How Diabetic Retinopathy Is Treated

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Diabetic retinopathy is an eye condition that can cause vision loss and even blindness in people with diabetes. It is caused by high blood sugar (glucose) levels, which can affect blood vessels in the retina of the eye.

Diabetic retinopathy can be diagnosed by a physician, usually an ophthalmologist, through a comprehensive dilated eye exam. Additional eye exams might be performed based on the results of the dilated eye exam. Treatment for diabetic retinopathy can vary depending on the severity of the condition.

Slit lamp eye exam


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Non-proliferative diabetic retinopathy (NPDR) is the early stage of the disease. Your doctor might recommend no medical treatment at first if your diabetic retinopathy is caught early. If this is the case, you may have more frequent eye exams to watch for any disease progression and the possible need for medical treatment.

Proliferative diabetic retinopathy (PDR) is a more advanced stage of the disease. Common therapies include laser treatments, eye surgery, and medication injections into the eye.

If you have PDR, you are at risk for other eye complications such as glaucoma and macular edema. Your doctor may recommend additional treatments depending on the severity of the disease and if you have any other complications.

In addition to medical treatments and regardless of the disease stage, managing your diabetes is recommended to help prevent or slow further vision problems.

Lifestyle

Managing your diabetes can help prevent or delay any further vision problems. There are several different things you can do to get better control of your condition.

Track Blood Sugar Levels

Keeping track of your blood sugar levels will help you know how your diabetes is doing. Lifestyle habits, such as food and physical activity, as well as medication adherence, stress, and even sleep habits can all affect your blood sugar levels.

By watching for trends in your blood sugar levels, you can better pinpoint what you might need to adjust to manage your diabetes better.

Depending on the type of diabetes you have, as well as the severity of the disease and the medications you take, your doctor may recommend different frequencies of testing.

Some people with type 2 diabetes might only test once daily. Other people with diabetes test multiple times a day. Follow your doctor's recommendations on how often you should check your blood sugar levels.

Exercise

Physical activity improves insulin sensitivity, which can then help improve your blood sugar levels.

It’s recommended that adults get at least 150 minutes of moderate-intensity aerobic exercise each week. Adults should also do muscle-strengthening activities of moderate or greater intensity at least two days a week.

Find a form of exercise you enjoy—you are more likely to stick to it if you have fun doing it. If you haven’t been exercising, start with just five to 10 minutes at a time. Slowly work your way up to longer stretches at a time.

Diet

Changing your eating habits to include a variety of healthy foods can have a direct impact on blood sugar levels.

There is no single diabetes diet. However, most healthy eating plans include fruits, vegetables, whole grains, lean meats, and plant-based sources of protein while limiting added sugars and ultra-processed foods.

A good rule of thumb: Fill half of your plate with non-starchy vegetables, a quarter with lean protein, and the remaining quarter with carbohydrates.

Whichever eating plan you choose to follow, make sure it is realistic and flexible for your lifestyle. This will help you be more successful in the long run.

Medications to Manage Diabetes

There are several different types of medications people with diabetes may be prescribed to help manage your diabetes, including oral medication or injectable medication. Taking your medication as prescribed will help your blood sugar levels be more stable, improving your glycemic control.

Regular Eye Exams

As part of your diabetes care, it is important for you to get an annual comprehensive dilated eye exam. This is because diabetic retinopathy may not have any symptoms at first. Detecting it early can help you take actions to prevent or slow further eye damage and progression of the disease.

If you have been diagnosed with diabetic retinopathy, you may need more frequent eye exams to monitor the disease. Be sure to follow your doctors recommended exam schedule to ensure the greatest chance of detecting any changes or progress in your diabetic retinopathy.

Surgeries and Specialist-Driven Procedures

Laser Treatment

Laser treatment, called photocoagulation, uses the heat from a laser to stop the leakage of blood and fluid into the retina.

Prior to the laser treatment, your doctor will dilate and numb your eye. They will then use a laser to create small burns on abnormal blood vessels of the retina. This process destroys the abnormal blood vessels or seals the blood from leaking.

