Diabetic retinopathy symptoms range from none (early stages of the disease) to vision changes, including difficulty reading and seeing distances. As the disease progresses, other symptoms may appear, such as blurred vision, black floating spots, and stripes that look like spider webs.
These symptoms usually affect both eyes and can come and go. The most severe symptoms — vision loss and blindness — are the most common causes of new cases of blindness among adults aged 20 to 74 in developed countries.
When diabetic retinopathy causes other eye conditions, such as glaucoma, you may start to lose peripheral vision. It is estimated that over half of people with diabetes will develop some form of diabetic retinopathy over time.
The good news is that you can prevent, manage, and treat diabetic retinopathy with early detection and proper blood sugar control.
Stages and Common Symptoms
There are four stages of diabetic retinopathy:
- Mild nonproliferative diabetic retinopathy (NPDR)
- Moderate NPDR
- severe NPDR
- Proliferative Diabetic Retinopathy (PDR)
The progression of retinopathy appears to depend on several factors, from the duration of diabetes to the level of glycemic control. But as diabetic retinopathy worsens, symptoms always become more pronounced.
mild nonproliferative diabetic retinopathy
This is the first stage of diabetic retinopathy. At this stage, a person may not have any symptoms at all.
During this time, small spherical swellings (microaneurysms) develop on the tiny blood vessels of the retina. Microaneurysms can leak fluid into the retina. In addition, hard exudates (fatty deposits) are often noted.
Because eye disease can start before symptoms appear, the American Diabetes Association recommends:
- All people newly diagnosed with type 2 diabetes undergo dilation eye exams shortly after diagnosis and annually thereafter
- People with type 1 diabetes undergo mydriasis within five years of diagnosis and annually thereafter
- More frequent tests for people with evidence of retinopathy
Moderate nonproliferative diabetic retinopathy
As the disease progresses, more blood vessels that nourish and support the retina can become weakened and blocked. They may also begin to swell and deform.
Blood vessels lose their ability to transport blood, which can cause the macula to swell and lead to diabetic macular edema. This distorts the clear view.
As the condition progresses to later stages, you may experience:
- Fluctuating vision (focus in and out)
- impaired color vision
- blurred vision
- dark floating point
- Can’t see at night
- stripes that look like spider webs
Severe nonproliferative diabetic retinopathy
During this stage, more blood vessels are blocked, which further disrupts the blood supply to areas of the retina, such as the macula.
The body compensates for this damage by secreting growth factors that signal new blood vessels to the retina.
proliferative diabetic retinopathy
This is the most advanced stage of retinopathy. PDR occurs when growth factors trigger the proliferation of new blood vessels. They grow along the inner surface of the retina and into the vitreous gel, the fluid that fills the eye. These blood vessels are weak and don’t work efficiently, making them more prone to leaking and bleeding.
If scar tissue forms, the retina may separate from the eye, resulting in permanent vision loss. Damage to retinal neurons and chronic inflammation may also lead to vision loss.
Advances in screening, early detection, strict blood sugar control, and specialized treatments can help reduce the severity of diabetic retinopathy. Intensive diabetes management has been shown to prevent and delay the onset and progression of diabetic retinopathy.
But rare and serious symptoms can still occur, especially in those with proliferative diabetic retinopathy and diabetic macular edema.
The growth of new blood vessels causes scar tissue to appear in the retina. When the scar tissue contracts, it distorts the retina and pulls it out of place.
If a small part of your retina is detached, you may not have symptoms. However, if larger parts are separated, you may encounter:
- floaters increase
- Shadows or “curtains” in the middle or sides of the eyes
Any symptoms of retinal detachment should prompt you to seek immediate medical attention. This is considered a medical emergency and requires immediate treatment to prevent further damage.
Retinal detachment is a medical emergency
Vision loss and blindness
This is the most serious symptom of diabetic retinopathy. If less severe retinopathy is left untreated, and a person’s blood sugar is chronically uncontrolled, vision loss and blindness often occur.
Early detection and treatment can limit the likelihood of severe vision loss.
In people with type 1 diabetes, pregnancy and puberty may accelerate retinopathy. In pregnant women with type 1 diabetes, retinopathy may worsen, especially when blood sugar rises at conception.
Researchers were unable to determine whether puberty affects the development of diabetic retinopathy. While some studies have found a lower prevalence of retinopathy in people who develop diabetes before adolescence, the difference disappears after 20 years.
One way that puberty may accelerate the risk of retinopathy is that hormones can affect blood sugar, making it harder to control. Poor blood sugar control, which usually occurs during adolescence, is associated with an increased risk of diabetic retinopathy.
Also, if you smoke and have diabetes, your risk of developing diabetic retinopathy increases.
Cataracts occur when your eye’s natural lens becomes cloudy. Cataracts are one of the most common eye complications of diabetes. Having diabetes makes you two to five times more likely to develop cataracts.
Earlier research suggested that cataract surgery may accelerate the progression of diabetic retinopathy, but the American Diabetes Association says more recent research has not clearly shown this association.
Glaucoma is an eye disease caused by elevated pressure in the eye. Increased pressure can affect the optic nerve and therefore increase the risk of vision loss. Primary open-angle glaucoma (POAG) is the most common type of glaucoma in people with diabetes.
Diabetic Macular Edema (DME)
DME occurs when the macula swells or thickens due to fluid buildup.
It can occur at any stage of diabetic retinopathy And lead to image distortion, as well as reduced visual clarity and clarity.
DME is the most common cause of vision loss in patients with diabetic retinopathy.
When to see a healthcare provider
All people with diabetes are encouraged to undergo a dilated eye exam by an ophthalmologist or optometrist. People with retinopathy should be seen by an eye care provider who understands and specializes in the management and treatment of diabetic retinopathy.
When and how often you should see an eye care provider will depend on the type of diabetes you have, when you were diagnosed, your blood sugar control, whether you have symptoms, and your eye health.
If you have recently been diagnosed with type 2 diabetes, the American Diabetes Association recommends an initial dilation and a comprehensive eye exam by an ophthalmologist or optometrist at the time of diagnosis.
If there is evidence of retinopathy, you may need annual or more frequent eye exams, depending on the severity of the disease. If there is no evidence of retinopathy on one or more annual eye exams, every two years will be considered.
Adults with type 1 diabetes should have an eye exam within five years of diagnosis. Parents of children with type 1 diabetes should ask their healthcare provider when and how often an eye exam is needed.
People with diabetes (type 1 or 2) who are planning to become pregnant should discuss eye health with their healthcare provider, and they should have an eye exam before or during the first trimester of pregnancy.
It is estimated that regular follow-up and early detection and treatment of retinopathy can prevent up to 98% of vision loss from retinopathy.
If you have any symptoms of vision disturbance, such as increased blurring, flashing lights, cloudiness, or loss of vision, you should contact your healthcare provider for immediate medical attention.
Retinal detachment is considered a medical emergency. If you have any symptoms, you should see your healthcare provider or go to the emergency room. Early treatment can save vision loss.
Diabetic retinopathy is a complication of diabetes that can be effectively treated with early detection, screening and treatment. People with diabetes can prevent or delay retinopathy by maintaining adequate blood sugar and lipid levels, as well as blood pressure.
There are different stages of retinopathy. In the earliest stages, you may not experience any symptoms. Therefore, it is important to have a dilated eye exam and routine exams at the advice of your healthcare provider.