Diabetic Eye DiseaseWhat Every Patient Needs to Know

When your blood sugar stays high over time, it causes damage in three main ways.

It Weakens Blood Vessels in the Retina

The retina has a network of very small blood vessels that bring it oxygen and nutrients. High blood sugar causes these vessels to develop tiny bulges called microaneurysms. These bulges can leak fluid or blood into the retina, which makes the retina swell and stops it from working the way it should.

It Clouds the Lens

Too much sugar enters the lens of your eye and gets turned into a substance called sorbitol. Sorbitol pulls water into the lens, making it swell and become cloudy. This is how cataracts form. At the same time, sugar sticks to proteins in the lens and makes them stiff and discolored.

It Raises Eye Pressure

Diabetes-related damage can block the natural drainage system inside your eye. When fluid cannot drain properly, pressure builds up. Over time, this pressure can hurt the optic nerve, which is the cable that sends images from your eye to your brain.

Why "New" Blood Vessels Are Dangerous

When high blood sugar closes off some of the retina's blood vessels, parts of the retina stop getting enough oxygen. The eye tries to fix this problem by growing new blood vessels. But these new vessels are weak and fragile. They break easily and can bleed inside the eye. They can also form scar tissue that pulls on the retina and may cause it to detach. This is one of the most serious stages of diabetic eye disease.

Diabetic retinopathy moves through four stages, going from mild to severe if it is not caught and managed.

Stage 1: Mild Non-Proliferative Retinopathy

This is the earliest stage. Small balloon-like swellings (microaneurysms) form in the retinal blood vessels. These may leak tiny amounts of fluid. Most people have no symptoms at this point. The condition is only found during an eye exam.

Stage 2: Moderate Non-Proliferative Retinopathy

More blood vessels are now affected. Some vessels swell and change shape, losing their ability to carry blood properly. Small areas of bleeding and fatty deposits (called hard exudates) may show up on the retina.

Stage 3: Severe Non-Proliferative Retinopathy

This is a critical turning point. Many blood vessels are now blocked, cutting off blood supply to large areas of the retina. These starved areas send signals telling the body to grow new blood vessels. Without treatment, there is a high risk of moving to the most dangerous stage within a year.

Stage 4: Proliferative Diabetic Retinopathy (PDR)

This is the most advanced stage. New, abnormal blood vessels grow along the retina and into the vitreous gel. Because these vessels are fragile, they leak and bleed easily. Minor bleeding causes dark floaters, while major bleeding can block vision entirely. Scar tissue can form around these vessels and pull the retina loose, causing a retinal detachment that needs emergency surgery.

This is one of the most important things to understand: diabetic eye disease often has no symptoms in its early stages. Damage can happen to your retina without you noticing any change in your vision. By the time symptoms appear, the disease may already be advanced.

Signs That May Develop Over Time

When symptoms do show up, they can include blurry or fuzzy vision, dark spots or "floaters" drifting across your view, dark or empty areas in your vision, colors that look faded or washed out, trouble seeing at night, straight lines looking wavy or bent, and vision that changes from day to day as blood sugar levels shift.

Your eye doctor uses several tests to check for diabetic eye disease. Here are the most common ones, all of which are available at our practice.

Comprehensive Dilated Eye Exam

This is the most important test. Your doctor places drops in your eyes to widen (dilate) your pupils. This gives a clear view of the retina, blood vessels, and optic nerve. The drops take about 20 to 30 minutes to work, and your vision will be blurry and light-sensitive for a few hours afterward, so plan to have someone drive you home.

OCT Scan (Optical Coherence Tomography)

This is a painless, non-invasive scan that uses light waves to create detailed cross-section images of your retina, almost like an ultrasound but using light instead of sound. It measures retinal thickness with great precision and is especially useful for finding macular edema, even before it causes symptoms.

Fluorescein Angiography

This test involves injecting a special yellow dye into a vein in your arm. As the dye travels through the blood vessels in your eyes, a camera takes rapid photos. This reveals leaking blood vessels, blocked vessels, and abnormal new vessel growth.

