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Diabetic retinopathy is a complication of diabetes which can damage tiny, blood vessels in the retina at the back of the eye.

The retina is the layer of very special nerve cells in the eye that detect light and convert the light into impulses that are transmitted to the brain. Damage to the retina leads to problems with vision. In severe cases, retinopathy can lead to blindness.²

The blood vessels that supply the retinal cells at the back of the eye are among the finest and most fragile blood vessels in the whole body.

Because they are so fine and fragile, they are among the first blood vessels affected by a number of risk factors.²  These include:

• Hypertension (high blood pressure)²
• High cholesterol and triglycerides²
• High blood sugar^2,3
• Long duration type 2 diabetes^2,3
• Diagnosed type 1 diabetes^2,3

These risk factors cause the blood vessels to become weaker and leak fluid and/or become blocked. Overtime, new blood vessels grow from the retina, but these new vessels are abnormal, and don't develop properly.^2,3

Part of the problem with diabetic retinopathy is that initially, there are no symptoms.^2,4 Symptoms do not occur until the disease is more advanced.^2,4

This problem is made worse when people either don’t notice the earliest symptoms or ignore them. This means that for many people, their diabetic retinopathy can be quite advanced when they are first diagnosed.

There are two strategies that are important in avoiding blindness in people with diabetic retinopathy:⁴

1. Early diagnosis. The earlier diabetic retinopathy can be diagnosed the better, because there is less damage and vision loss has not yet occurred. This means better vision for longer. Early diagnosis can be difficult when the early stages of diabetic retinopathy have no symptoms³ especially when up to 50% of Australians with diabetes do not undergo the recommended eye examinations.^3,5
2. Appropriate treatment. There are a variety of treatments and management approaches including oral prescription medications, laser and other surgical procedures and injections.⁴ All of these attempt to remove or reduce the progression of diabetic retinopathy.

Because the prevention of diabetic retinopathy is so important, the government has created an initiative called the KeepSight program. You can learn more about this here.

It’s important to remember that, at first, there may be no symptoms.^2-4 As diabetic retinopathy advances, people may notice:⁷

• Floaters (spots or dark strings)
• Blurred vision
• Fluctuating vision
• Impaired colour vision
• Dark or empty areas in vision
• Vision loss

Once the disease reaches an advanced stage, vision loss can occur rapidly and can be permanent.

Your vision may be assessed by both your GP and/or specialist eye care provider using a special camera-like instrument to take photos of the retina at the back of the eye. Some GPs may do this if they have the special device to take photos of the back of the eye.

Before examination, the specialist eye care provider may use eye drops to dilate your pupil (make them wider) so they can see inside. They are looking for:⁸

• Abnormal blood vessels
• Swelling, blood or fatty deposits in the retina
• Growth of new blood vessels
• Scar tissue
• Bleeding
• Retinal detachment (where the retina come away from the back of the eye)
• Abnormalities of the optic nerve

Additional testing
Your specialist eye care provider might also inject a special dye (into the vein in your arm) and take more pictures of your eye as the dye circulates through the blood vessels in your eye.⁸

Your doctor is worried about your eyesight and doesn’t want you to go blind.

High blood pressure, blood lipids and blood sugar cause diabetic retinopathy,^2,3 and while they are high, your eyesight will keep getting worse.

Your doctor will probably want to monitor your eyes and blood levels very closely to see whether they are improving as they adjust treatment. You can learn more about the options for treating diabetic retinopathy here.

• It’s important to get your risk factors under control. This means reducing your blood sugar, blood pressure, blood cholesterol and triglycerides. You may be able to do this with lifestyle changes or, you may need medications. Your doctor will discuss your individual risks and the best solutions for you.²
• Get your eyes examined by an eye specialist (or your GP if the practice has the special camera) regularly. If you have diabetes and have never had your eyes checked, get them checked as soon as possible. If you have diabetes and it has been more than two years since you had your eyes checked, get them checked as soon as possible. If you would like to receive a reminder whenever your eye examination is due, sign up for KeepSight’s reminder service. You can learn more about this service here.
• Be mindful of the first symptoms of diabetic retinopathy. If you believe that you are experiencing any of them, it’s important to act quickly and speak with your doctor. If you’re hesitating, you might find Ebony’s Story motivating.
• If you smoke, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications, including diabetic retinopathy.
• Ensure you are managed by your doctor for diabetic retinopathy. If you already have diabetic retinopathy, treatment will slow and possibly stop its progression. If you don't have diabetic retinopathy, your doctor will provide you with advice to reduce your chance of getting it.