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Diabetic retinopathy: symptoms, stages and when to get checked

Diabetic retinopathy is one of the main causes of preventable sight loss in working-age adults. It affects people with both type 1 and type 2 diabetes, and the longer someone has diabetes, the more likely it becomes. The good news is that it develops slowly, it can be seen by an eye doctor long before it affects sight, and treatment at the right time protects vision. This guide explains the condition for people with diabetes and their families anywhere in India.

What happens in the eye?

The retina is the light-sensitive layer at the back of the eye, and it is fed by very small blood vessels. Over time, high blood sugar damages the walls of these vessels. They develop tiny swellings, leak fluid and blood into the retina, and some close off. The parts of the retina that lose their blood supply send out signals that make fragile new vessels grow. These new vessels bleed easily and can pull on the retina with scar tissue.

When fluid leaks into the macula, the centre of the retina used for reading and fine vision, the macula swells. This is called diabetic macular oedema, and it can happen at any stage of retinopathy.

What are the symptoms of diabetic retinopathy?

In the early stages, there are usually no symptoms at all. Vision can be perfectly clear while damage is building up. That is why waiting for symptoms is not safe.

As the disease advances, you may notice:

• blurred vision, especially for reading, if the macula swells
• vision that changes from day to day
• dark spots, threads or floaters drifting across your vision
• dark or empty patches in your vision
• colours looking faded
• sudden loss of vision, if a new blood vessel bleeds inside the eye

Sudden loss of vision, a sudden shower of floaters or a shadow across your vision needs to be seen the same day. At ReNew Vision, emergency eye care is available 24 hours; see eye emergency.

What are the stages of diabetic retinopathy?

Non-proliferative retinopathy: mild, moderate and severe

The blood vessels show tiny swellings, small bleeds and leaks. In the mild stage, regular check-ups and better control of sugar, blood pressure and cholesterol are usually all that is needed. In the moderate and severe stages, more of the retina loses its blood supply and the risk of the next stage rises, so check-ups become more frequent.

Proliferative retinopathy

Fragile new blood vessels grow on the retina. They can bleed into the gel inside the eye (a vitreous haemorrhage), which suddenly clouds vision, and the scar tissue around them can pull the retina away from the back of the eye (a retinal detachment). New vessels can also grow in the drainage area at the front of the eye and cause a painful kind of glaucoma; see glaucoma care. This stage needs prompt treatment.

Diabetic macular oedema

Swelling of the macula can occur with any stage and is a common reason for blurred reading vision in people with diabetes.

Who is at risk?

• How long you have had diabetes: the most important factor.
• Sugar control: higher HbA1c means higher risk.
• High blood pressure and high cholesterol.
• Kidney disease caused by diabetes.
• Pregnancy in a woman who had diabetes before becoming pregnant.
• Smoking.

In Goa the question touches many families: the ICMR-INDIAB study (2023) found diabetes in 26.4% of adults, and a national survey (2015-19) found diabetic retinopathy in nearly one in five people with diabetes aged 50 and above in North Goa.

How is diabetic retinopathy found?

By examining the retina through a dilated pupil. Drops widen the pupil and the eye doctor looks at the retina and the macula with a bright light and special lenses. Retina photographs and scans such as OCT help to measure swelling and plan treatment; at ReNew Vision the retina is examined directly, and if you need a scan the eye doctor will tell you and explain the next step. Read what a diabetic eye check-up includes.

How is diabetic retinopathy treated?

At every stage, the foundation is control of blood sugar, blood pressure and cholesterol, with your physician. When retinopathy or macular swelling threatens sight, eye treatment is added:

• Eye injections to reduce macular swelling and new vessel growth.
• Retina laser to treat leaking areas or the oxygen-starved retina.
• Surgery (vitrectomy) for bleeding that does not clear, or for a retina being pulled away.

These treatments are not done at ReNew Vision. When you need one, the eye doctor refers you to a retina centre and tells you how urgent it is, and your check-ups can continue here.

Can diabetic retinopathy be reversed?

Damage that has already happened often cannot be fully undone. But treatment can stop or slow the disease, macular swelling can improve with treatment, and good control of sugar, blood pressure and cholesterol lowers the chance of it getting worse. The earlier it is found, the more sight can usually be kept.

One point surprises people: if your sugar control is being tightened quickly, for example after starting insulin or a new medicine, retinopathy can sometimes get worse for a while before it improves. If your treatment has changed a great deal and you already have retinopathy, ask whether an extra eye check is needed. Never delay better sugar control because of this; just tell the eye doctor.

How often should I have my eyes checked?

• No retinopathy: at least once a year, unless your eye doctor advises otherwise.
• Any retinopathy: more often, as advised; the more advanced it is, the shorter the gap.
• Pregnancy with diabetes that started before the pregnancy: early in the pregnancy and as advised during it.

Diabetes also brings cataract earlier; see cataract surgery for people with diabetes.

How can I protect my sight?

• Know your HbA1c and blood pressure, and work with your physician to keep them on target.
• Take your diabetes and blood pressure medicines regularly.
• Do not smoke.
• Have a dilated eye check-up at least once a year, even when you see well.
• Come in quickly for any new blurring, floaters or patches in your vision.

Diabetic eye check-ups in Vasco

ReNew Vision Eye Hospital, Vaddem, Vasco da Gama does diabetic eye check-ups in the Eye OPD, Monday to Saturday, 4 pm to 7 pm. Call or WhatsApp 072489 88039. For retina care in general, see retina and diabetic eye care in Vasco.

Questions patients ask

Can diabetic retinopathy be reversed?

Damage that has already happened often cannot be fully undone, but treatment can stop or slow the disease and macular swelling can improve. Good control of sugar, blood pressure and cholesterol lowers the chance of it getting worse.

Can I have diabetic retinopathy with normal vision?

Yes. Early diabetic retinopathy usually causes no symptoms and does not blur vision. Only an eye examination through a dilated pupil can find it.

Does diabetic retinopathy cause blindness?

It can, if advanced disease is not treated. Regular check-ups and treatment at the right time greatly lower that risk, which is why yearly dilated eye check-ups matter.

Does everyone with diabetes get retinopathy?

No, but the risk rises the longer you have diabetes, and with poor sugar control, high blood pressure, high cholesterol and kidney disease. Regular check-ups find it early in those who do.

How often should diabetics get their eyes checked?

At least once a year if there is no retinopathy, unless your eye doctor advises otherwise, and more often if any retinopathy is found or during pregnancy in a woman who already had diabetes.

This page is general eye-health information, not personal medical advice. Your eye doctor advises you after examining your eyes.