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However, it usually takes several years for diabetic retinopathy to reach a stage where it could threaten your sight.
To minimise the risk of this happening, people with diabetes should:
This page covers:
The retina is the light-sensitive layer of cells at the back of the eye that converts light into electrical signals. The signals are sent to the brain and the brain turns them into the images you see.
The retina needs a constant supply of blood, which it receives through a network of tiny blood vessels. Over time, a persistently high blood sugar level can damage these blood vessels in three main stages:
However, if a problem with your eyes is picked up early, lifestyle changes and/or treatment can stop it getting worse.
Read about the stages of diabetic retinopathy.
You're at a greater risk if you:
By keeping your blood sugar, blood pressure and cholesterol levels under control, you can reduce your chances of developing diabetic retinopathy.
You won't usually notice diabetic retinopathy in the early stages, as it doesn't tend to have any obvious symptoms until it's more advanced.
However, early signs of the condition can be picked up by taking photographs of the eyes during diabetic eye screening.
Contact your GP or diabetes care team immediately if you experience:
These symptoms don't necessarily mean you have diabetic retinopathy, but it's important to get them checked out. Don't wait until your next screening appointment.
Everyone with diabetes who is 12 years old or over is invited for eye screening once a year.
Screening is offered because:
The screening test involves examining the back of the eyes and taking photographs. Depending on your result, you may be advised to return for another appointment a year later, attend more regular appointments, or discuss treatment options with a specialist.
Read more about diabetic eye screening.
You can reduce your risk of developing diabetic retinopathy, or help prevent it getting worse, by:
Read more about how to prevent diabetic retinopathy.
Treatment for diabetic retinopathy is only necessary if screening detects significant problems that mean your vision is at risk.
If the condition hasn't reached this stage, the above advice on managing your diabetes is recommended.
The main treatments for more advanced diabetic retinopathy are:
Read more about the treatment of diabetic retinopathy.
Diabetic retinopathy develops in stages over time.
If you're diagnosed with diabetic retinopathy after diabetic eye screening, lifestyle changes and/or treatment can reduce the chances of the problem progressing.
The main stages of diabetic retinopathy are described below. You won’t necessarily experience all of these.
This means that tiny bulges (microaneurysms) have appeared in the blood vessels in the back of your eyes (retina), which may leak small amounts of blood. This is very common in people with diabetes.
At this stage:
This means that more severe and widespread changes are seen in the retina, including bleeding into the retina.
At this stage:
This means that new blood vessels and scar tissue have formed on your retina, which can cause significant bleeding and lead to retinal detachment (where the retina pulls away from the back of the eye).
At this stage:
In some cases, the blood vessels in the part of the eye called the macula (the central area of the retina) can also become leaky or blocked. This is known as diabetic maculopathy.
If this is detected:
Read more about treating diabetic retinopathy.
Diabetic retinopathy usually only requires specific treatment when it reaches an advanced stage and there's a risk to your vision.
It's typically offered if diabetic eye screening detects stage three (proliferative) retinopathy, or if you have symptoms caused by diabetic maculopathy.
At all stages, managing your diabetes is crucial.
Read about the stages of diabetic retinopathy for more information about what these terms mean.
The most important part of your treatment is to keep your diabetes under control.
In the early stages of diabetic retinopathy, controlling your diabetes can help prevent vision problems developing.
In the more advanced stages, when your vision is affected or at risk, keeping your diabetes under control can help stop the condition getting worse.
For diabetic retinopathy that is threatening or affecting your sight, the main treatments are:
Laser treatment is used to treat new blood vessels at the back of the eyes in the advanced stages of diabetic retinopathy. This is done because the new blood vessels tend to be very weak and often cause bleeding into the eye.
Treatment can help stabilise the changes in your eyes caused by your diabetes and stop your vision getting any worse, although it won't usually improve your sight.
After treatment, you may have some side effects for a few hours. These can include:
You should be told about the risks of treatment in advance. Potential complications include:
Get medical advice if you notice that your sight gets worse after treatment.
