Diabetic retinopathy

In the early stages, diabetic retinopathy doesn't usually have any symptoms. This is why it is so important to attend regular screening appointments to check for early changes in your eyes. Most people with diabetes are screened for retinopathy once a year, but this may vary. Check with your healthcare provider how often you need to be screened for retinopathy.

As diabetic retinopathy worsens, symptoms may include:

• Worsening or fluctuating vision
• Sudden loss of vision
• Blurred vision
• Dark or empty areas in your visual field
• Floaters (shapes, spots or strings floating in your field of vision)
• Eye pain or redness
• Poor night vision
• Difficulty driving at night

Diabetic retinopathy can occur in people with either type 1 or type 2 diabetes, a condition where the pancreas does not produce enough insulin, or your body can't use insulin effectively to keep your blood sugar within the normal range. The condition occurs when persistently high blood sugar levels damage the blood vessels in the retina at the back of the eye. This leads to the formation of new, fragile blood vessels that leak fluid or bleed more easily.

You are at higher risk of diabetic retinopathy if you:

• Have had diabetes for a long time
• Have high blood sugar over a long time
• Have high cholesterol
• Have high blood pressure
• Are of Asian, Afro-Caribbean, or Hispanic descent
• Are pregnant

Diabetic retinopathy is normally only treated when the condition is advanced enough to cause a threat to your vision (proliferative retinopathy). Treatment includes improving diabetes control, laser treatment, eye injections or implants or eye surgery.

Diabetes management

Keeping your blood sugars as close to normal as possible can help prevent complications from developing in the first place and stop existing complications from worsening.

If you're not sure how to manage your diabetes properly, speak to your healthcare provider.

Laser treatment for diabetic retinopathy

During laser treatment, a laser is used to shrink blood vessels at the back of the eye and minimise bleeding in the eye. It aims to stabilise damage within the eye and prevent your condition from getting worse. The procedure is normally done as an outpatient and takes between twenty and forty minutes. You might need more than one session for the best results.

Eye injections for diabetic retinopathy

Injections into the eye can be used to treat diabetic maculopathy (damage to the centre of the retina) and work by preventing new blood vessels from forming on the retina. The treatment aims to stop your condition from getting worse and may also improve your sight. Injections are usually given once a month until your condition has stabilised, after which they may be stopped or given less frequently.

Steroid implants for diabetic retinopathy

In this treatment, a tiny implant is injected into the eye. The implant releases a steroid gradually over a few months to reduce swelling and inflammation and improve your vision.

Eye surgery for diabetic retinopathy

Surgery for diabetic retinopathy involves removing some of the clear, jelly-like fluid (vitreous humour) from the space behind the eye. This is known as vitreoretinal surgery and may be performed when a large amount of blood has built up behind the eye, or to remove excess scar tissue.

A laser is also used during the procedure to prevent any further loss of vision. Vitreoretinal surgery is normally performed under local anaesthetic as a day case.

You should be able to go home on the same day or the day after your eye surgery. You will possibly need to wear a patch over your eye for a few days. Your vision will be blurry after surgery but should improve with time. It might take a few months for it to return to normal.

At your initial consultation, you will be seen by a consultant ophthalmologist, a doctor specialising in conditions affecting the eyes. Your consultant will ask you about your symptoms and general health as well as some questions about your diabetes and blood sugar management. Your consultant will then perform an extensive eye examination. This may include:

• Visual acuity assessment test - your vision will be checked by reading letters on a chart from a distance away
• Tonometry - a test to measure the pressure inside your eye. This is known as intra-ocular pressure or IOP
• Pupil dilation - you will be given eye drops to dilate (widen) your pupils. This allows your consultant to see inside your eye
• Ophthalmoscopy - your consultant will examine your retina using a special magnifying glass
• Fluorescein angiography - a special dye is injected into a vein, and photographs are taken to check the blood supply to your retina
• Optical coherence tomography - light waves are used to create a detailed picture of your retina

Your consultant will then make a diagnosis based on your medical history and the results of your eye examination.

