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Treating Diabetic Macular Edema

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A Complete Guide to Diabetic Retinopathy

Medically Reviewed By William C. Lloyd III, MD, FACS

Diabetic retinopathy is an eye disease that is a common complication of diabetes. Diabetic retinopathy occurs when high blood sugar levels damage the blood vessels in the eye’s retina over time. While diabetic retinopathy can cause blindness, treatment can help reduce risks and stop its progress. The retina is a delicate layer of nerve tissue at the back of the eye. It receives images and sends them to the brain as electrical signals through the optic nerve.

Regular eye checkups and effective diabetes treatment can significantly reduce the risks to eye health.

This article explains the symptoms, stages, and causes of diabetic retinopathy. It also discusses when to contact a doctor, treatment, and outlook. Finally, this article reviews prevention and support approaches for people with diabetes and diabetic retinopathy.


An ophthalmologist uses a slit lamp to examine someone's eyes.
Photography by FG Trade/Getty Images

Diabetic retinopathy usually does not cause noticeable symptoms in the early stages. Instead, you may notice symptoms at a more advanced stage. These can include:

  • worsening vision, such as difficulty reading or difficulty seeing faraway objects
  • gradual or sudden vision loss
  • floaters, shapes or small blurry figures floating across your field of vision
  • streaks in the field of vision
  • blurry or patchy vision
  • eye pain
  • redness in the eye

These symptoms can vary per person. Some people may notice symptoms that come and go. Others may experience persistent or gradually worsening symptoms.

Read more about the signs and symptoms of diabetic retinopathy.

Causes and risk factors

Diabetic retinopathy occurs when diabetes and chronically high blood sugar levels cause damage to the retina’s blood vessels. The damage occurs over time. Diabetic retinopathy may be more likely Trusted Source National Eye Institute Governmental authority Go to source to develop if you do not receive effective treatment for diabetes, or the diabetes is not responding effectively to care.

The National Institutes of Health (NIH) suggests that more than half of people with diabetes eventually develop diabetic retinopathy.

People with any kind of diabetes can develop diabetic retinopathy. However, some people may have a higher risk because of additional factors, such as:

  • having had diabetes for a long time
  • having a persistently high blood sugar level
  • having high blood pressure or high cholesterol
  • being pregnant and developing gestational diabetes
  • already having diabetes and then becoming pregnant

The National Health Service (NHS) suggests that people who are of Asian or Afro-Caribbean descent may have a higher risk of diabetic retinopathy. A 2020 review Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source suggest that socioeconomic disparities and severity of diabetic retinopathy may affect follow-up care.

Stages and development

There are two main diabetic retinopathy stages: non-proliferative and proliferative.

Non-proliferative diabetic retinopathy (NPDR)

A medical illustration of eyes with and without diabetic retinopathy.
Illustrated by Jason Hoffman

NPDR is the first stage of diabetic retinopathy.

At this stage, tiny blood vessels may bulge and form tiny aneurysms known as microaneurysms. The affected blood vessels may leak blood and fluids into a section of the retina called the macula. This is known as diabetic macular edema, and it can cause retinal swelling and blurry vision.

With NPDR, the affected blood vessels may also close off over time, depriving the retina of oxygen.

NPDR may also cause cotton-wool spots, which are whitish lesions on the eye.


Proliferative diabetic retinopathy (PDR)

PDR is a more advanced stage of diabetic retinopathy. It may take several years for diabetic retinopathy to progress to PDR or vision loss.

With PDR, the oxygen-deprived retina starts to grow new, atypical blood vessels to try to improve circulation. This is known as neovascularization. These new blood vessels are fragile and may leak blood, causing hemorrhages and impairing vision. The atypical vessels may also cause scar tissue and membranes to form, disrupting sight.

At this stage, diabetic retinopathy is very serious.

When to see a doctor

Contact an eye doctor as soon as possible if you have eye or vision symptoms that:

  • are new
  • are persistent
  • go away and come back

Call 911 for severe or sudden symptoms, such as sudden vision loss or severe eye pain.

Having eye or vision symptoms does not necessarily mean that you have diabetic retinopathy. However, symptoms can indicate an underlying eye condition. As a result, it is important to contact an eye doctor to check your eye health.

The Centers for Disease Control and Prevention (CDC) recommends that people with diabetes get an eye exam at least once per year Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source . However, your doctor may recommend a different schedule for you based on your personal condition.

Contact your primary care doctor if you experience new or changing symptoms of diabetes. Your doctor also can answer questions about your diabetes treatment.

Read more about the symptoms of type 1 and type 2 diabetes.


An eye doctor may ask questions about your symptoms and medical history before carrying out a comprehensive eye exam. If you contact your general doctor first, they may then refer you to an eye doctor.

