Diabetic Eye Disease and Diabetic Retinopathy

Diabetic eye disease is the group of eye problems that diabetes can cause, and diabetic retinopathy is the most common of them. Retinopathy is damage to the small blood vessels of the retina, the light sensing layer at the back of the eye, from high blood sugar over time. Diabetic macular edema is swelling in the center of the retina that can follow, and the American Academy of Ophthalmology describes it as the most common reason people with diabetes lose vision. The early stages usually have no symptoms, which is why the National Eye Institute asks everyone with diabetes to have a comprehensive dilated eye exam at least once a year.

Diabetic Eye Disease at a Glance

What it is: eye problems caused by diabetes, mainly diabetic retinopathy and diabetic macular edema, plus a higher risk of cataract and open angle glaucoma.
Who it affects: anyone with any kind of diabetes, type 1, type 2, or gestational, according to the National Eye Institute.
How common it is: the National Eye Institute states that over time more than half of people with diabetes will develop diabetic retinopathy, and about 1 in 15 will develop diabetic macular edema.
Early symptoms: usually none.
Later symptoms: new floaters, blurry or changing vision, dark or blank areas, faded colors, and trouble seeing at night.
How it is found: a comprehensive dilated eye exam, with retinal imaging when needed.
How often to be checked: at least once a year; some people need an exam every 2 to 4 months.
Where to start: a diabetic eye exam at our Westerville office.

What Diabetes Does to the Retina

Diabetes damages blood vessels throughout the body, and the retina is one of the places that damage shows first. The retina is lined with tiny blood vessels that feed it. When blood sugar stays high, those vessels weaken. They can leak fluid and blood, they can swell, and they can close off so that parts of the retina lose their blood supply.

The retina answers in two ways. Fluid that leaks into it causes swelling, and swelling in the macula, the small central area responsible for sharp straight ahead vision, is macular edema. Where vessels have closed, the retina signals for new ones. The new vessels are fragile and grow in the wrong places, which is the advanced stage of the disease.

The Stages of Diabetic Retinopathy

Eye doctors describe diabetic retinopathy in two stages, nonproliferative and proliferative. The names refer to whether new blood vessels have started to grow.

Nonproliferative Diabetic Retinopathy

Nonproliferative diabetic retinopathy is the early stage. Tiny blood vessels in the retina leak, and the retina swells. Small bulges in the vessel walls, specks of blood, and deposits of leaked fluid can be seen during a dilated exam long before you notice anything. This stage ranges from mild to severe depending on how many vessels are affected and how much of the retina has lost blood flow.

Proliferative Diabetic Retinopathy

Proliferative diabetic retinopathy is the advanced stage. The retina grows new, fragile blood vessels that often bleed into the vitreous, the clear gel that fills the eye. A small bleed looks like a few dark floaters. A larger bleed can block vision. The new vessels can also form scar tissue that pulls on the retina and can detach it. The American Academy of Ophthalmology names panretinal laser treatment as an important treatment at this stage, and surgery for bleeding that does not clear.

Diabetic Macular Edema

Diabetic macular edema is swelling in the macula caused by diabetic retinopathy. It can develop at any stage of retinopathy, early or advanced. Because the macula handles reading, faces, and detail, swelling there blurs the center of what you see and can make colors look dull or faded. The National Eye Institute puts the figure at about 1 in 15 people with diabetes over time, and the American Academy of Ophthalmology describes macular edema as the most common reason people with diabetes lose vision.

A related problem is macular ischemia, in which the small vessels that feed the macula close off and blood cannot reach it. Both are found during a dilated exam and measured with retinal imaging.

Symptoms, and Why the Early Stages Have None

Diabetic retinopathy usually has no symptoms in its early stages. The leaking and swelling happen in places you cannot feel, and both eyes are often affected at the same time, so there is no healthy eye to compare against. You can have retinopathy and not know it.

As the disease progresses, you may notice an increasing number of floaters, vision that is blurry or that changes from day to day, dark or empty areas in your field of view, poor night vision, or colors that look washed out. By the time these appear, the retina has usually been changing for some time. That gap between the start of the disease and the first symptom is the reason the exam schedule below does not wait for symptoms.