OCT Angiography (OCTA)

This newer test creates detailed maps of blood flow in your retina without needing a dye injection. It can find areas where blood supply has been cut off and changes in the tiny blood vessels of the macula.

AI-Assisted Screening

FDA-cleared AI systems can now screen for diabetic retinopathy using a retinal camera in a primary care office, without needing an eye specialist. The camera takes pictures of your retina, and the AI analyzes them in under a minute. If a screening flags a concern, a follow-up visit with a specialist like ours is the next step.

Your First Exam

If you have type 1 diabetes, you should have your first comprehensive dilated eye exam within 5 years of being diagnosed. If you have type 2 diabetes, get your first exam right away when you are diagnosed, because you may have had high blood sugar for years before finding out.

After Your First Exam

Yearly dilated eye exams are the standard recommendation. If you have had one or more normal exams in a row and your blood sugar is well controlled, your doctor may extend the schedule to every two years. However, if any signs of retinopathy are found, you should be examined at least once a year, and more often if the disease is progressing. For severe non-proliferative retinopathy, follow-up visits may be needed every 2 to 4 months.

Children and Teenagers

Children with type 1 diabetes should begin screening after 3 to 5 years of diabetes or at the start of puberty, whichever comes first. Children with type 2 diabetes should be screened at the time of diagnosis. Our pediatric ophthalmology team is experienced in caring for young patients with diabetes.

Treatment depends on the type and stage of your diabetic eye disease. Catching problems early gives you the most options. Treatment can stop your vision from getting worse and, in some cases, improve it—but it usually cannot undo damage that has already been done.

Anti-VEGF Injections

The most common treatment for diabetic macular edema and proliferative retinopathy. These medicines block VEGF, a protein that causes blood vessels to grow and leak, reducing swelling and stopping abnormal vessel growth. The main drugs used today include Eylea, Lucentis, Avastin, Vabysmo, and Eylea HD. We administer these injections in our office using a very fine needle after numbing the eye. Most patients say the procedure feels like brief pressure rather than pain.

Treatment typically starts with monthly injections for the first few months, then the time between injections is gradually extended. During the first year, patients typically receive about 9 injections, dropping to 5 or 6 in the second year. Newer drugs like Vabysmo and Eylea HD may allow 12 to 16 weeks between treatments.

Focal Laser Treatment

Used for diabetic macular edema, the laser seals leaking blood vessels near the macula to reduce fluid buildup. While anti-VEGF injections have mostly replaced laser as the first choice for DME, focal laser still plays a useful role, especially when combined with injections.

Panretinal Photocoagulation (PRP)

Also called scatter laser, PRP is used to treat proliferative diabetic retinopathy. The doctor applies hundreds of tiny laser burns to the outer areas of the retina, destroying oxygen-starved tissue that triggers abnormal blood vessel growth. PRP reduces the risk of severe vision loss by more than 50% and its effects are permanent.

Vitrectomy Surgery

When bleeding into the vitreous gel does not clear on its own, or when scar tissue is pulling on the retina, your doctor may recommend vitrectomy. In this outpatient surgery, the doctor removes the blood-filled vitreous gel and any scar tissue through tiny cuts. Laser treatment is usually done during the procedure.

Steroid Implants

For patients with DME who do not respond well to anti-VEGF injections, steroid implants are an option. Ozurdex releases medicine over about six months. Iluvien delivers medicine continuously for up to three years. These reduce swelling and inflammation but can cause cataracts and raise eye pressure, so they are generally used as a second choice.

Cataract Surgery

The surgeon removes the cloudy lens and replaces it with a clear artificial lens (IOL). We use laser-assisted cataract surgery along with advanced ultrasound technology for a precise, gentle procedure. A range of premium lens options are available, including trifocal and extended-depth-of-focus lenses. For patients who also have glaucoma, MIGS can be performed at the same time.

