Diabetic retinopathy is a common complication of diabetes that affects the retina, the light-sensitive tissue at the back of the eye responsible for vision. High blood sugar levels can damage the tiny retinal blood vessels over time, causing them to leak, become blocked or grow abnormally.
Importantly, diabetic retinopathy often develops without noticeable symptoms, meaning retinal damage can occur before you become aware of any change in your vision. Early diagnosis through specialist retinal imaging allows treatment to begin before permanent vision loss develops.
At The Retina Clinic London, we provide comprehensive assessment, advanced retinal imaging and personalised treatment to help preserve vision at every stage of diabetic retinopathy.
What are the symptoms of diabetic retinopathy?
In its early stages, diabetic retinopathy often causes no symptoms. As the condition progresses, symptoms may include:
- Blurred or fluctuating vision
- Floaters (spots or cobweb-like shapes drifting across your vision)
- Dark or empty areas in your vision
- Distorted central vision
- Colours appearing less vivid
- Difficulty seeing in dim light
- Sudden vision loss in more advanced cases
Symptoms may only become noticeable once the disease has significantly progressed, highlighting the importance of regular retinal examinations even when your vision appears normal.
Diabetic retinopathy is generally classified into two stages:
Non-proliferative diabetic retinopathy (NPDR) is the earlier stage, where damaged retinal blood vessels may leak fluid or blood.
Proliferative diabetic retinopathy (PDR) is the more advanced stage, where fragile new blood vessels grow on the retinal surface. These abnormal vessels can bleed, cause scar tissue to form and increase the risk of retinal detachment.
Diabetic retinopathy often affects both eyes, although one eye may be more severely affected than the other.
What is diabetic macular oedema?
Diabetic macular oedema (DMO) develops when fluid leaks from damaged retinal blood vessels into the macula, the central part of the retina responsible for detailed vision. This can cause blurred or distorted central vision and is one of the leading causes of vision loss in people with diabetic retinopathy.
Learn more about Diabetic Macular Oedema.
How is diabetic retinopathy diagnosed?
Diagnosing diabetic retinopathy requires a detailed examination of the retina using advanced imaging technologies. At The Retina Clinic London, every assessment is tailored to the individual and may include:
- Ultra-widefield retinal imaging to capture up to 200 degrees of the retina in a single image, allowing disease in the far peripheral retina to be identified.
- Optical Coherence Tomography (OCT) to produce detailed cross-sectional images of the retina and detect diabetic macular oedema.
- Optical Coherence Tomography Angiography (OCTA) to provide a detailed layer-by-layer assessment of the retinal and choroidal circulation without dye injection, complementing fluorescein angiography by revealing vascular changes that conventional angiography cannot demonstrate.
- Ultra-widefield fluorescein angiography, in which a fluorescent dye is injected into a vein in the arm to show how blood flows through the retinal circulation. This allows areas of leakage, retinal ischaemia (reduced blood supply) and abnormal new blood vessel growth to be identified with exceptional detail, helping guide treatment decisions.
These investigations allow us to determine the severity of the disease and create an individualised treatment plan.
How is diabetic retinopathy treated?
Treatment depends on the stage of diabetic retinopathy and whether diabetic macular oedema is present. The aim is to preserve vision, prevent disease progression and reduce the risk of sight-threatening complications.
Treatment options may include:
- Anti-VEGF intravitreal injections to treat diabetic macular oedema by reducing leakage from abnormal blood vessels and drying fluid within the retina. Anti-VEGF therapy is also an effective treatment for many patients with proliferative diabetic retinopathy, helping abnormal new blood vessels regress and, in some cases, reducing or delaying the need for laser treatment.
- Steroid injections for selected patients with persistent or recurrent diabetic macular oedema.
- Pan-retinal photocoagulation (PRP) laser to treat proliferative diabetic retinopathy by reducing the retina’s oxygen demand, encouraging abnormal new blood vessels to regress and reducing the risk of serious complications such as vitreous haemorrhage and retinal detachment. PRP may be used alone or alongside anti-VEGF treatment.
- Vitrectomy surgery for advanced complications such as non-clearing vitreous haemorrhage, tractional retinal detachment or persistent vitreomacular traction associated with diabetic eye disease.
Treatment aims to preserve vision, reduce the risk of complications and maintain long-term retinal health.
Preventing progression
Although diabetic retinopathy cannot always be prevented, its progression can often be slowed through good diabetic control and regular eye monitoring.
Good control of blood sugar, blood pressure and cholesterol not only reduces the risk of diabetic retinopathy developing but can also slow progression in patients who already have the condition.
You can help reduce your risk by:
- Maintaining good blood sugar control
- Keeping blood pressure within the recommended range
- Managing cholesterol levels
- Attending regular diabetic retinal screening appointments
- Seeking specialist retinal assessment if diabetic retinopathy has been detected or your vision changes
Monitoring diabetic retinopathy
Regular monitoring is essential, even if treatment is not immediately required. Changes in diabetic retinopathy can occur gradually and without symptoms.
Using advanced retinal imaging, we can monitor subtle changes over time and recommend treatment at the most appropriate stage.
What is the outlook for diabetic retinopathy?
A diagnosis of diabetic retinopathy does not necessarily mean that vision loss will occur. With early diagnosis, careful monitoring and timely treatment where appropriate, many people maintain useful vision throughout their lives.
Modern retinal imaging, including ultra-widefield fluorescein angiography and ultra-widefield optical coherence tomography angiography (OCTA), allows retinal changes to be detected at an earlier stage, often before they affect vision. This enables treatment to be planned promptly and tailored to the individual, reducing the risk of permanent sight loss.
The outlook depends on the severity of the disease, whether diabetic macular oedema is present, and how well diabetes and other risk factors are controlled.
When should you seek urgent assessment?
Seek urgent ophthalmic assessment if you experience:
- A sudden reduction in vision
- A large increase in floaters
- Flashing lights
- A dark curtain or shadow across your vision
These symptoms can indicate serious retinal complications that require prompt assessment.
Why choose The Retina Clinic London?
At The Retina Clinic London, diabetic retinopathy care is led by internationally recognised retinal specialists using comprehensive multimodal imaging, including ultra-widefield fluorescein angiography, to detect even subtle retinal changes.
Every treatment plan is tailored to the individual, with access to the latest medical therapies, advanced laser treatments, vitreoretinal surgery and selected clinical research studies where appropriate.
Our integrated approach combines early diagnosis, state-of-the-art multimodal imaging, expert monitoring and evidence-based treatment to help patients preserve vision and reduce the risk of long-term complications.
Book a diabetic retinal assessment
If you have diabetes, have been diagnosed with diabetic retinopathy, or have noticed changes in your vision, early assessment is essential.
Book a comprehensive Diabetic Retinal Assessment at The Retina Clinic London to benefit from expert retinal care, advanced imaging and a personalised treatment plan designed to protect your sight.