Who Is at Risk

Anyone with any kind of diabetes can develop diabetic retinopathy. The National Eye Institute lists the factors that raise the risk: the longer you have had diabetes, the higher it is; high blood sugar drives the damage; and high blood pressure or high cholesterol alongside diabetes increases it further.

Pregnancy is a particular case. The American Academy of Ophthalmology advises that women with diabetes who become pregnant be examined early in the pregnancy and followed closely, because the disease can progress quickly during those months. If you develop gestational diabetes, ask your eye doctor whether an exam is needed.

Diabetes and Your Risk of Cataract and Glaucoma

Retinopathy is not the only eye condition linked to diabetes. The National Eye Institute states that having diabetes makes you 2 to 5 times more likely to develop cataracts, often at a younger age, and that it nearly doubles your risk of open angle glaucoma, the most common type. Both are checked at the same dilated exam that looks for retinopathy.

Our office treats both. Our Cataract Center evaluates cataracts and performs cataract surgery, and our doctors manage glaucoma with drops and in office laser treatment. A diabetic eye exam looks at the lens and the optic nerve as well as the retina.

How Diabetic Eye Disease Is Found: the Diabetic Eye Exam

A diabetic eye exam is a comprehensive dilated eye exam with close attention to the retina. At our Westerville office, drops widen your pupils so the doctor can see fully into the back of the eye. The exam takes about an hour. The drops cause blurred vision and light sensitivity for a while afterward, which can affect driving, so plan a ride home and bring sunglasses.

When the exam shows retinopathy or possible macular edema, retinal imaging adds detail the exam alone cannot. Optical coherence tomography scans the retina and measures its thickness, which shows how much swelling is present. Fluorescein angiography uses a dye injected into an arm vein to show which vessels are leaking, blocked, or abnormal. Your doctor explains which tests apply to you and what they show.

The American Academy of Ophthalmology sets the exam schedule. People with type 1 diabetes should begin yearly exams 5 years after their diabetes began. People with type 2 diabetes should have an exam promptly at diagnosis, because retinopathy may already be present, and at least yearly after that. Women with diabetes who become pregnant should be examined early and followed closely. The National Eye Institute adds that some people with retinopathy need to be seen as often as every 2 to 4 months. Your doctor sets your interval from what the exam shows.

How Diabetic Retinopathy and Macular Edema Are Treated

Treatment begins with your diabetes. The American Academy of Ophthalmology states that maintaining control of glucose and blood pressure lowers the risk of retinopathy developing or progressing. Many people with early retinopathy need no eye treatment beyond that control and a closer exam schedule.

When the retina needs treatment, the options depend on the problem. For diabetic macular edema that involves the center of the macula and has reduced vision, the Academy names anti VEGF medicines, given by injection into the eye, as an effective treatment; where vision is still good, it notes that treatment may reasonably be deferred until vision is affected. Steroid injections are another option for swelling. Laser treatment can seal leaking vessels, and panretinal laser treatment remains an important treatment for proliferative retinopathy. Vitrectomy, surgery to remove blood and scar tissue from inside the eye, is used when bleeding does not clear or the retina is being pulled.

Our role is to find diabetic eye disease, measure it, and follow it. Injections are not given at our office. When your retina needs injections or surgery, we refer you to a retina specialist and continue your general eye care, including your cataract and glaucoma care, here.

Lowering Your Risk

Managing your diabetes does more than anything else to lower your risk of diabetic retinopathy, and meeting your A1C goal helps prevent it or keep it from progressing, according to the National Eye Institute. Controlling blood pressure and cholesterol lowers the risk of vision loss as well. The Centers for Disease Control and Prevention adds that quitting smoking lowers your risk of diabetes related eye disease.

One point from the Academy’s guideline is worth knowing: a rapid tightening of blood sugar control, including with some newer diabetes medicines, can cause retinopathy to appear or progress sooner, so tell your eye doctor when your diabetes treatment changes. And keep the yearly exam. It is the one step that finds the disease while it can still be treated well.