Glaucoma Treatments

Options include daily eye drops, selective laser trabeculoplasty (SLT), minimally invasive glaucoma surgery (MIGS) such as iStent, and more advanced procedures like trabeculectomy or tube shunt surgery. Anti-VEGF injections can also help shrink abnormal blood vessels blocking drainage, especially in neovascular glaucoma.

Several exciting advances are changing how diabetic eye disease is treated and found. Our team stays current with the latest research and treatments so that we can offer you the most effective care available.

Vabysmo (Faricimab)

Approved in January 2022, Vabysmo is the first eye treatment that blocks two different disease pathways at once. It targets both VEGF-A and angiopoietin-2 (Ang-2), which makes blood vessels unstable. In clinical trials, more than 60% of patients were able to stretch injections to every 16 weeks—roughly half as many office visits as older treatments.

Eylea HD

Approved in August 2023, Eylea HD delivers four times the dose of standard Eylea. This higher dose allows patients to go longer between injections while getting the same level of vision improvement.

The Susvimo Port Delivery System

Approved for DME in February 2025 and for diabetic retinopathy in May 2025. A tiny refillable device is surgically placed in the eye wall and continuously releases medicine over months. Patients with DME need refills only every 6 months, and those with diabetic retinopathy only every 9 months. In clinical trials, roughly 95 to 98% of patients did not need any extra injections between refills.

Biosimilar Medications

Lower-cost versions of established anti-VEGF drugs are now available. Multiple biosimilars for both Eylea and Lucentis received FDA approval in 2024, and are expected to reduce treatment costs significantly.

Gene Therapy Research

Researchers are exploring treatments that could teach the eye's own cells to produce anti-VEGF proteins. Early clinical trials have shown promising results, with some patients going years without needing injections. These treatments are still experimental and not yet approved.

Control Your Blood Sugar

This is the most powerful thing you can do. The American Diabetes Association recommends an A1C below 7% for most adults. Intensive blood sugar control in people with type 1 diabetes reduced the risk of developing retinopathy by 76%. In type 2, every 1% drop in A1C cut small-vessel complications by about 35%. These benefits last for years, even decades—a pattern researchers call "metabolic memory."

Keep Your Blood Pressure Under Control

Aim for a target below 130/80 mmHg. Studies show that good blood pressure control reduces the risk of retinopathy worsening by about a third.

Manage Your Cholesterol

Work with your doctor to keep your cholesterol and other blood fats in a healthy range, using statin therapy if recommended.

Get Regular Dilated Eye Exams

This is the single best way to catch diabetic eye disease early, when treatment is most effective. Do not wait for symptoms. Significant damage can happen before you notice any vision changes.

Do Not Smoke

Smoking worsens blood vessel damage throughout your body, including in your eyes. If you smoke, quitting is one of the best things you can do for your eye health and overall health.

Stay Active and Eat Well

Aim for at least 150 minutes of moderate exercise per week. A healthy diet rich in vegetables, fruits, whole grains, and lean proteins supports your overall health. Losing just 5 to 7% of your body weight, if you are overweight, can meaningfully improve blood sugar control.

Wear UV-Blocking Sunglasses

UV rays from the sun contribute to cataract development. Choose wrap-around sunglasses with a UV400 rating when you are outdoors.

Take Your Medications as Prescribed

Whether you take insulin, oral diabetes medicines, blood pressure pills, or cholesterol-lowering drugs, sticking to your medication plan is essential for protecting your eyes.

Pregnancy can cause diabetic retinopathy to develop or worsen quickly, so careful monitoring is critical. About 15 out of every 100 pregnancies in women with pre-existing diabetes lead to new retinopathy, and about a third of women who already have retinopathy see it get worse during pregnancy.

Why Pregnancy Affects Your Eyes

The reasons include the body's increased blood volume, hormonal changes, and sometimes rapid tightening of blood sugar control. Bringing blood sugar down quickly can temporarily worsen retinopathy even though it is helpful in the long run.

