Diabetic retinopathy

What is diabetic retinopathy?

Diabetic retinopathy is the leading cause of vision loss in the working-age population. A complication of diabetes, it’s a condition where uncontrolled high blood sugar levels damage your retina (the back of your eye).

If left untreated, diabetic retinopathy can lead to changes in your vision and even permanent blindness. It requires prompt treatment which may include laser treatment or retinal detachment surgery (vitrectomy).

At St Thomas’ Hospital, our ophthalmology team can diagnose diabetic retinopathy, determine its stage and provide personalised treatment plans to protect your eye health and vision. 

Who is at risk of diabetic retinopathy? 

Anybody with type 1 diabetes, type 2 diabetes or gestational diabetes can develop diabetic retinopathy, but you may have a higher risk if: 

• you have had diabetes for many years 
• you have high blood pressure or high cholesterol 
• your blood sugar levels are high and uncontrolled 
• you’re pregnant 

However, if you control your blood pressure, cholesterol and blood sugar, your risk of developing diabetic retinopathy can decrease. 

Types of diabetic retinopathy 

There are 2 main types of diabetic retinopathy: 

• diabetic maculopathy – this is the most common form which occurs when the blood vessels weaken and leak fluid in the macula (the centre of area of the retina), causing vision changes that must be treated to prevent permanent loss
• proliferative diabetic retinopathy – this is the most severe type of diabetic retinopathy where new blood vessels develop and cause bleeding or retinal detachment in your eye, leading to vision loss and further complications like glaucoma 

 Within these types, there are 3 levels of retinopathy that can develop:  

1. background retinopathy – small bulges develop in your retina’s blood vessels, which can bleed slightly but won’t typically affect your sight
2. pre-proliferative retinopathy – more severe changes to your blood vessels cause significant bleeding and changes to your vision 
3. proliferative retinopathy – scar tissue develops, and your blood vessels bleed easily, causing partial or total loss of vision  

The good news is that we can treat diabetic retinopathy and protect your vision if we diagnose it early. 

If you experience any changes to your vision, contact our team to book an appointment with one of our specialists.

Symptoms of diabetic retinopathy 

Your retina requires a continuous blood supply from the network of blood vessels around it. However, if your blood sugar levels are permanently higher than they should be, it could damage these vessels and limit the blood supply to your retina. 

Most people do not have symptoms of diabetic retinopathy when it’s in its earliest stages. 

However, as it progresses, it can cause symptoms like:  

• blurry vision 
• difficulty seeing in the dark  
• eye pain 
• gradual worsening of your vision 
• redness in your eyes 
• shapes floating in your vision (floaters) 
• vision loss 

What causes diabetic retinopathy? 

When the blood vessels in your eye become blocked or weakened because of too much sugar in your blood, diabetic retinopathy can occur. The most likely reason for this is uncontrolled diabetes. 

The scar tissue that develops in the blood vessels can lead to your retina detaching and increased pressure in your eye, causing temporary or permanent vision changes. Find out more about retinal detachment here.

If you are experiencing symptoms of diabetic retinopathy, book an appointment with one of our specialists who can help with a diagnosis.

Complications of diabetic retinopathy 

Untreated diabetic retinopathy can lead to permanent vision changes and loss.  

Other complications can include:  

• glaucoma – new blood vessels can develop in the front of your eye and cause pressure to build up, leading to damage to the nerves that carry images from the eyes to the brain
• retinal detachment – scar tissue that develops because of diabetic retinopathy can cause your retina to pull away from the back of your eye, leading to vision changes and loss
• vitreous haemorrhage – as new blood vessels develop, they may bleed into the central cavity of your eye and cause dark spots or floaters 

However, you can avoid these changes and protect your eye health with early treatment. Contact our team to book an appointment to help protect your eye health.

Diagnosing diabetic retinopathy 

A thorough dilated eye exam is usually used to diagnose diabetic retinopathy. Your ophthalmologist places special drops into your eyes to widen the pupils (the black circles in the middle of your eye that let in light) to see inside your eyes.  

Other examinations they might perform to diagnose diabetic retinopathy include:  

• fluorescein angiography – the ophthalmologist dilates your eyes and injects a special dye into a vein in your arm to fill your blood vessels. A special machine captures images of your eye and the dye will highlight whether any blood vessels in your eyes are leaking
• optical coherence tomography (OCT) – this scan involves taking pictures of your retina to show how thick it is and if any fluid has leaked into it. We can also use OCT scans to check whether your diabetic retinopathy treatment is working 

Regular eye examinations are also essential as an ophthalmologist can diagnose diabetic retinopathy in its early stages at these checks. 

Diabetic retinopathy treatment 

Preventing diabetic retinopathy is crucial for protecting your eyesight. To do this effectively, you should control your blood sugar levels and regularly attend diabetic eye screening appointments so that ophthalmologists can detect any signs of the condition earlier on. 

Treating diabetic retinopathy will depend on the stage of the condition.

Early diabetic retinopathy

Early diabetic retinopathy might not need immediate treatment. Instead, we’ll monitor your condition and recommend treatment when required. Managing your high blood pressure, cholesterol and diabetes can also slow the progression of early diabetic retinopathy.  

Advanced diabetic retinopathy

Advanced diabetic retinopathy requires prompt treatment, which can include: 

Eye injections

Injecting medications into your eye can stop new blood vessels from forming and limit fluid build up. Sometimes, you need multiple injections over time to slow your the progression of your diabetic retinopathy

Laser treatment

Photocoagulation is a laser treatment that turns on a cascade of chemical reactions within the treated eye to control the new blood vessel growth

Retinal detachment surgery

Otherwise known as a vitrectomy, retinal detachment surgery involves making three tiny incisions into your eye to remove blood from the middle of the eye (your vitreous) and any scar tissue pulling on your retina. This also allows complete laser treatment of the retina 

We champion preventative care for diabetic retinopathy and encourage people with diabetes to have regular eye examinations to detect early signs of the condition. That way, we can deliver effective treatment options as soon as required. 

Get in touch by completing our online enquiry form and our team will confirm the treatment that suits your condition.