Diabetic Retinopathy | National Eye Institute

What is diabetic retinopathy?

Diabetic retinopathy is an eye condition that can cause vision loss and blindness in people who have diabetes. It affects blood vessels in the retina (the light-sensitive layer of tissue in the back of your eye).

If you have diabetes, it’s important to get a comprehensive dilated eye exam at least once a year. Diabetic retinopathy may not have any symptoms at first — but finding it early can help you take steps to protect your vision. 

Managing your diabetes — by staying physically active, eating healthy, and taking your medicine — can also help you prevent or delay vision loss.  

Other types of diabetic eye disease

Diabetic retinopathy is the most common cause of vision loss for people with diabetes. But diabetes can also make you more likely to develop several other eye conditions: 

• Cataracts.  Having diabetes makes you 2 to 5 times more likely to develop cataracts. It also makes you more likely to get them at a younger age. Learn more about cataracts. 

• Open-angle glaucoma. Having diabetes nearly doubles your risk of developing a type of glaucoma called open-angle glaucoma. Learn more about glaucoma. 

What are the symptoms of diabetic retinopathy?

The early stages of diabetic retinopathy usually don’t have any symptoms. Some people notice changes in their vision, like trouble reading or seeing faraway objects. These changes may come and go. 

In later stages of the disease, blood vessels in the retina start to bleed into the vitreous (gel-like fluid that fills your eye). If this happens, you may see dark, floating spots or streaks that look like cobwebs. Sometimes, the spots clear up on their own — but it’s important to get treatment right away. Without treatment, scars can form in the back of the eye. Blood vessels may also start to bleed again, or the bleeding may get worse.

What other problems can diabetic retinopathy cause?

Diabetic retinopathy can lead to other serious eye conditions: 

• Diabetic macular edema (DME). Over time, about 1 in 15 people with diabetes will develop DME. DME happens when blood vessels in the retina leak fluid into the macula (a part of the retina needed for sharp, central vision). This causes blurry vision.
• Neovascular glaucoma. Diabetic retinopathy can cause abnormal blood vessels to grow out of the retina and block fluid from draining out of the eye. This causes a type of glaucoma (a group of eye diseases that can cause vision loss and blindness).

Learn more about types of glaucoma

• Retinal detachment. Diabetic retinopathy can cause scars to form in the back of your eye. When the scars pull your retina away from the back of your eye, it’s called tractional retinal detachment.

Learn more about types of retinal detachment

Am I at risk for diabetic retinopathy?

Anyone with any kind of diabetes can get diabetic retinopathy — including people with type 1, type 2, and gestational diabetes (a type of diabetes that can develop during pregnancy).   

Your risk increases the longer you have diabetes. Over time, more than half of people with diabetes will develop diabetic retinopathy. The good news is that you can lower your risk of developing diabetic retinopathy by controlling your diabetes.  

Women with diabetes who become pregnant — or women who develop gestational diabetes — are at high risk for getting diabetic retinopathy. If you have diabetes and are pregnant, have a comprehensive dilated eye exam as soon as possible. Ask your doctor if you’ll need additional eye exams during your pregnancy.  

What causes diabetic retinopathy?

Diabetic retinopathy is caused by high blood sugar due to diabetes. Over time, having too much sugar in your blood can damage your retina — the part of your eye that detects light and sends signals to your brain through a nerve in the back of your eye (optic nerve).  

Diabetes damages blood vessels all over the body. The damage to your eyes starts when sugar blocks the tiny blood vessels that go to your retina, causing them to leak fluid or bleed. To make up for these blocked blood vessels, your eyes then grow new blood vessels that don’t work well. These new blood vessels can leak or bleed easily. 

How will my eye doctor check for diabetic retinopathy?

Eye doctors can check for diabetic retinopathy as part of a dilated eye exam. The exam is simple and painless — your doctor will give you some eye drops to dilate (widen) your pupil and then check your eyes for diabetic retinopathy and other eye problems.

Learn what to expect from a dilated eye exam

If you have diabetes, it’s very important to get regular eye exams. If you do develop diabetic retinopathy, early treatment can stop the damage and prevent blindness.  

If your eye doctor thinks you may have severe diabetic retinopathy or DME, they may do a test called a fluorescein angiogram. This test lets the doctor see pictures of the blood vessels in your retina. 

What can I do to prevent diabetic retinopathy?

Managing your diabetes is the best way to lower your risk of diabetic retinopathy. That means keeping your blood sugar levels in a healthy range. You can do this by getting regular physical activity, eating healthy, and carefully following your doctor’s instructions for your insulin or other diabetes medicines.  

To make sure your diabetes treatment plan is working, you’ll need a special lab test called an A1C test. This test shows your average blood sugar level over the past 3 months.  You can work with your doctor to set a personal A1C goal. Meeting your A1C goal can help prevent or manage diabetic retinopathy.

