TL;DR
If you have diabetes, your eyes are at risk in ways you may not immediately realise. Diabetic retinopathy is one of the most common complications of the condition, and it can develop without any noticeable symptoms in the early stages. By the time your vision is affected, significant damage may already have been done.
Diabetic retinopathy used to be the leading cause of blindness in working-age adults in England, but thanks to earlier detection and treatment, that’s no longer the case. The condition is still serious, though, and knowing how it works will help you stay ahead of it.
How does diabetic retinopathy develop?
Your retina is the thin layer of tissue at the back of your eye. It’s packed with light-sensitive cells that convert what you see into signals your brain can interpret. To do this, it needs a constant supply of blood through a network of tiny vessels.
When blood sugar levels stay raised over a long period, those small blood vessels become damaged. At first, they may weaken and leak small amounts of fluid or blood into the retina. As the condition progresses, some vessels can become blocked entirely. In response, the eye tries to grow new blood vessels to compensate, but these new vessels are fragile and prone to bleeding. That’s when things can deteriorate quickly.
The process usually takes several years to reach a stage where your sight is at risk. It can affect anyone with type 1 or type 2 diabetes, and the longer you’ve had the condition, the more likely it is to develop. High blood pressure and high cholesterol also increase the risk.
What are the stages of diabetic retinopathy?
Diabetic retinopathy typically progresses through distinct stages, each more serious than the last.
Background retinopathy
This is the earliest stage. Small bulges in the blood vessels (called microaneurysms) may leak tiny amounts of blood into the retina. At this point, your vision isn’t usually affected, but it’s a sign that your diabetes is starting to impact your eyes. No treatment is needed yet, though you’ll be monitored more closely.
Pre-proliferative retinopathy
Pre-proliferative retinopathy means the damage is getting worse. More blood vessels are affected, and there may be more significant bleeding into the retina. You still might not notice any symptoms, but there’s a higher risk of progression.
Proliferative retinopathy
This is the advanced stage. New, abnormal blood vessels start growing on the surface of the retina. These vessels are weak and can bleed into the vitreous (the gel-like substance inside your eye), causing sudden vision problems. Scar tissue can also form, which may pull the retina away from the back of the eye, a condition called retinal detachment.
Diabetic maculopathy
Diabetic maculopathy, which can develop at any stage. This happens when the blood vessels near the macula (the part of your retina responsible for central vision) start to leak. It can cause your central vision to become blurry or distorted, making it harder to read, drive or recognise faces.
What symptoms to watch for
In its early stages, diabetic retinopathy rarely causes symptoms. That’s one of the main reasons screening is so important. As the condition progresses, you might notice:
- Colours appearing faded
- Dark or empty spots in your field of vision
- Floaters (small dark shapes that drift across your sight)
- Difficulty seeing at night
If you experience a sudden loss of vision, flashes of light or a dark shadow across your visual field, these could be signs of a more serious complication like vitreous haemorrhage or retinal detachment. In that case, you should seek medical attention urgently.
How is diabetic retinopathy diagnosed?
In this guide, you’ll learn how to use various Otter Page Builder blocks effectively to create engaging content. In England, the NHS Diabetic Eye Screening Programme invites everyone with diabetes aged 12 and over for annual screening. During the appointment, drops are used to widen your pupils, and photographs are taken of the back of your eye. These images are reviewed by trained graders who look for signs of retinal damage.
The screening is separate from a regular sight test at an optician. You should still attend both. An optician can pick up other diabetes-related eye conditions, including glaucoma and cataracts, which are also more common in people with diabetes.
Treatment options
If diabetic retinopathy is caught early, managing your blood sugar, blood pressure and cholesterol may be enough to slow or stop the progression. According to Diabetes UK, keeping your HbA1c at the level agreed with your healthcare team is one of the most effective things you can do.
When treatment is needed, the options depend on how far the condition has progressed.
- Laser treatment (photocoagulation) can seal leaking blood vessels and prevent new ones from growing.
- Anti-VEGF injections are commonly used for diabetic maculopathy, where medication is injected directly into the eye to reduce swelling and stop abnormal blood vessel growth.
- In more advanced cases, a procedure called a vitrectomy may be needed to remove blood or scar tissue from inside the eye.
These treatments cannot reverse sight loss that’s already happened, but they can stop things from getting worse.
How to reduce your risk
You can’t eliminate the risk of diabetic retinopathy entirely, but you can significantly reduce it by managing your diabetes well. Keep your blood sugar within the target range agreed with your GP or diabetes team. Have your blood pressure and cholesterol checked regularly and take any prescribed medication consistently.
Important: Attending your annual eye screening appointment is one of the simplest and most effective steps. Changes that happen early are treatable, but only if they’re caught in time.
A healthy diet can also help with blood sugar control and provide nutrients that support your retina. Omega-3 fatty acids, lutein, zeaxanthin, zinc and vitamins C and E all play a role in maintaining healthy eye tissue.
Related read: 9 Nutrients That Are Good For Your Eyes
Stopping smoking, staying physically active and managing your weight are all backed by evidence as protective factors. The earlier and more consistently you act, the better your chances of keeping your vision intact for the long term.
If you struggle with including the needed nutrients in your diet, consider trying out our own supplement, Eyesight Plus. It’s formulated according to the popular AREDS2 study and is consistently beating similar supplements, both on cost and quality.