Symptoms That Need Same Day Care

Call us right away at 614-890-5692, or go to an emergency department, if you notice any of these:

Sudden loss of vision in one eye or both, even if it comes back within moments.
Double vision, even if it passes.
A curtain or shadow across part of what you see.
A sudden burst of new floaters, or flashes of light.
Sudden blind spots, halos around lights, or an area where things look distorted.
Sudden blurred vision with eye pain, especially if the eye is also red.

During evening or weekend hours, the same number reaches a physician on call. If you cannot reach us, go to the nearest emergency department.

Frequently Asked Questions

Can diabetic retinopathy be cured?

No. Diabetic retinopathy is a long term condition that is managed rather than cured. Controlling blood sugar and blood pressure lowers the risk of it developing or progressing, and treatments for macular edema and proliferative disease aim to slow vision loss and, in some cases, improve vision. The earlier it is found, the more those treatments can do.

Can you have diabetic retinopathy without knowing it?

Yes. The early stages usually cause no symptoms, and both eyes are often affected together, so nothing feels different. A dilated exam finds the changes before you notice them.

How often do I need an eye exam if I have diabetes?

At least once a year. People with type 1 diabetes start yearly exams 5 years after diagnosis, and people with type 2 diabetes start at diagnosis. Women with diabetes who become pregnant are examined early in the pregnancy and followed closely. If retinopathy is found, your doctor may ask to see you every few months.

What happens at a diabetic eye exam?

Your pupils are dilated with drops, the doctor examines the retina, optic nerve, and lens, and retinal imaging is added when the exam calls for it. Plan about an hour, expect blurred vision and light sensitivity afterward, and arrange a ride home.

Does everyone with diabetic retinopathy need injections?

No. Many people with early retinopathy need only diabetes control and closer follow up. Injections are used for macular edema that involves the center of the macula and has reduced vision, and for some cases of proliferative disease. When they are needed, we refer you to a retina specialist, who gives them.

What is the difference between diabetic retinopathy and diabetic macular edema?

Diabetic retinopathy is the damage to the retina’s blood vessels. Diabetic macular edema is swelling in the macula that the damaged vessels can cause. Edema can occur at any stage of retinopathy, and it is the part of the disease that most often affects reading and detail vision.

Schedule Your Diabetic Eye Exam in Westerville

If you have diabetes and it has been a year or more since your last dilated exam, call us at 614-890-5692 or use our contact form. Comprehensive EyeCare of Central Ohio has cared for patients in Westerville since 1975, with ophthalmologists and optometrists in one office at 450 Alkyre Run Drive, Suite 100, Westerville, Ohio 43082. We see patients from Westerville, Worthington, Sunbury, Lewis Center, and the greater Columbus area, Monday through Friday from 7:00 AM to 4:30 PM and Saturday from 8:00 AM to 12:00 PM. Office information and directions.

Keep Reading

Sources

National Eye Institute, Diabetic Retinopathy. Last updated September 11, 2025. https://www.nei.nih.gov/eye-health-information/eye-conditions-and-diseases/diabetic-retinopathy
National Eye Institute, Macular Edema. Last updated August 6, 2025. hhttps://www.nei.nih.gov/eye-health-information/eye-conditions-and-diseases/macular-edema
Centers for Disease Control and Prevention, Diabetes and Vision Loss. Last reviewed May 15, 2024. https://www.cdc.gov/diabetes/diabetes-complications/diabetes-and-vision-loss.html
American Academy of Ophthalmology, Diabetic Retinopathy Preferred Practice Pattern 2024. Posted February 2025, updated August 4, 2025. https://www.aao.org/education/preferred-practice-pattern/diabetic-retinopathy-ppp
American Academy of Ophthalmology, EyeSmart, What Is Diabetic Retinopathy? Reviewed by Veena R. Raiji, MD. Published October 23, 2026. https://www.aao.org/eye-health/diseases/what-is-diabetic-retinopathy
MedlinePlus, Vision problems. Review date August 5, 2024. https://medlineplus.gov/ency/article/003029.htm

Medically reviewed by Steven H. Suh, MD, Director of Cataract Surgery. Reviewed November 3, 2026.

Diabetic Eye Disease: Retinopathy and Macular Edema