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Diabetic Retinopathy

Diabetic retinopathy, vision-threatening damage to the retina of the eye caused by diabetes, is the leading cause of blindness among working-age Americans, according to the U.S. National Institutes of Health (NIH). Yet, many cases could be prevented with regular eye exams and appropriate treatment.


Currently more than 5 million Americans age 40 and older have diabetic retinopathy due to type 1 or type 2 diabetes. And that number will grow to about 16 million by 2050, according to the U.S. Centers for Disease Control and Prevention (CDC).  The CDC also estimates that nearly 26 million Americans, or 8.3 % of the U.S. population, had diabetes in 2010, and 79 million Americans adults age 20 or older are at high risk for the disease.


Make sure you promptly advocate for your own eye health and that of affected family members or friends when any kind of diabetes is present.


Between 12,000 and 24,000 new cases of blindness related to diabetic retinopathy occur in the United States each year.

How does diabetes cause diabetic retinopathy?

Diabetes mellitus (DM) causes abnormal changes in the blood sugar (glucose) that your body ordinarily converts into energy to fuel different bodily functions.


Uncontrolled diabetes allows unusually high levels of blood sugar (hyperglycemia) to accumulate in blood vessels, causing damage that hampers or alters blood flow to your body's organs — including your eyes.


Diabetes generally is classified as two types:

  • Type 1 diabetes—Insulin is a natural hormone that helps regulate the levels of blood sugar needed to help "feed" your body. When you are diagnosed with type 1 diabetes, you are considered insulin-dependent because you will need injections or other medications to supply the insulin your body is unable to produce on its own. When you don't produce enough of your own insulin, your blood sugar is unregulated and levels are too high.

  • Type 2 diabetes—When you are diagnosed with type 2 diabetes, you generally are considered non-insulin-dependent or insulin-resistant. With this type of diabetes, you produce enough insulin but your body is unable to make proper use of it. Your body then compensates by producing even more insulin, which can cause an accompanying abnormal increase in blood sugar levels.


With both types of diabetes, abnormal spikes in blood sugar increase your risk of diabetic retinopathy. Eye damage occurs when chronically high amounts of blood sugar begin to clog or damage blood vessels within the eye's retina, which contains light-sensitive cells (photoreceptors) necessary for good vision.


Symptoms of diabetic retinopathy and other diabetes-related eye problems

You first may notice diabetic retinopathy (DR) or other eye problems related to diabetes when you have symptoms such as:

  • Fluctuating vision

  • Eye floaters and spots

  • Scotoma development or shadow in your field of view

  • Corneal abnormalities such as slow healing of wounds due to corneal abrasions

  • Blurry and/or distorted vision

  • Double vision

  • Eye pain

  • Near vision problems unrelated to presbyopia

  • Cataracts

During an eye examination, your eye doctor will look for other signs of diabetic retinopathy and diabetic eye disease. Signs of eye damage found in the retina can include swelling, deposits and evidence of bleeding or leakage of fluids from blood vessels. One sometimes overlooked symptom of diabetic eye disease is nerve damage (neuropathy) affecting ocular muscles that control eye movements. Symptoms can include involuntary eye movement (nystagmus) and double vision.

For a definitive diagnosis, you may need to undergo a test called a fluorescein angiography. In this test, illuminated dye is injected into the body through your veins (IV). As your blood flows, the dye gradually appears in the retina. Your ophthalmologist will photograph the retina and evaluate its appearance with the help of the illuminated dye. This analysis helps determine if the disease is present and how far it has progressed.