Eye diseases like diabetic retinopathy often do lasting damage. Although there’s no way to reverse what’s done, you can work with your eye specialist — like an ophthalmologist or optometrist — to slow down diabetic retinopathy progression and stop your vision from becoming worse.
In this article, we’ll discuss what diabetic retinopathy is and why the damage is often permanent. We’ll also cover the treatment options that can help stabilize your vision and prevent further vision loss. To learn more about how to better manage your diabetic retinopathy, talk with your doctor and ophthalmologist.
The retina is the light-sensitive tissue found at the back of the eye. It collects the entering light and passes it along to the optic nerve. This connection sends what you see to your brain to process it. If your retina is damaged, your brain can’t make sense of the information from your eyes.
In people with type 1 and type 2 diabetes, high blood glucose (sugar) levels block and damage the delicate blood vessels in the retina. This is known as nonproliferative diabetic retinopathy because new blood vessels aren’t proliferating (growing). In this stage, the walls of the retina’s smaller blood vessels weaken and form tiny bulges, called microaneurysms. They also begin leaking blood and fluid into the retina itself, which causes swelling.
Swelling of the macula (center of the retina) is called diabetic macular edema (DME). The macula helps you see things in front of you clearly and sharply. DME, a complication of diabetes, usually occurs with nonproliferative diabetic retinopathy.
As the larger blood vessels become blocked, the retina can’t get enough oxygen and nutrients. Your eyes grow new blood vessels to get blood to the retina, but they’re fragile and leak easily. This is known as proliferative diabetic retinopathy.
The leakage causes blood and fluid to collect in the vitreous (also called the vitreous humor) — the clear jelly filling in your eyes. Scar tissue that forms around the new blood vessels can pull your retina away from the back of your eye, which is known as retinal detachment.
Unfortunately, there’s no way to reverse the damage done to the blood vessels in your retina. The best plan of action is to monitor your eye health and take early steps to treat diabetic retinopathy. Be sure to let your eye doctor know you have diabetes so that they can check your eye health often. Many people with mild and moderate nonproliferative diabetic retinopathy don’t need treatment at first, so careful monitoring is important.
With nonproliferative diabetic retinopathy, you can slow your vision loss by getting your blood sugar levels under control. According to the American Academy of Ophthalmology, this may even bring back some of your vision. You can work with your diabetes specialist or endocrinologist to make sure you’re following the best treatment plan for you. This includes eating a healthy diet, taking insulin or diabetes medication, and exercising regularly.
In most cases of proliferative diabetic retinopathy, the treatment goal is to keep your vision stable and prevent it from getting worse. It’s unlikely that medications or surgery will bring back any lost vision, but it’s still important to stick with your diabetes treatment plan and work with your eye doctor to preserve as much of your vision as possible.
Currently, no treatments will fully reverse diabetic retinopathy, but some therapies may reverse damage to a certain extent. Many of these treatment options also work for diabetic macular edema.
Some DiabetesTeam members have had success with their diabetic retinopathy treatments. “In 2019 I had diabetic retinopathy in both eyes,” one member said. “I had laser therapy done at a series of visits. I also had cataract surgery done in both eyes. I now have 20/20 vision.”
It’s important to note that each diabetic retinopathy case is different, and treatments that work for one person may not work for others.
Your body uses a protein called vascular endothelial growth factor (VEGF) to produce new blood vessels. In diabetic retinopathy, this protein is key for making abnormal blood vessels that leak fluid into the retina. Doctors have discovered that targeting VEGF prevents these new blood vessels from growing and damaging your eyes.
Anti-VEGF treatments are given as intravitreal injections (directly into the vitreous). They stabilize vision in around 90 percent of people who get them and may even improve vision for about a third. It’s important to note that anti-VEGF therapy can’t reverse the damage from diabetic retinopathy.
Examples of anti-VEGF injections for diabetic retinopathy include:
Also known as photocoagulation, laser surgery offers another way to treat diabetic retinopathy. This method uses light beams to create burns and seal off leaky blood vessels, which reduces retinal swelling and slows new blood vessel growth. If used early in people with nonproliferative diabetic retinopathy, laser surgery can protect the retina from severe damage.
In later stages, laser surgery typically won’t improve your sight or reverse damage from diabetic retinopathy. Your doctor will likely tell you that this treatment will stabilize your vision instead.
The vitreous is normally a clear fluid that lets light pass through and travel to your retina. People with advanced proliferative diabetic retinopathy may have blood and debris in the vitreous, which worsens their vision. In advanced proliferative diabetic retinopathy, scar tissue can also form on the retina and tug on the tissue, increasing the risk of retinal detachment.
Your eye specialist may perform a vitrectomy to replace the cloudy vitreous with a sterile saline (salt) solution or gas bubble and remove any scar tissue near your retina. Your vision may improve once the cloudy vitreous is removed, and your eyes may be better prepared for laser therapy so that it’s more effective.
If you’re living with diabetes, controlling your blood sugar is the first step toward preventing damage to retinal blood vessels. Further, screening for eye diseases with a detailed eye exam can detect problems like diabetic retinopathy in early stages — prompt treatment can help protect against loss of vision. Diabetes can also lead to other eye conditions, including glaucoma (damage to the optic nerve) and cataracts (clouding of the eye lens).
It’s also important to make an eye appointment if you notice any vision problems or new signs of diabetic retinopathy, including:
Your doctor, endocrinologist, and ophthalmologist can work together to create the best treatment plan for you. Your eye health is extremely important, and it’s best to take steps sooner rather than later to prevent complications of diabetes.
DiabetesTeam is the social network for people with diabetes and their loved ones. On the DiabetesTeam, more than 136,000 members come together to ask questions, give advice, and share their stories with others who understand life with diabetes.
Are you living with diabetic retinopathy? What symptoms did you experience? Have you tried any treatments? Share your thoughts in the comment below, or start a conversation by posting on your Activities page.