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 retinal condition that occurs when prolonged high blood glucose levels damage the small blood vessels that supply the retina.
The retina is a light-sensitive layer at the back of the eye that converts light into signals sent to the brain, allowing us to see. When the retinal blood vessels become damaged, they may leak fluid or blood, become blocked, or trigger abnormal blood vessel growth. Over time, these changes can affect vision and, in advanced cases, lead to significant vision loss.
Diabetic Retinopathy is one of the leading causes of preventable vision loss worldwide among working-age adults. It can affect people living with both type 1 and type 2 diabetes, and the risk increases with longer duration of diabetes.
Early stages of Diabetic Retinopathy may cause no noticeable symptoms, which is why regular retinal screening and monitoring are essential.
Retina International works with people affected by retinal conditions, patient organisations, researchers, clinicians, and healthcare partners worldwide to improve awareness, support early detection, promote access to care, and ensure that patient experiences inform research and healthcare decisions.
What is Diabetic Retinopathy?
Diabetic Retinopathy occurs when diabetes-related changes affect the blood vessels of the retina.
High levels of glucose in the blood can damage the walls of retinal blood vessels, causing them to:
- Weaken and leak fluid
- Become blocked and reduce blood supply
- Trigger inflammation
- Stimulate the growth of abnormal blood vessels
These changes can affect different parts of the retina, including the macula, the central area responsible for detailed vision.
Diabetic Retinopathy is generally classified into two main stages:
- Non-Proliferative Diabetic Retinopathy (NPDR)
The earlier stage of disease, where retinal blood vessels become damaged but abnormal new vessel growth has not yet occurred.
- Proliferative Diabetic Retinopathy (PDR)
The more advanced stage, where the retina responds to reduced blood supply by growing abnormal new blood vessels that can bleed and cause serious vision complications.
Diabetic Macular Oedema (DMO) can occur at any stage of Diabetic Retinopathy and is a major cause of vision impairment in people with diabetes.
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
Earlier Detection
Researchers are developing improved imaging and artificial intelligence tools to detect retinal changes earlier.
Learn About Earlier DetectionArtificial intelligence and imaging
AI systems are being explored to support:
- Screening programmes
- Disease detection
- Risk prediction
New Medicines
Researchers are investigating new approaches targeting:
- Inflammation
- Blood vessel growth
- Retinal protection
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.
