Diabetic Retinopathy (DR)
A diabetes-related retinal condition that occurs when prolonged high blood glucose levels damage the small blood vessels that supply the retina.
Understanding Diabetic Retinopathy (DR)
Diabetic Retinopathy (DR) is a diabetes-related condition that affects the retina, the light-sensitive layer at the back of the eye. It develops when prolonged high blood glucose levels damage the small blood vessels that supply the retina. These vessels may weaken and leak fluid or blood, become blocked, or trigger the growth of abnormal new blood vessels. Over time, these changes can damage the retina and affect vision.
DR affects people living with both type 1 and type 2 diabetes, and the risk increases with the duration of diabetes. It is generally classified into two main stages:
- Non-Proliferative Diabetic Retinopathy (NPDR): The earlier stage, in which retinal blood vessels become damaged, leak or become blocked. Abnormal new blood vessel growth has not yet occurred.
- Proliferative Diabetic Retinopathy (PDR): The more advanced stage, in which reduced blood supply to the retina can trigger abnormal new blood vessel growth. These fragile vessels may bleed and cause serious complications, including significant vision loss.
Diabetic Macular Oedema (DMO) can develop at any stage of DR. It occurs when fluid accumulates in the macula, the central area of the retina responsible for detailed vision, causing swelling and potentially affecting central sight.
Early DR often causes no noticeable symptoms, making regular retinal screening and monitoring essential for detecting changes before significant vision loss occurs. Timely diagnosis and appropriate management can help reduce the risk of sight-threatening complications.
Retina International works with people affected by retinal conditions, patient organisations, researchers, clinicians and healthcare partners worldwide to raise awareness, support early detection and access to care, and ensure patient experiences inform research and healthcare decisions.
2 main stages
Diabetic Retinopathy is generally classified as NPDR or the more advanced PDR.
Often no early symptoms
Diabetic Retinopathy can progress before noticeable vision changes occur.
Central vision
Diabetic Macular Oedema can cause blurred or distorted vision, affecting reading, driving and recognising faces.
How Diabetic Retinopathy can affect vision
Blurred vision
Changes in the retina or swelling of the macula can cause unclear vision.
Floaters
Bleeding from abnormal blood vessels may cause dark spots or floating shapes in vision.
Dark or empty areas in vision
Reduced blood flow or retinal damage may create areas of missing vision.
Difficulty seeing at night
Changes in retinal function can affect vision in low-light conditions.
Difficulty reading or seeing detail
Macular involvement can affect detailed central vision.
Sudden vision loss
Sudden changes may occur if abnormal blood vessels bleed into the eye.
Any sudden vision change should be assessed urgently.
Identifying Diabetic Retinopathy
Retinal Examination
An eye specialist examines the retina for signs of:
- Blood vessel damage
- Bleeding
- Swelling
- Abnormal vessel growth
Retinal Photography
Digital retinal images allow healthcare professionals to identify and monitor changes over time.
Optical Coherence Tomography (OCT)
OCT provides detailed images of retinal layers and helps identify:
- Macular swelling
- Fluid accumulation
- Retinal changes
Fluorescein Angiography
This imaging test uses a dye to highlight blood flow and identify leaking or abnormal blood vessels.
OCT Angiography
OCTA provides detailed images of retinal blood vessels without dye injection and can help assess vascular changes.
Non-Proliferative Diabetic Retinopathy (NPDR)
Mild NPDR
Mild NPDR is often the first visible stage of retinal damage.
Changes may include:
- Small areas of swelling in blood vessel walls (microaneurysms)
- Minor blood vessel changes
Many people have no noticeable symptoms at this stage.
Moderate NPDR
As blood vessel damage increases, additional changes may occur, including:
- Increased leakage from blood vessels
- Retinal haemorrhages
- Deposits of fatty material (hard exudates)
- Changes in retinal blood flow
Vision may remain unaffected unless the macula becomes involved.
Severe NPDR
Severe NPDR indicates significant retinal blood vessel damage.
Features may include:
- Extensive retinal haemorrhages
- Blocked retinal blood vessels
- Reduced oxygen supply to retinal tissue
At this stage, there is a higher risk of progressing to Proliferative Diabetic Retinopathy.
Supporting independence
Diabetes Management
Controlling:
- Blood glucose
- Blood pressure
- Cholesterol
is essential to reducing progression risk.
Regular Monitoring
People with NPDR require regular eye examinations to monitor changes.
Lifestyle Support
Healthy lifestyle choices may support overall diabetes and eye health.
Treatment of Associated Macular Oedema
If NPDR is associated with Diabetic Macular Oedema, treatments may include injections or other therapies.
Proliferative Diabetic Retinopathy (PDR)
Increasing floaters
New or increasing spots, dots or shapes may appear in your vision.
Sudden blurred vision
Vision may become unclear or hazy, sometimes quite suddenly.
Dark shadows or a “curtain” effect
A dark area or curtain-like shadow may appear across part of your vision.
Loss of vision
Vision may become significantly reduced, particularly if bleeding occurs.
Difficulty seeing detail
Reading, recognising faces, or seeing fine details may become harder.
Supporting independence
Anti-VEGF Therapy
Anti-VEGF injections may be used to reduce abnormal blood vessel growth and leakage.
Laser Photocoagulation
Laser treatment may be used to reduce areas of the retina requiring additional oxygen supply and decrease signals driving abnormal vessel growth.
Vitrectomy Surgery
In cases of significant bleeding or scar tissue formation, surgery may be required to remove blood from the vitreous or repair retinal complications.
Ongoing Monitoring
Long-term follow-up is essential because PDR can recur or progress.
Diabetic Macular Oedema (DMO)
Blurred central vision
Objects in the centre of your vision may appear unclear or hazy.
Distorted vision
Straight lines or objects may appear bent, wavy, or misshapen.
Difficulty reading
Words may become harder to see clearly, especially when reading for longer periods.
Reduced colour perception
Colours may appear less vivid or harder to distinguish.
Difficulty seeing fine details
Tasks such as recognising faces or seeing small details may become more challenging.
Supporting independence
Anti-VEGF Therapy
Anti-VEGF therapies reduce leakage and swelling by blocking signals involved in abnormal blood vessel activity.
Steroid Treatments
Laser treatment may be used to reduce areas of the retina requiring additional oxygen supply and decrease signals driving abnormal vessel growth.
Vitrectomy Surgery
In some cases, corticosteroid treatments may be considered.
Laser Treatment
Laser therapy may be used in selected cases.
Vision Rehabilitation
Support services can help people adapt to changes in vision.
Managing both eye health and overall diabetes care
Living with Diabetic Retinopathy involves managing both eye health and overall diabetes care.
People can help protect their vision by:
- Attending regular eye screening appointments
- Managing diabetes effectively
- Monitoring blood pressure and cholesterol
- Reporting changes in vision quickly
- Following treatment plans
Vision loss can affect independence, employment, mobility, and emotional wellbeing. Support from healthcare professionals and patient communities can help people adapt and maintain quality of life.
Advancing the future of Diabetic Retinopathy treatment
Clinical trials
Clinical trials continue to evaluate new medicines, technologies, and treatment approaches aimed at preserving vision.
Gene therapy
Researchers are investigating gene-based treatments that may provide longer-term therapeutic benefits.
Information and community support
Take the Next Step
Diabetic Retinopathy is a common complication of diabetes, but early detection, effective diabetes management, and advances in treatment can help protect vision.
Through collaboration between people living with diabetes, researchers, clinicians, and communities worldwide, progress continues towards preventing vision loss and improving outcomes for everyone affected.
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