Diabetic Eye Care

Diabetes can affect the health of your eyes and increase the risk of several eye conditions, including diabetic retinopathy, diabetic macular edema, cataracts, and glaucoma.

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What Is Diabetic Eye Disease?

Diabetes can affect many parts of the body, including the eyes. Over time, high blood sugar can damage the small blood vessels that supply the retina—the light-sensitive tissue at the back of the eye.

Diabetic eye disease is not one single condition. It includes several problems that can occur more often or develop differently in people with diabetes, including diabetic retinopathy, diabetic macular edema, cataracts, and certain types of glaucoma. Understanding these conditions is an important first step toward protecting your vision.

What Is Diabetic Retinopathy?

Diabetic retinopathy is one of the most important eye complications associated with diabetes. It occurs when long-term changes in blood sugar damage the small blood vessels in the retina.

The retina needs a healthy blood supply to detect light and send visual information to the brain. When diabetes damages these vessels, they can become blocked, swollen, or leaky. In more advanced disease, the retina may respond by growing abnormal new blood vessels.

Diabetic retinopathy can develop in people with type 1 or type 2 diabetes. The risk generally increases the longer a person has diabetes, although the condition can vary considerably from one person to another.

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Nonproliferative and Proliferative Diabetic Retinopathy

Diabetic retinopathy is commonly described in two broad stages.

Nonproliferative diabetic retinopathy occurs when the existing retinal blood vessels become damaged but abnormal new blood vessels have not developed. Small areas of the vessels may swell or leak, and some retinal blood vessels can become blocked.

As the disease becomes more advanced, areas of the retina may receive an inadequate blood supply. This can lead to proliferative diabetic retinopathy, in which abnormal new blood vessels grow. These vessels are fragile and can bleed into the vitreous, the gel-like substance that fills the inside of the eye.

Not everyone with diabetes develops advanced diabetic retinopathy. Regular eye examinations can help identify changes before they cause noticeable vision problems.

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What Is Diabetic Macular Edema?

The macula is the central part of the retina responsible for detailed, central vision. When damaged retinal blood vessels leak fluid into the macula, the tissue can swell. This is called diabetic macular edema, or DME.

DME can cause blurry or distorted central vision and may interfere with activities such as reading or driving. It can occur at different stages of diabetic retinopathy and may sometimes be present without obvious symptoms.

How Can Diabetes Affect Other Parts of the Eye?

Diabetic retinopathy is not the only eye condition associated with diabetes.

People with diabetes are also more likely to develop cataracts, in which the normally clear lens of the eye becomes cloudy. Cataracts may also occur at a younger age in people with diabetes. Diabetes is also associated with an increased risk of open-angle glaucoma, a group of conditions that damage the optic nerve.

This is one reason diabetic eye care involves more than simply checking for diabetic retinopathy. A comprehensive examination can evaluate the overall health of the eyes.

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Why Does Diabetic Eye Disease Matter?

One of the challenges of diabetic eye disease is that significant changes can occur before a person notices anything unusual.

Early diabetic retinopathy often causes no symptoms. A person may feel that their vision is normal while changes are already occurring in the retina. This is why waiting until vision becomes blurry is not a reliable way to decide whether an eye examination is necessary.

When diabetic eye disease becomes more advanced, it can cause permanent vision loss. However, early detection and appropriate treatment can reduce the risk of serious vision problems.

What Increases the Risk of Diabetic Eye Disease?

Anyone with diabetes can develop diabetic retinopathy. Several factors can affect an individual’s risk, including:

  • How long they have had diabetes
  • Blood sugar control
  • Blood pressure
  • Cholesterol levels
  • Pregnancy in people with pre-existing diabetes
  • Other health conditions
  • Smoking and other lifestyle factors

The longer diabetes has been present, the greater the opportunity for damage to develop in the small blood vessels of the retina. Managing blood sugar, blood pressure, and cholesterol can help reduce the risk of diabetes-related vision problems.

Pregnancy deserves special consideration for people who already have type 1 or type 2 diabetes because diabetic retinopathy can develop or progress during pregnancy. Eye-care recommendations during pregnancy depend on the person’s existing retinal health and other circumstances.

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What Are the Symptoms?

Early diabetic retinopathy may have no noticeable symptoms.

As retinal damage progresses, symptoms may include:

  • Blurry or fluctuating vision
  • Difficulty seeing clearly when reading or looking at distant objects
  • Dark spots or floating shapes in the field of vision
  • Cobweb-like streaks or spots caused by bleeding inside the eye
  • Distorted or wavy central vision when diabetic macular edema is present
  • Loss of vision in more advanced disease

Symptoms may affect one or both eyes and can vary depending on which part of the retina is affected.

A sudden increase in floaters, dark areas in the vision, or a significant change in sight should not be ignored.

When Should You See an Eye Doctor?

If you have diabetes, regular eye examinations are important even if your vision seems normal.

The timing of your examinations depends on factors such as your type of diabetes, how long you have had it, whether diabetic retinopathy is already present, your pregnancy status, and your eye-care professional’s recommendations. Current American Diabetes Association guidance recommends an initial comprehensive dilated examination at different points for people with type 1 and type 2 diabetes, followed by intervals based on retinal findings and individual risk.

  • A sudden or significant decrease in vision
  • A sudden increase in dark spots or floaters
  • New flashes of light
  • A shadow or curtain-like area across your vision
  • New or rapidly worsening distortion of central vision

These symptoms can have several possible causes, some of which require urgent evaluation.

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Can Diabetic Eye Disease Be Prevented?

Diabetes-related eye disease cannot always be completely prevented, but its risk and progression can often be reduced.

Important parts of protecting your vision include:

  • Following your diabetes treatment plan
  • Working with your healthcare team to manage blood sugar
  • Managing blood pressure and cholesterol
  • Avoiding smoking
  • Staying physically active when appropriate
  • Attending recommended eye examinations
  • Following your eye-care professional’s recommendations if retinal changes are found

Your personal blood sugar and A1C goals should be determined with the healthcare professional managing your diabetes.

Frequently Asked Questions

Yes. Early diabetic retinopathy often produces no noticeable symptoms. Regular examinations are therefore important even when your vision appears unchanged.

No. Anyone with diabetes can develop it, but individual risk varies. The risk generally increases with longer duration of diabetes and can also be influenced by blood sugar, blood pressure, cholesterol, pregnancy, and other factors.

Advanced diabetic retinopathy can cause severe vision loss and blindness. Early detection and appropriate treatment can help reduce this risk.

Diabetic macular edema occurs when damaged retinal blood vessels leak fluid into the macula, causing swelling. It can affect central vision and may require treatment depending on its severity and characteristics.

Yes. Diabetes is associated with an increased risk of cataracts and open-angle glaucoma, which is another reason comprehensive eye care is important.

Yes. This is one of the main reasons people with diabetes should follow recommended eye-examination schedules rather than waiting for vision changes.

Continue Learning

Diabetic Eye Exams: Screening & Diagnosis

Learn when people with diabetes should have their eyes examined and what tests may be used to identify retinal changes.

Diabetic Eye Disease Treatment & Long-Term Care

Learn about monitoring, injections, laser treatment, surgery, follow-up care, and protecting vision over time.

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Medical Disclaimer

The information on this page is provided for general educational purposes and is not a substitute for a professional eye examination, diagnosis, or individualized medical advice. Cataract treatment and surgical decisions depend on each patient’s eye health, medical history, visual needs, and other individual factors. If you have sudden or significant changes in vision, severe eye pain, or other concerning symptoms, seek prompt medical attention.

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