Summary
Diabetic retinopathy is a complication of diabetes that damages the blood vessels of the retina. It is silent in its early stages and is the leading cause of blindness in working-age adults (20–64 years). Optimal control of diabetes greatly reduces the risk; early diagnosis through regular eye examinations is essential to save sight.
- Risk factors
- Duration of diabetes, poor blood sugar control, high blood pressure, dyslipidaemia, pregnancy.
- Diagnosis
- Dilated fundus examination, OCT, OCT angiography, fluorescein angiography.
- Treatment
- Anti-VEGF intravitreal injections, corticosteroids, laser photocoagulation, vitrectomy.
- Prevention
- Control of blood sugar, blood pressure and lipids; regular eye examinations for everyone with diabetes.
What is diabetic retinopathy
How diabetes affects the retina
Long-term high blood sugar makes the blood vessels of the retina fragile and leaky. Microaneurysms, small haemorrhages and fluid build-up form; in advanced stages, abnormal new vessels may develop, causing vitreous haemorrhage and tractional retinal detachment.
Learn more about retinopathyWhat is diabetic retinopathy?
Diabetic retinopathy is a serious complication of diabetes that damages the blood vessels of the retina, the layer of nerve tissue that makes sight possible. Long-term high blood sugar makes the vessels fragile and leaky: microaneurysms form and, as the disease progresses, abnormal new vessels can develop, which may cause bleeding and scarring. Diabetic macular oedema is particularly serious: fluid builds up in the macula, impairing sharp vision.
Learn more about retinopathyWhat to do if you have retinopathy
- Keep your diabetes consistently under control: blood sugar, diet and medication.
- Keep your blood pressure, cholesterol and triglycerides at the recommended levels.
- Have an eye examination with dilation at least once a year.
- Follow your prescribed treatments carefully and do not miss scheduled appointments.
- Contact your ophthalmologist straight away if your vision suddenly worsens.
Types and progression
Early non-proliferative formAsymptomatic
In the early stage, the retinal blood vessels show small bulges (microaneurysms), mild pinpoint haemorrhages and fatty deposits (hard exudates). The patient feels no symptoms: the condition is detected only during an eye examination with dilation.
Moderate-to-severe non-proliferative formMacular oedema
Haemorrhages and exudates increase; some capillaries become blocked, depriving areas of the retina of oxygen. When fluid seeps into the macula (diabetic macular oedema), the first problems with central vision appear: difficulty reading, reduced visual acuity.
Proliferative formRisk of blindness
The eye responds to low oxygen (hypoxia) by stimulating the growth of abnormal, fragile new vessels that break easily. Vitreous haemorrhage, scar tissue and tractional retinal detachment can cause severe loss of sight. It needs prompt treatment.
Diagnosis
Diagnosis follows a clearly defined pathway that combines several instrumental tests. The essential test is the eye examination with pupil dilation, which allows the back of the eye to be examined and microaneurysms, haemorrhages or oedema to be spotted. It is crucial for everyone with diabetes, even without symptoms.
- Dilated fundus examination
- the core test, and painless.
- OCT (optical coherence tomography)
- maps retinal thickness and macular oedema.
- OCT angiography
- shows the blood vessels without contrast dye.
- Fluorescein angiography
- highlights ischaemia, neovessels and areas of leakage.
Treatment options
Treatment is tailored to the stage of the disease and the presence of macular oedema. The three main groups of treatment — intravitreal injections, laser and surgery — are often combined as part of the care pathway.
Intravitreal injections
Anti-VEGF medicines (bevacizumab, aflibercept, ranibizumab) are the first-choice treatment for diabetic macular oedema: they block the formation of abnormal new vessels and reduce swelling. Intravitreal corticosteroids are an alternative in cases that do not respond.
See the medicines
Laser photocoagulation
Panretinal photocoagulation closes off the ischaemic areas of the retina and prevents neovascularisation in the proliferative form. Focal laser selectively treats the microaneurysms that feed macular oedema.
Laser treatments
Vitrectomy
Surgery reserved for advanced cases: it removes blood from the vitreous, frees the retina from scar tissue and treats tractional retinal detachment. It restores clarity to the eye and can save sight when other treatments are not enough.
Surgical proceduresPrevention
Important
Everyone with diabetes should have regular eye examinations, even without symptoms: retinopathy is silent in its early stages.
- 01
Diabetes control
Optimal control of blood sugar, glycated haemoglobin, blood pressure and lipid profile is the main tool for prevention. It greatly reduces the onset and progression of retinopathy.
- 02
Regular eye examinations
For type 1 diabetes, the first check should be carried out within 5 years of diagnosis; for type 2, immediately at diagnosis. Pregnant women with diabetes should have a check in the first trimester. After that, checks at least once a year.
- 03
Healthy lifestyle
A balanced diet, regular physical activity, not smoking and weight control support vascular and eye health. Contact your ophthalmologist straight away if your vision suddenly worsens.