High Blood Sugar Can Affect Your Eyes—Here’s What to Know About Diabetic Retinopathy Symptoms

Thanks to advancements in early detection and treatment options, it’s possible to live a long and healthy life after being diagnosed with type 1 or type 2 diabetes. But since the chronic condition can affect your total-body health, doing so may require regular check-ups—including regular eye exams to screen for early symptoms of diabetic retinopathy. 

Diabetic retinopathy occurs when high levels of blood sugar (a common marker of diabetes) damage the tiny blood vessels in the retina, a layer of tissue in the back of the eye that detects light and sees objects, explains Philip Ferrone, MD, a retina specialist at Vitreoretinal Consultants of New York. This leads to vision changes, and if it goes untreated for long enough, it can even cause vision loss. 

Anyone with type 1 or type 2 diabetes is at risk of developing diabetic retinopathy. In fact, the National Eye Institute says that up to 50 percent of people with diabetes will eventually develop diabetic retinopathy symptoms, which can range from mild to severe. 

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Luckily, diabetic retinopathy treatment can help stabilize and often improve symptoms before they progress to the point where the condition significantly affects your vision. That’s why Dr. Ferrone says it’s essential to keep your hemoglobin A1C levels below 7.0 in addition to knowing the early warning signs of diabetic retinopathy.  

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Diabetic retinopathy symptoms you shouldn’t ignore

Since diabetic retinopathy develops due to chronically-high blood sugar levels, people with undiagnosed or unmanaged diabetes are most at risk. It’s important to realize that it may not cause noticeable symptoms in the earliest stages, which means people are more likely to notice general diabetes symptoms before diabetic retinopathy symptoms, Dr. Ferrone says.

Symptoms of diabetes may include: 

• Uncontrollable thirst
• Excessive urination 
• Extreme hunger 
• Weight loss 
• Intermittent blurred vision 

Symptoms of diabetic retinopathy may include: 

• Blurred vision
• Distorted vision 
• Floaters 
• Dark spots in your vision
• Partial or total vision loss 

How doctors diagnose the condition

After being diagnosed with any type of diabetes, your healthcare provider should recommend a visit to an eye doctor. If diabetic retinopathy is detected, then you’ll be referred to a retina specialist, Dr. Ferrone says. During your exams, the doctor will dilate your eyes to examine your retina (often taking photos) and look for early stages of diabetic retinopathy. And you should continue getting eye exams at least yearly to keep tabs on the condition’s progression, he says. 

“If you’re diagnosed with diabetes, you should have a dilated eye exam every year by someone who’s familiar with diabetic changes and can treat you or refer you appropriately,” Dr. Ferrone says. “Just getting a check [like what you’d get to determine if you need] glasses is not the same thing. They have to dilate your pupils and examine the eyes and retinas well.”

“If you have diabetes, you should have a dilated eye exam every year.” —Philip Ferrone, MD

There are a few tests used for diabetic retinopathy diagnosis. One is called a fluorescein angiogram, during which a vegetable-based dye is injected into a vein in your arm, says Dr. Ferrone. A special camera is used to take pictures as the dye travels through the small blood vessels in your eye, allowing a specialist to look for signs of diabetes-related damage. 

Another test is the OCT or optical coherence tomography, Dr. Ferrone says. This uses light waves to create detailed images of the retina, which can then be examined for swelling of the retina and other changes. This test is less invasive than the fluorescein angiogram, but may be more limited to the area it can examine. Your physician can help you determine which one is best for you. 

Diabetic retinopathy stages explained

Diabetic retinopathy is categorized into several stages depending on progression. Ranging from the least to most severe, there are: 

• Mild non-proliferative diabetic retinopathy. During this stage, there’s evidence of microaneurysms, or small bulges in the blood vessels.
• Moderate non-proliferative diabetic retinopathy. There are more microaneurysms and the damaged blood vessels can leak blood and fluid into the retina.
• Severe non-proliferative diabetic retinopathy. The retinal hemorrhages (blood leaks) and lack of normal blood flow of are even more significant.  
• Proliferative diabetic retinopathy. There’s evidence of new abnormal blood vessel growth in the retina and eye. This is the most severe stage of diabetic retinopathy. 

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Effective diabetic retinopathy treatments 

If you’ve been diagnosed with the condition, don’t panic. There are a handful of diabetic retinopathy treatment options that can help protect your vision.

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First, it’s crucial to adhere to your diabetes treatment plan as closely as possible, since that’s the underlying cause of diabetic retinopathy. Dr. Ferrone says patients are typically asked to try to keep their hemoglobin A1C test result (a blood test that measures your average blood sugar levels over the past three months) below seven percent, as well as follow any diet, medication and lifestyle protocols recommended by their doctor. This includes treating any other conditions you may have such as high blood pressure, which can contribute to blood vessel damage as diabetes does.

Additionally, your healthcare provider may recommend injections of anti-vascular endothelial growth factor (anti-VEGF) drugs or laser treatment to manage diabetic retinopathy, Dr Ferrone says. These decrease swelling buildup and treat harmful, weak blood vessel changes in the retina. “The anti-VEGF drugs work very well, but they have a limited duration of action. So you need to get re-treated with these drugs every four to 12 weeks or so,” Dr Ferrone says. 

Occasionally steroid drug injections are also used for treatment of these problems. Dr. Ferrone notes that in the future, other drugs that may be helpful for treatment include tyrosine kinase inhibitor drugs, which are being studied but not yet FDA-approved. The most severe diabetic retinopathy changes and bleeding may require what’s called vitrectomy surgery to remove blood, scar tissue and treat other changes in the eye that result from advanced diabetic retinopathy, he says.