Can diabetic retinopathy be reversed?

Early changes can stabilize and sometimes improve with excellent blood sugar and blood pressure control. Established damage cannot usually be undone, but modern treatments such as anti-VEGF injections and laser can preserve and sometimes improve vision. The key is detecting changes early through screening, before sight is affected.

If my vision is fine, do I still need eye screening?

Yes. Diabetic retinopathy causes no symptoms until it is advanced, and treatment works best when started before vision changes. Annual dilated eye examinations or retinal photographs can detect damage years before you would notice anything.

Do eye injections hurt?

The eye is numbed with drops before the injection, and most people feel only pressure or a brief sting. The procedure takes a few minutes in a clinic. Injections are typically given monthly at first and then spaced out depending on how the retina responds.

Will I go blind from diabetic retinopathy?

With regular screening, good diabetes control and timely treatment, the great majority of people keep useful vision for life. Severe vision loss mainly occurs when retinopathy goes undetected or untreated, which is why screening attendance is so important.

Eye & EarICD-10: H36.0Common among people with diabetes; a leading cause of vision loss in working-age adults

Diabetic Retinopathy

Also known as: Diabetic eye disease, Diabetic macular edema

Diabetic retinopathy is damage to the tiny blood vessels of the retina, the light-sensitive layer at the back of the eye, caused by prolonged high blood sugar. In the early stage (non-proliferative retinopathy) the vessels weaken, leak fluid and form small bulges, often without any symptoms. In the advanced stage (proliferative retinopathy) fragile new vessels grow on the retina and can bleed into the eye or cause retinal detachment. Swelling of the central retina (diabetic macular edema) can occur at any stage and blurs central vision. Diabetic retinopathy is a leading cause of vision loss in working-age adults, yet it is largely preventable. Good control of blood sugar, blood pressure and cholesterol, together with regular eye screening, allows treatment before sight is affected.

At a Glance

Common symptoms: No symptoms in the early stages, which is why regular screening is essential, Blurred or fluctuating vision, Dark spots, strings or floaters drifting across your vision
Main treatments: Tight control of blood sugar, blood pressure and cholesterol, which slows progression at every stage, Regular monitoring for mild retinopathy that does not yet need eye treatment, Anti-VEGF injections into the eye to reduce macular swelling and shrink abnormal vessels
Category: Eye & Ear · Common among people with diabetes; a leading cause of vision loss in working-age adults
See a doctor if: Sudden loss of vision, a shower of new floaters or a curtain across your vision (seek emergency eye care)

Symptoms

No symptoms in the early stages, which is why regular screening is essential

Blurred or fluctuating vision

Dark spots, strings or floaters drifting across your vision

Difficulty seeing colours or reading

Dark or empty areas in your field of vision

Sudden vision loss, which can indicate bleeding into the eye or retinal detachment

Causes

Chronically high blood sugar damaging the walls of the retinal blood vessels
Leakage of fluid and fats from damaged vessels into the retina
Blockage of small vessels, starving parts of the retina of oxygen
Growth of abnormal new blood vessels in response to oxygen shortage
Scar tissue from new vessels pulling on and detaching the retina

Risk Factors

Longer duration of diabetes (type 1 or type 2)
Poorly controlled blood sugar
High blood pressure and high cholesterol
Pregnancy in women with pre-existing diabetes
Kidney disease
Smoking

Diagnosis

A dilated eye examination by an optometrist or ophthalmologist, usually at least once a year for people with diabetes
Retinal photography, often used in national screening programmes
Optical coherence tomography (OCT) scanning to detect macular swelling
Fluorescein angiography, in which dye is injected into a vein to highlight leaking or blocked vessels
Visual acuity testing

Treatment

Tight control of blood sugar, blood pressure and cholesterol, which slows progression at every stage
Regular monitoring for mild retinopathy that does not yet need eye treatment
Anti-VEGF injections into the eye to reduce macular swelling and shrink abnormal vessels
Laser treatment to seal leaking vessels or to reduce abnormal vessel growth
Steroid implants or injections for macular edema in some cases
Vitrectomy surgery to remove blood from the eye or repair a detached retina
Supportive: stopping smoking, regular exercise and a diabetes-friendly diet to improve metabolic control

Prevention

Attend diabetic eye screening every year, or more often if advised
Keep HbA1c, blood pressure and cholesterol at the targets agreed with your diabetes team
Take diabetes, blood pressure and cholesterol medications as prescribed
Do not smoke
Report any change in vision promptly rather than waiting for your next appointment
Plan pregnancy with your diabetes team, as retinopathy can progress during pregnancy

When to See a Doctor

Sudden loss of vision, a shower of new floaters or a curtain across your vision (seek emergency eye care)
Any blurred, distorted or fluctuating vision if you have diabetes
Eye pain or redness with diabetes
If you have diabetes and have not had a dilated eye examination in the past year
If you are pregnant or planning pregnancy and have diabetes, for more frequent eye checks

Frequently Asked Questions

Related Conditions

Type 2 Diabetes

Endocrine

Type 1 Diabetes

Endocrine

Diabetic Neuropathy

Neurological

Age-Related Macular Degeneration

Eye & Ear

Glaucoma

Eye & Ear

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