Learn more about the A1c test

Having high blood pressure or high cholesterol along with diabetes increases your risk for diabetic retinopathy. So controlling your blood pressure and cholesterol can also help lower your risk for vision loss.

What’s the treatment for diabetic retinopathy and DME?

In the early stages of diabetic retinopathy, your eye doctor will probably just keep track of how your eyes are doing. Some people with diabetic retinopathy may need a comprehensive dilated eye exam as often as every 2 to 4 months.  

In later stages, it’s important to start treatment right away — especially if you have changes in your vision. While it won’t undo any damage to your vision, treatment can stop your vision from getting worse. It’s also important to take steps to control your diabetes, blood pressure, and cholesterol.  

Injections. Medicines called anti-VEGF drugs can slow down or reverse diabetic retinopathy. Other medicines, called corticosteroids, can also help.

Learn more about injections

Laser treatment. To reduce swelling in your retina, eye doctors can use lasers to make the blood vessels shrink and stop leaking.

Learn more about laser treatment for diabetic retinopathy

Eye surgery. If your retina is bleeding a lot or you have a lot of scars in your eye, your eye doctor may recommend a type of surgery called a vitrectomy.

Learn more about vitrectomy

What is the latest research on diabetic retinopathy and DME?

Scientists are studying better ways to find, treat, and prevent vision loss in people with diabetes. One NIH-funded research team is studying whether a cholesterol medicine called fenofibrate can stop diabetic retinopathy from getting worse.

Get the latest news on NEI-supported diabetic eye disease research

Diabetic Eye Disease Resources

• Find statistics and data on diabetic retinopathy in the United States
• Check out our library of diabetic eye disease videos
• See our materials for community health educators
• Get flyers, booklets, and other resources about diabetic eye disease

Last updated: July 8, 2022

Fluorescein angiography: MedlinePlus Medical Encyclopedia

Fluorescein angiography is an eye test that uses a special dye and camera to look at blood flow in the retina and choroid. These are the two layers in the back of the eye.

You will be given eye drops that make your pupil dilate. You will be asked to place your chin on a chin rest and your forehead against a support bar to keep your head still during the test.

The health care provider will take pictures of the inside of your eye including the back of your eye (retina). After the first group of pictures is taken, a dye called fluorescein is injected into a vein. Most often it is injected at the inside of your elbow. A camera-like device takes pictures as the dye moves through the blood vessels in the back of your eye.

A newer method called ultra-widefield fluorescein angiography can provide more information about certain diseases than regular fluorescein angiography.

You will need someone to drive you home. Your vision may be blurry for up to 12 hours after the test.

You may be told to stop taking medicines that could affect the test results. Tell your provider about any allergies, particularly reactions to iodine.

You must sign an informed consent form. You must remove contact lenses before the test.

Tell the provider if you may be pregnant.

When the needle is inserted, some people feel slight pain. Others feel only a prick or sting. Afterward, there may be some throbbing.

When the dye is injected, you may have mild nausea and a warm feeling in your body. These symptoms go away quickly most of the time.

The dye will cause your urine to be temporarily darker. It may be orange in color for a day or two after the test.

This test is done to see if there is proper blood flow in the blood vessels in the two layers in the back of your eye (the retina and choroid).

It can also be used to diagnose problems in the eye or to determine how well certain eye treatments are working.

A normal result means the vessels appear a normal size, there are no new abnormal vessels, and there are no blockages or leakages.

If blockage or leakage is present, the pictures will map the location for possible treatment.

An abnormal result of a fluorescein angiography may be due to:

• Blood flow (circulatory) problems, such as blockage of the arteries or veins
• Cancer
• Diabetic or other retinopathy
• High blood pressure
• Inflammation or swelling edema
• Macular degeneration
• Microaneurysms — enlargement of capillaries in the retina
• Tumors
• Swelling of the optic disc

The test may also be done if you have:

• Retinal detachment
• Retinitis pigmentosa

There is a slight chance of infection any time the skin is broken. Rarely, a person is overly sensitive to the dye and may experience:

• Dizziness or faintness
• Dry mouth or increased salivation
• Hives
• Increased heart rate
• Metallic taste in mouth
• Nausea and vomiting
• Sneezing

Serious allergic reactions are rare.

The test results are harder to interpret in people with cataracts. Blood flow problems shown on fluorescein angiography may suggest blood flow problems in other parts of the body.

Retinal photography; Eye angiography; Angiography – fluorescein

• Retinal dye injection

Chen JJ, Peng M, Haug S, et al. Fluorescein angiography: basic principles and interpretation. In: Sadda SVR, Sarraf D, Freund KB, et al , eds. Ryan’s Retina. 7th ed. Philadelphia, PA: Elsevier; 2023:chap 1.

Elnahry AG, Ramsey DJ. Automated image alignment for comparing microvascular changes detected by fluorescein angiography and optical coherence tomography angiography in diabetic retinopathy. Semin Ophthalmol. 2021;36(8):757-764. PMID: 33784213 pubmed.ncbi.nlm.nih.gov/33784213/.