Recommended Eye Exam Schedule During Pregnancy

If you have type 1 or type 2 diabetes and are planning to become pregnant, have a dilated eye exam before you conceive. You should also be examined in the first trimester, with follow-up visits each trimester based on how your eyes look. Your eye doctor should continue monitoring you for up to one year after delivery.

Treatment During Pregnancy

Laser treatment (PRP) is considered safe during pregnancy for vision-threatening retinopathy. Anti-VEGF injections are generally avoided during pregnancy, especially in the first trimester, because their effects on the developing baby are not fully known.

What About Gestational Diabetes?

If you develop gestational diabetes, you do not need a diabetic eye exam during pregnancy. Gestational diabetes typically goes away after delivery, though it does raise your future risk of developing type 2 diabetes.

Both types of diabetes cause the same kinds of eye problems, but the timing and screening recommendations are different.

Type 1 Diabetes

Retinopathy typically takes at least 5 years to develop after diabetes begins. That is why screening starts 5 years after diagnosis. However, type 1 carries a high lifetime risk. After 20 years, nearly all people with type 1 diabetes have some degree of retinopathy, and about half develop the advanced proliferative stage.

Type 2 Diabetes

The situation is different because type 2 diabetes often goes unnoticed for years. By the time it is diagnosed, 20 to 40% of patients already have some retinopathy. That is why screening should start right away at diagnosis. After 20 years, more than 60% of type 2 patients have retinopathy.

No matter which type you have, the same protective steps apply: control blood sugar, manage blood pressure and cholesterol, get regular eye exams, and seek treatment promptly if problems are found.

In the United States, about 9.6 million people with diabetes had diabetic retinopathy in 2021—roughly 1 in 4 Americans over age 40 who have diabetes. Of these, about 1.84 million had vision-threatening disease. The number of people living with diabetic eye disease has more than doubled since 2004.

Globally, over 103 million adults had diabetic retinopathy in 2020, a number expected to rise to 160 million by 2045. Diabetic retinopathy remains the leading cause of new blindness in working-age adults aged 20 to 74 in the United States. Yet only about 60% of people with diabetes get their recommended yearly eye screening.

Why Are the Most Serious Cases Going Down?

Better diabetes medications, including newer drugs like GLP-1 receptor agonists (such as semaglutide and liraglutide), are helping patients control blood sugar more effectively. Anti-VEGF injection therapy has proven highly effective at preserving vision. And expanded health insurance access has brought more patients into regular medical care, meaning problems are found and treated earlier.

Current Research Areas

Scientists are continuing to find better ways to detect, treat, and prevent diabetic eye disease. Exciting areas include a medication originally developed for HIV that can help improve vision in retinopathy complications, new research showing that low blood sugar episodes may also contribute to retinal damage, NIH-funded research into fenofibrate for stopping retinopathy progression, and advanced AI systems that can analyze eye images more accurately.

Even with the best treatment, some people will have lasting changes to their vision. This is sometimes called "low vision"—vision loss that cannot be fully fixed with glasses, contacts, or surgery, but still leaves you with useful sight. The good news is that there is a wide range of tools, services, and support to help you stay independent.

Tools and Services That Can Help

Magnifiers (handheld or electronic devices that enlarge text and images), screen readers and text-to-speech apps, voice assistants and audio books, high-contrast and large-print materials, adaptive lighting with special lamps and contrast filters, occupational therapy to help you adapt your home and workplace, and orientation and mobility training. A low vision therapist can assess your needs and recommend the right combination of aids for your daily life.

Taking Care of Your Emotional Health

Adjusting to vision loss can be emotionally tough. Feelings of frustration, anxiety, or grief are completely normal. Talk to a counselor or therapist who has experience working with people who have sight loss. Join a peer support group, because sharing your experiences with others in similar situations can make a real difference. Open up to family and friends about what you need. Explore community programs that offer social connections and confidence-building activities. Our team can help connect you with these resources.

Yes, it can. Diabetic retinopathy is the leading cause of new blindness in working-age adults in the United States. But here is the important part: most diabetes-related vision loss can be prevented. With regular eye exams and the right treatment, the risk of serious vision loss drops dramatically. Catching problems early, before you even notice any symptoms, is the key.

