severe NPDR, and as frequently as monthly during active treatment for PDR or DME. Intervals are extended as your condition stabilizes.

Your retina specialist will work closely with your endocrinologist or primary care doctor to optimize your overall diabetes management alongside your eye care.

When to See a Retina Specialist

If you have diabetes, you should have a comprehensive dilated eye exam at least once a year, even if your vision seems fine. People with type 2 diabetes should be examined at the time of diagnosis; those with type 1 diabetes should have their first exam within five years of diagnosis.

If you notice any sudden change in your vision, new floaters, or a shadow in your field of view, don’t wait for your next scheduled visit. Call Retina Vision Consultants at (310) 269-8565 to request an appointment. Early treatment is the most effective way to protect your sight.