Other procedures for diabetic retinopathy diagnosis may include Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source :

  • blood tests to monitor the underlying diabetes
  • CT scans of the eyes to measure retinal thickness
  • ultrasound scans of the eyes to examine their internal structure
  • fluorescein angiography

To perform a fluorescein angiography, a clinician injects a vegetable dye into the arm or elsewhere in the body. This dye will travel to the eye through the bloodstream. This allows your eye doctor to check the circulation in the retina.

Treatment and management

Treatment for diabetic retinopathy focuses on improving management of diabetes and supporting eye health.

In the beginning stages of diabetic retinopathy, your doctor may not Trusted Source National Eye Institute Governmental authority Go to source prescribe medical treatments. Instead, they may regularly monitor your condition, such as with eye exams every 2–4 months. They may also adjust your treatment plan for diabetes to improve its management.

Read more about treating type 1 and type 2 diabetes.

If you have more advanced diabetic retinopathy, treatment for your eyes and vision can include:

  • injections with medications to slow or reverse diabetic retinopathy, such as:
    • corticosteroids
    • anti-VEGF medications
  • laser treatment to reduce swelling and address leaking blood vessels
  • eye surgery to remove hemorrhages or scar tissue membranes

Complications and outlook

The outlook of diabetic retinopathy can vary based on factors such as Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source :

  • how long you have had diabetes
  • blood sugar levels and how effectively they are managed
  • severity of the diabetic retinopathy and any eye damage
  • access to effective treatment
  • whether you experience complications

Possible complications of diabetic retinopathy include:

  • permanent vision loss or blindness
  • eye damage as a complication from treatment, such as from anti-VEGF treatment or laser therapy
  • other eye conditions, such as:
    • neovascular glaucoma, increased pressure in the eye due to fluid buildup
    • retinal detachment, whereby membranes pull on the retina and cause it to detach from the back of the eye

However, treatment can improve your outlook and reduce the risk of complications.

Contact your doctor for personal advice on your treatment and outlook.

Can diabetic retinopathy be reversed?

In some cases, managing blood sugar levels effectively may reverse Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source damage from NPDR and the early stages of diabetic retinopathy, according to a 2023 overview.

However, many people with diabetic macular edema may need long-term treatment with injected medications.


Not all cases of diabetic retinopathy will be prevented. However, there are approaches that can help reduce risks or keep diabetic retinopathy from getting worse.

The main way to help prevent diabetic retinopathy is to manage:

  • blood sugar levels
  • blood pressure
  • cholesterol levels

Approaches to help do this include:

  • having regular checkups with your primary care doctor and eye doctor
  • following your treatment plan as prescribed
  • contacting your doctor as soon as you notice new symptoms or changes in your symptoms
  • eating a balanced diet recommended by your doctor, for example, one that is low in salt, added sugar, and trans fats
  • maintaining a moderate weight
  • getting regular physical activity
  • not smoking

Read more about lowering high blood pressure and high cholesterol levels.

Awareness and support

Diabetic retinopathy and vision loss can affect quality of life. It may also have social and emotional effects as well as impacting health.

The NIH lists programs Trusted Source National Eye Institute Governmental authority Go to source that provide low cost or free eye care. Some people may also be eligible to apply for free eye care with the EyeCare America program through the American Academy of Ophthalmology.

Other care approaches include counseling and social support groups. Ask your doctor or local clinic to recommend support groups or groups that help with access to care.


Diabetic retinopathy is a complication of diabetes whereby high blood sugar levels cause damage to the retina over time. There may be no symptoms in early stages. Symptoms that develop later include blurry vision, eye redness, and floaters. Severe diabetic retinopathy may cause permanent vision loss.

Treatment for diabetic retinopathy can help stop its progression and improve eye health. Treatment can include:

  • managing underlying diabetes
  • eye surgery
  • laser therapy
  • medication injections

Regular eye exams and effective diabetes treatment may prevent diabetic retinopathy.

Contact your eye doctor to plan routine eye checkups. Seek immediate advice for eye or vision symptoms.

Was this helpful?
  1. Boyd, K. (2022). Diabetic retinopathy: Causes, symptoms, treatment.
  2. Diabetic retinopathy. (2022).
  3. Diabetic retinopathy. (2022).
  4. Diabetic retinopathy. (n.d.).
  5. Mehta, S. (2022). Diabetic retinopathy.
  6. Peavey, J. J., et al. (2020). Impact of socioeconomic disadvantage and diabetic retinopathy severity on poor ophthalmic follow-up in a rural Vermont and New York population.
  7. Porter, D. (2021). What is fluorescein angiography?
  8. Shukla, U. V., et al. (2023). Diabetic retinopathy.

Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2023 May 30
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