Yes, and this is one of the trickiest things about diabetic eye disease. In the early stages, there is usually no pain, no blurriness, and no warning signs at all. The damage can build up quietly for months or even years before you notice anything. By the time your vision changes, the disease may already be advanced. That is exactly why routine eye exams are so important, even when everything seems normal.

You might notice straight lines looking wavy or bent, blurry or washed-out central vision, colors looking duller than usual, or trouble reading small print or doing close-up work. Because your side vision usually stays fine, it is easy to miss the early signs. If you notice any blurring or waviness, let our team know right away.

The idea of a needle in the eye sounds scary, but the reality is much less uncomfortable than most people expect. We numb the eye completely before the injection. Most patients describe the feeling as brief pressure rather than pain. The entire injection takes only a few seconds. Some people feel mild soreness or irritation for a day or so afterward, but serious discomfort is rare.

Treatment usually starts with monthly injections for the first several months. After that, the time between injections is gradually extended depending on how your eyes respond. During the first year, patients typically receive about 9 injections, dropping to 5 or 6 in the second year and fewer after that. Newer drugs may allow you to go 12 to 16 weeks between treatments. Your doctor will adjust your schedule based on regular OCT scans that show how your retina is doing.

Control your "ABCs." A1C is a blood test that shows your average blood sugar over the last 2 to 3 months. Keeping it below 7% helps protect the tiny blood vessels in your eyes. Blood pressure should be kept under 130/80. And keeping your cholesterol in a healthy range helps prevent additional damage to small blood vessels. Even small improvements in each of these areas can add up to big benefits for your eye health.

Hazy or blurry vision that does not get better with new glasses, more glare from headlights at night or bright sunlight, colors looking faded or yellowish, and needing frequent changes to your glasses prescription. Unlike age-related cataracts, which may take years to worsen, diabetic cataracts can affect your sight in just a few months. If your vision changes noticeably between eye exams, let us know.

That is the tricky part. In most cases, there are no symptoms in the early stages. By the time you notice vision changes, significant damage to the optic nerve may have already happened. In some cases, you might notice a slow loss of side vision, headaches or eye discomfort (more common with neovascular glaucoma), or seeing halos or colored rings around lights. Regular eye pressure checks are an important part of every diabetic eye exam.

Metabolic memory is a term researchers use to describe an important finding: the benefits of good blood sugar control last for years, even decades. Landmark studies showed that people who controlled their blood sugar well early in their diabetes had lower rates of eye disease and other complications many years later, even if their control was not perfect the entire time. Every period of good blood sugar management counts and pays off in the long run.

In some cases, bringing blood sugar down very quickly can temporarily worsen diabetic retinopathy. This is sometimes called "early worsening." It happens because the retina adjusts to high blood sugar over time, and a sudden change can stress the blood vessels. This effect is usually temporary, and the long-term benefits of better blood sugar control far outweigh this short-term risk. Your doctor may adjust how quickly they bring your blood sugar down and monitor your eyes more closely during this period.

If you develop gestational diabetes, you do not need a special diabetic eye exam during pregnancy. Gestational diabetes typically goes away after delivery. However, if you already had type 1 or type 2 diabetes before becoming pregnant, pregnancy can speed up diabetic retinopathy. In that case, you should have eye exams before conception, during the first trimester, and at regular intervals throughout and after your pregnancy.

Yes, several advances are helping reduce the burden of frequent injections. The Susvimo port delivery system is a tiny refillable device placed in the eye wall that releases medicine continuously for 6 to 9 months between refills. Newer drugs like Vabysmo and Eylea HD can allow some patients to go 12 to 16 weeks between treatments. Biosimilar medications are now available, making treatment more affordable. And gene therapy research is exploring treatments that could teach the eye's own cells to produce the medicine they need.

