Diabetic retinopathy

Diabetic retinopathy is often diagnosed with a dilated eye exam. For this exam, an eye care professional places drops in your eyes. The drops widen your pupils to give the eye care professional a better view inside your eyes. The drops can cause your near vision, also called reading vision, to blur for several hours.

During the exam, the eye care professional looks for irregularities in the inside and outside parts of your eyes.

Other tests that may be used include:

Optical coherence tomography

With this test, also called OCT, cross-sectional images of the retina show the anatomy and thickness of the retina. This helps determine how much fluid, if any, has leaked into retinal tissue. Later, OCT exams can be used to check if treatment is working.

Fluorescein angiography

After your eyes are dilated, a dye is injected into a vein in your arm. Then pictures are taken as the dye circulates through blood vessels in your eyes. The pictures can pinpoint blood vessels that are closed, broken or leaking.

Treatment depends largely on the type of diabetic retinopathy you have and how severe it is. Treatment is aimed at slowing or stopping the condition from getting worse.

Early diabetic retinopathy

If you have mild or moderate nonproliferative diabetic retinopathy, you might not need treatment right away. Your eye care professional will closely watch your eyes to decide if and when you might need treatment.

Work with the healthcare professional who treats your diabetes to see if there are ways to improve your diabetes management. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the worsening of symptoms.

Advanced diabetic retinopathy

If you have proliferative diabetic retinopathy, you'll need treatment. Macular edema is often treated as well, but your retina specialist helps guide the best time to treat. Depending on the specific problems with your retina, options might include:

• Eye injections. These medicines, called vascular endothelial growth factor inhibitors, are injected into the fluid in the center of your eye, called the vitreous. The medicines help stop the growth of new blood vessels and decrease fluid buildup.

  Three drugs are approved by the U.S. Food and Drug Administration, also called the FDA, for treatment of diabetic macular edema. These medicines are ranibizumab (Lucentis), aflibercept (Eylea) and faricimab (Vabysmo). A fourth drug, bevacizumab (Avastin), is often used off-label for the treatment of diabetic macular edema. Off-label means a medicine is used for a condition other than what the FDA approved it for.

  These medicines are injected using topical anesthesia. The injections can cause mild discomfort, such as burning, tearing or pain, for 24 hours after the injection. Possible side effects include a buildup of pressure in the eye and infection.

  These injections need to be repeated. In some cases, the medicine is used with laser photocoagulation.

• Laser therapy. In this treatment, also called laser photocoagulation, laser beams of light are used to burn or shrink irregular blood vessels in the eye or treat areas of the retina without good blood flow. This can stop or slow the leakage of blood and fluid. Treating areas of the retina without good blood flow also reduces the growth of irregular blood vessels.

  Laser treatment usually is done in a medical professional's office or eye clinic. You may need more than one session. Most people have blurry vision for about a day after the treatment. Some loss of outer vision or night vision after the treatment is possible.

• Vitrectomy. Vitrectomy is a surgical procedure where small tools are inserted through the white part of the eye, called the sclera, into the vitreous cavity in the center of the eye. During the procedure, blood from vitreous hemorrhages can be removed. Retinal detachments and scar tissue related to proliferative diabetic retinopathy also can be treated. This surgery is done in a surgery center or hospital using local or general anesthesia.

While treatment can slow or stop the worsening of diabetic retinopathy, it's not a cure. Because diabetes is a lifelong health problem, future retinal damage and vision loss are still possible.

Even after treatment for diabetic retinopathy, you'll need regular eye exams. At some point, you might need added treatment.

Some alternative therapies might help people with diabetic retinopathy, but more research is needed to understand whether these treatments are effective and safe.

Let your healthcare team know if you take herbal or vitamin supplements. They can affect other medicines or cause problems in surgery, such as too much bleeding.

It's important not to delay standard treatments to try unproven therapies. Early treatment is the best way to stop vision loss.

The thought that you might lose your sight can be frightening, and you may benefit from talking to a therapist or finding a support group. Ask your eye care professional for referrals.

If you've already lost vision, ask about low vision products, such as magnifiers, and services that can make daily living easier.

The American Diabetes Association suggests that people with type 1 diabetes have an eye exam within five years of being diagnosed with type 1 diabetes. If you have type 2 diabetes, the group suggests getting your first eye exam at the time you're found to have type 2 diabetes.

If there's no evidence of retinopathy on your initial exam, the American Diabetes Association recommends that people with diabetes get dilated and have a complete eye exam at least every two years. If you have any level of retinopathy, you'll need eye exams at least annually. Ask your healthcare professional what is best for you.

The America Diabetes Association suggests that people with diabetes have an eye exam before becoming pregnant or during the first trimester of pregnancy. People who are pregnant need to be monitored closely and checked for 12 months after giving birth. Pregnancy can sometimes cause diabetic retinopathy to develop or get worse.

Here's some information to help you get ready for your eye appointment.

What you can do

• Write a summary of your diabetic history. This includes when you were diagnosed, medicines you have taken for diabetes now and in the past, recent average blood sugar levels, and your last few hemoglobin A1C readings.
• List all medications, vitamins and other supplements you take. This includes the dosages.
• List your symptoms, if any. Include those that may seem unrelated to your eyes.
• Ask a family member or friend to go with you. If someone comes with you, it may be easier to remember the information you receive. Also, because your eyes will be dilated, this person can drive you home.
• List questions for your healthcare professional.

For diabetic retinopathy, questions to ask include:

• How is diabetes affecting my vision?
• Do I need other tests?
• Is this health problem short term or long lasting?
• What treatments are available, and which do you suggest?
• What side effects might I expect from treatment?
• I have other health problems. How can I best manage them together?
• If I manage my blood sugar well, will my eye problems improve?
• What do my blood sugar goals need to be to protect my eyes?
• Can you suggest services for people with visual damage?

Don't be afraid to ask other questions you have.

What to expect from your doctor

Your eye care professional is likely to ask you questions, including:

• Do you have eye complaints, such as blurred vision or floaters?
• How long have you had eye complaints?
• In general, how well are you controlling your diabetes?
• What was your last hemoglobin A1C?
• Do you have other health problems, such as high blood pressure or high cholesterol?
• Have you had eye surgery?