When the blood and fluid leaking is stopped, swelling of the retina is reduced. Laser photocoagulation can also shrink blood vessels and prevent them from growing again. You may need more than one laser treatment to achieve optimal results.

Laser therapy is an outpatient medical treatment. After the treatment, your vision will be blurry for a day or two, so you will need someone to drive you home from your appointment. You may also have slight pain in your eye for a couple of days following the procedure.

As with any medical treatment, there are risks in addition to the benefits. Due to the laser making burns in your retina, risks of photocoagulation therapy include the loss or decrease of color vision, peripheral (side) vision, and night vision.

Nevertheless, many people decide to get laser photocoagulation treatments because the benefits of preventing severe vision loss or blindness outweigh the risks.

Discuss the pros and cons with your doctor to aid you in making your decision.

Surgery

Your doctor may recommend vitrectomy eye surgery if you have advanced stage PDR. During a vitrectomy, your doctor will make very small openings in your eye and remove most of the vitreous gel in your eye.

Vitrectomy is useful because it tries to remove the inflammatory vitreous-macula interface that often causes persistent changes despite treatment.

Additionally, sometimes vitrectomy with endolaser is performed to clear non-clearing vitreous hemorrhage that occurs in proliferative diabetic retinopathy. This is the most severe form of diabetic retinopathy and the one that is most threatening to your vision.

Your doctor may numb your eye with drops or shots for the procedure, or they might use anesthesia to put you to sleep. You can discuss these options with your doctor.

Many times a vitrectomy is an outpatient procedure. However, some people do stay in the hospital overnight. You will need someone to drive you home, as you may have some eye pain and blurry vision. Additionally, your eye may be swollen and red for several weeks following the surgery.

Injections

A relatively new treatment mode for diabetic retinopathy comes in the form of injecting medication into the eye. There are two main types of medications your doctor might inject into your eye, including anti-VEGF medications and corticosteroids. Injections may be used alone or in combination with other modes of treatment.

Anti-VEGF

Anti-VEGF medication, or vascular endothelial growth factor (VEGF) inhibitors, is a class of medication that helps reduce swelling of the macula, delaying or reversing diabetic retinopathy. It works by blocking the effects of growth signals the body sends to create new blood vessels.

There are different anti-VEGF medications available. These include Avastin, Eylea, and Lucentis. Which one your doctor prescribes depends on the severity of your diabetic retinopathy.

Typically a round of three to four injections is done and the response is checked by exam and optical coherence tomography. If there is resolution of the issue, the injections are ceased, or pan-retinal photocoagulation is performed if indicated.

If there is persistent macular edema or swelling in the macula, an additional round of treatment is initiated.

Steroids

Steroid medications are another injectable medication used to treat diabetic retinopathy. It can reduce swelling and help stabilize or improve your vision. These can be administered as eye drops, eye injections, or an implanted device.

Risks of corticosteroids include an increased risk of developing glaucoma and cataracts. If you get steroid injections in your eye, be sure to get regular eye exams to look for any signs of these complications.

Complementary Alternative Medicine

Many alternative therapies for diabetic retinopathy lack strong scientific backing. No form of complementary alternative medicine can compensate for having consistently high blood sugar levels.

Some supplements, such as alpha-lipoic acid (ALA), lutein, zeaxanthin, and vitamins A, C, and E, have been claimed to help with vision problems, including diabetic retinopathy. However, while these supplements may be beneficial for overall eye health, they are not considered a standard treatment for diabetic retinopathy.

More research is needed before recommendations can be made regarding their possible use as a supplemental treatment for diabetic retinopathy.

A Word From Verywell

The goal of diabetic retinopathy treatment is to preserve your vision while preventing or delaying further vision loss. As with any disease, talk with your healthcare team regarding your different treatment options. Weigh the benefits and risks of the various treatment methods to aid you in making the best decision for yourself.

Always tell your doctor about any other medications, vitamins, herbs, or supplements you are taking, as they may interact with or impact different treatment options.

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