Feinstein E, Olson JL, Mandava N. Camera-based ancillary retinal testing: autofluorescence, fluorescein, and indocyanine green angiography. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 6.6.

Glacet-Bernard A, Miere A, Houmane B, Tilleul J, Souied E. Nonperfusion assessment in retinal vein occlusion: comparison between ultra-widefield fluorescein angiography and widefield optical coherence tomography angiography. Retina. 2021;41(6):1202-1209. PMID: 33105298 pubmed.ncbi.nlm.nih.gov/33105298/.

Karampelas M, Sim DA, Chu C, et al. Quantitative analysis of peripheral vasculitis, ischemia, and vascular leakage in uveitis using ultra-widefield fluorescein angiography. Am J Ophthalmol. 2015;159(6):1161-1168. PMID: 25709064 pubmed.ncbi.nlm.nih.gov/25709064/.

Taha NM, Asklany HT, Mahmoud AH, et al. Retinal fluorescein angiography: a sensitive and specific tool to predict coronary slow flow. Egypt Heart J. 2018;70(3):167-171. PMID: 30190642 pubmed.ncbi.nlm.nih.gov/30190642/.

Updated by: Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Blood from the eyes • Anna Novikovskaya • Scientific picture of the day on “Elements” • Herpetology

Creepy, isn’t it? The toad-like or horned lizard ( Phrynosoma ) squirts blood from its eyes into a predator when all other defenses fail. Such a “bloody cannon” shoots at a distance of up to one and a half meters! This ability is called “autohemorrhaging” (see Autohaermorrhaging), and among animals it is quite rare.

At least eight of the twenty-two species of toad-like lizards are capable of splattering blood. This is achieved through the use of sphincter muscles in the large cranial veins, typical of all lepidosaurs (the superorder that includes lizards, snakes, and tuatara). Usually these muscles are used to control blood pressure, but horned lizards use them in a rather original way, blocking the outflow of blood from the head, as a result of which the pressure in the skull rises sharply. Because of this, small capillaries around the eyelids burst, and blood splashes out of the tear duct.

Since blood flows from each half of the head through its own veins, the lizard can regulate which eye it “splashes”. Such an attack not only has a stunning effect, it can also scare away a coyote or wild cat with an unpleasant smell of blood; however, it does not have such a strong effect on birds of prey.

The compounds that make lizard blood taste bad were previously thought to be secreted by glands in the orbital cavity immediately prior to attack, but it is now understood that they circulate in the blood of horned lizards all the time. The origin of these substances is still unknown, although it can be assumed that the lizard receives them from food – a variety of insects and desert plants.

Still, shooting blood from the eyes is quite wasteful, and the lizards resort to this as a last resort. In the deserts of North and Central America, where horned lizards live, there are quite a lot of predators, so these reptiles approached the defense with all responsibility. Firstly, their small, rounded bodies (no larger than a human palm) are painted in gray, brown and black tones, which allows them to blend in perfectly with the terrain. Secondly, numerous spikes and horn-like outgrowths not only perform the function of passive protection, but also “blur” the silhouette of the lizard, so that it becomes even more difficult for the enemy to notice it. When escaping, these reptiles try to move in short dashes with abrupt stops, trying to confuse the predator and make it lose sight of itself. If this does not help, the lizard goes on active defense. First of all, it swells up, raising all its spikes on end and giving itself an even more spiked, “inedible” appearance. To make it more difficult for an enemy to grab its head or neck, the lizard bends down or, conversely, raises its head so that its cranial spines are directed upwards or backwards. To prevent a predator from grabbing its body, the lizard can press its belly to the ground – this will prevent, say, a hungry coyote from closing its jaws around its body. Well, if this whole set of actions still does not help, then, as we already know, the lizard shoots blood at the offender.

Among vertebrates, in addition to horned lizards, some snake species can also squirt blood. They mainly exude blood from their mouths or cloacas – for example, a common grass snake pretending to be dead will bleed from its mouth to be convincing. But only representatives of the genus earthen boas ( Tropidophis ) are able to secrete blood from the nostrils or eyes.

However, most often autohemorrhage is observed in insects. At the same time, many species in the hemolymph contain toxic or unpleasantly smelling substances that scare away enemies: for example, the caustic substance cantharidin circulates in the hemolymph of blister beetles (which bustards skillfully use, see the picture of the day Dance of the bustard and blister beetles), and “milk” ladybugs, which they secrete from the knee joints, contains alkaloid toxins, whose taste and smell reliably repel even the most unassuming predators.

Grasshopper hemolymph Eugaster spinulosa , which it sprays from the holes on its legs, is non-poisonous, but sticky. (see picture of the day Grasshopper splashing “blood”). In addition to beetles and grasshoppers, bed bugs, some hymenoptera (such as sessile belly larvae) and stoneflies also use this method of protection.

Image from freewechat.com.

Anna Novikovskaya

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