Why is this first consultation so important?

Your first appointment is important because it's where we get to know you and discuss your symptoms, general health, and expectations for treatment. Your first appointment is also where you can discuss any concerns with your consultant or ask any questions you may have.

At the end of your appointment, your consultant will discuss your diagnosis, and the results of your eye examination and recommend a suitable treatment.

Untreated diabetic retinopathy can lead to other eye conditions including diabetic maculopathy, glaucoma, retinal detachment and vitreous haemorrhage.

Diabetic oedema

Diabetic macular oedema (also known as diabetic oedema) is the most common cause of vision loss among people with diabetic retinopathy in the UK. Diabetic oedema involves a swelling of fluid in an area of the retina called the macula, which controls central vision. Around half of all people with diabetic retinopathy will develop diabetic oedema.

Diabetic maculopathy

Diabetic maculopathy occurs when the centre of the retina (the macula) becomes damaged. It may be caused by diabetic macular oedema. This may cause hardening of the retina and the formation of fatty deposits. Diabetic maculopathy commonly causes blurring in the centre of your vision which may make reading and facial recognition difficult. It is the most common cause of blindness in people with diabetic retinopathy.

Open-angle glaucoma

This type of glaucoma occurs when the growth of new blood vessels blocks the drainage of fluid from the eye. This increases pressure in the eye which can damage the optic nerve and lead to loss of vision.

Retinal detachment

Diabetic retinopathy can cause the formation of scars at the back of the eye. This scar tissue can pull the retina away from the back of the eye (retinal detachment).

Vitreous haemorrhage

Fragile new blood vessels at the back of the eye may bleed into the clear, jelly-like fluid (vitreous humour) in the space between your lens and retina. Mild bleeding can cause shapes (floaters) to appear across your vision, but a large bleed can cause a total block in your vision. This loss of vision is normally temporary and resolves within a few weeks or months.

The best way to reduce the risk of developing diabetic retinopathy is by keeping your blood sugar within the normal range by following the diet and medication regimen recommended by your diabetes care team.

Some other ways to reduce your risk include:

• Have your HbA1c (a blood test to measure your average blood sugar over the past three months) checked regularly
• Manage any other health conditions like high blood pressure and high cholesterol
• Attend regular diabetes check-ups and retinal screening
• Maintain a healthy weight
• Don't smoke
• Take regular exercise
• If you drink alcohol, stick to safe limits
• See your doctor straight away if you notice any changes to your vision

We answer some of your most commonly asked questions about diabetic retinopathy.

What is the first sign of diabetic retinopathy?

Early diabetic retinopathy doesn't usually have any symptoms and by the time you notice changes to your vision, your retinopathy may already be advanced. The first signs may be problems seeing things close up, or far away and this may get better or worse. Later signs may include seeing floaters across your eyes, blurred vision or difficulty seeing in the dark.

Can diabetic retinopathy be reversed?

Diabetic retinopathy cannot be reversed, but some treatments may improve your vision or prevent the condition from getting worse.

Can diabetic retinopathy only affect one eye?

Diabetic retinopathy usually affects both eyes, though damage to the retina may be worse in one eye than the other.

How long does it take to develop diabetic retinopathy?

How long it takes to develop diabetic retinopathy depends on many factors such as your general health, how quickly you began diabetes treatment, how long you have had diabetes, and how well your blood sugar is controlled.

What is background diabetic retinopathy?

Background diabetic retinopathy is the earliest stage of retinopathy where there may be small changes to the blood vessels behind the eye and minimal bleeding. Background retinopathy does not normally cause any changes to your vision. If you have background retinopathy, you may be screened more frequently to monitor your condition.

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care
  
  If you would like to see a consultant or learn more about diabetic retinopathy treatment, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in April 2023. Next review due April 2026.

1. Overview: Diabetic retinopathy, NHS
2. Diabetic Retinopathy, NIH National Eye Institute
3. Diabetic retinopathy, NHS Inform
4. Diabetic Retinopathy- Diabetes and Eye Problems, Diabetes UK