Research shows that Black Americans, Hispanic and Latino Americans, and Native Americans have higher rates of diabetic retinopathy compared to white Americans. Studies report retinopathy rates among people with diabetes of about 38.8% in Black Americans and 31% in Hispanic Americans, compared to 26.4% in white Americans. These differences are linked to factors such as access to care, rates of diabetes, and other health conditions. No matter your background, regular eye exams and good diabetes management are the most effective ways to protect your vision.

Yes, children with diabetes can develop diabetic eye disease. Children with type 1 diabetes should begin eye screening after 3 to 5 years of diabetes or at the start of puberty, whichever comes first. Children with type 2 diabetes should be screened at the time of diagnosis. The same protective strategies apply: good blood sugar control, regular eye exams, and prompt treatment if problems are found. Our pediatric ophthalmology team has specialized experience caring for young patients with these needs.

Yes, in many cases. Minimally invasive glaucoma surgery (MIGS), such as iStent implantation, can be performed during cataract surgery. This combined approach treats both conditions in a single procedure, which means one recovery period instead of two. Not every patient is a candidate, so your surgeon will evaluate your specific situation and recommend the best plan.

High blood sugar weakens tiny blood vessels in the retina, causing them to develop bulges that can leak fluid or blood. It also causes extra sugar to enter the lens of your eye, pulling in water and making the lens cloudy (a cataract). On top of that, diabetes-related damage can block the eye's natural drainage system, raising pressure inside the eye and potentially harming the optic nerve.

When cataracts start getting in the way of your daily life (reading, driving, watching TV), surgery is the solution. The surgeon removes the cloudy lens and replaces it with a clear artificial lens called an intraocular lens, or IOL. We use laser-assisted cataract surgery along with advanced ultrasound technology for a precise, gentle procedure. A range of premium lens options are available, including trifocal and extended-depth-of-focus designs that can reduce or even eliminate the need for glasses after surgery.

Eat a balanced diet with whole grains, vegetables, lean proteins, and beans to keep your blood sugar steady. Stay active with at least 150 minutes of moderate exercise per week (about 30 minutes, five days a week). Even losing 5 to 10% of your body weight can lower your A1C and blood pressure, which means less strain on the blood vessels in your eyes. Quit smoking, because tobacco speeds up damage to blood vessels in the retina and lens. Wear UV-blocking sunglasses outdoors, since UV rays contribute to cataract development. You do not have to change everything at once. Pick one or two goals to start and build from there.

Diabetes care works best as a team effort. Keep your primary care doctor, eye doctor, and any specialists in the loop by sharing test results across your care team. Set phone reminders for quarterly blood tests and your annual dilated eye exam. Keep a record of your daily blood sugar readings and bring it to your appointments. Write down your target numbers, medications, and emergency contacts in one place so you can review them at each visit.

It is a bit of both, and understanding the difference matters. More people are being diagnosed with some form of diabetic eye disease because more Americans have diabetes than ever before and screening programs are catching more cases. But the most serious, vision-threatening forms are actually going down. New cases of vision-threatening retinopathy have dropped by more than 50%, proliferative retinopathy by about 70%, and diabetic macular edema by about 40%. The takeaway is encouraging: while more people have some degree of the disease, the risk of it reaching the point where it threatens your vision has dropped significantly.

Even with the best treatment, some people will have lasting vision changes. This does not mean you are out of options. There is a wide range of tools to help you stay independent, from magnifiers and screen readers to voice assistants, adaptive lighting, and occupational therapy. Orientation and mobility training can teach you safe ways to get around. A low vision therapist can assess your specific needs and recommend the right combination of aids for your daily life. Emotional support matters too. Feelings of frustration, anxiety, or grief are normal. Counselors, peer support groups, and community programs can all help. Our team can connect you with these resources.

New research from 2025 shows that episodes of low blood sugar (not just high blood sugar) may also contribute to retinal damage and vision loss. This finding could change how doctors think about diabetes management for eye health. It highlights the importance of keeping blood sugar in a stable range, avoiding big swings in either direction. Talk to your care team about strategies to prevent both highs and lows.