In some cases of diabetic maculopathy, injections of a medicine called anti-VEGF may be given directly into your eyes to prevent new blood vessels forming at the back of the eyes.
The main medicines used are called ranibizumab (Lucentis) and aflibercept (Eylea). These can help stop the problems in your eyes getting worse, and may also lead to an improvement in your vision.
The injections are usually given once a month to begin with. Once your vision starts to stabilise, they'll be stopped or given less frequently.
Injections of steroid medication may sometimes be given instead of anti-VEGF injections, or if the anti-VEGF injections don't help.
Possible risks and side effects of anti-VEGF injections include:
There's also a risk that the injections could cause blood clots to form, which could lead to a heart attack or stroke. This risk is small, but it should be discussed with you before you give your consent to treatment.
The main risk with steroid injections is increased pressure inside the eye.
Surgery may be carried out to remove some of the vitreous humour from the eye. This is the transparent, jelly-like substance that fills the space behind the lens of the eye.
The operation, known as vitreoretinal surgery, may be needed if:
During the procedure, the surgeon will make a small incision in your eye before removing some of the vitreous humour, removing any scar tissue and using a laser to prevent a further deterioration in your vision.
Vitreoretinal surgery is usually carried out under local anaesthetic and sedation. This means you will not experience any pain or have any awareness of the surgery being performed.
You should be able to go home on the same day or the day after your surgery.
For the first few days, you may need to wear a patch over your eye. This is because activities such as reading and watching television can quickly tire your eye to begin with.
You will probably have blurred vision after the operation. This should improve gradually, although it may take several months for your vision to fully return to normal.
Your surgeon will advise you about any activities you should avoid during your recovery.
Possible risks of vitreoretinal surgery include:
There's also a small chance that you will need further retinal surgery afterwards. Your surgeon will explain the risks to you.
You can reduce your risk of developing diabetic retinopathy, or help stop it getting worse, by keeping your blood sugar levels, blood pressure and cholesterol levels under control.
This can often be done by making healthy lifestyle choices, although some people will also need to take medication.
Adopting a few lifestyle changes can improve your general health and reduce your risk of developing retinopathy. These include:
You may also be prescribed medication to help control your blood sugar level (such as insulin or metformin), blood pressure (such as ACE inhibitors) and/or cholesterol level (such as statins).
It can be easier to keep your blood sugar levels, blood pressure and cholesterol levels under control if you know what level they are and monitor them regularly.
The lower you can keep them, the lower your chances of developing retinopathy are. Your diabetes care team can let you know what your target levels should be.
If you check your blood sugar level at home, it should be 4 to 10mmol/l. The level can vary throughout the day, so try to check it at different times.
The check done at your GP surgery is a measure of your average blood sugar level over the past few weeks. You should know this number, as it is the most important measure of your diabetes control.
It’s called HbA1c, and for most people with diabetes it should be around 48 mmol/l or 6.5%.
You can ask for a blood pressure test at your GP surgery, or you can buy a blood pressure monitor to use at home. Blood pressure is measured in millimetres of mercury (mmHg) and is given as two figures.
If you have diabetes, you'll normally be advised to aim for a blood pressure reading of no more than 140/80mmHg, or less than 130/80mmHg if you have diabetes complications, such as eye damage.
Your cholesterol level can be measured with a simple blood test carried out at your GP surgery. The result is given in millimoles per litre of blood (mmol/l).
If you have diabetes, you'll normally be advised to aim for a total blood cholesterol level of no more than 4 mmol/l.
Even if you think your diabetes is well controlled, it's still important to attend your annual diabetic eye screening appointment, as this can detect signs of a problem before you notice anything is wrong.
The earlier that retinopathy is detected, the greater the chance of effectively treating it and stopping it getting worse.
You should also contact your GP or diabetes care team immediately if you develop any problems with your eyes or vision, such as:
These symptoms don't necessarily mean you have diabetic retinopathy, but it's important to get them checked out straight away.