Diabetic retinopathy is damage to the retina’s blood vessels caused by chronically high blood sugar, and it often causes no symptoms until it has progressed. Anyone with diabetes needs an annual comprehensive eye exam, which is a central part of the eye disease management our Vancouver doctors provide, to catch it before it threatens vision.
What Diabetic Retinopathy Is
Diabetic retinopathy is damage to the retina caused by chronically elevated blood sugar. Over time, high glucose levels weaken the walls of the tiny blood vessels that nourish the retina, the light-sensitive tissue at the back of the eye. Those vessels leak fluid and blood, swell, and in some cases close off completely.
When part of the retina is starved of oxygen, it signals for new blood vessel growth. These new vessels are fragile and prone to bleeding and scarring — the shift that separates early disease from advanced, sight-threatening disease.
The Four Stages of Diabetic Retinopathy
Diabetic retinopathy progresses in a fairly predictable pattern, which is why consistent annual screening matters — it lets your optometrist catch changes before they become severe.
- Mild nonproliferative retinopathy – Small bulges called microaneurysms form in the retina’s blood vessels. This stage is usually symptom-free.
- Moderate nonproliferative retinopathy – More vessels are affected, some become blocked, and retinal swelling can begin, raising the risk of diabetic macular edema.
- Severe nonproliferative retinopathy – A larger area of the retina loses its blood supply. This is generally considered the tipping point toward proliferative disease.
- Proliferative retinopathy – Abnormal, fragile new blood vessels grow across the retina. This is the most advanced and sight-threatening stage, carrying a high risk of bleeding, scar tissue, and retinal detachment.
Diabetic macular edema, a buildup of fluid in the central retina, can develop at any of these stages and is one of the leading causes of vision loss among people with diabetes.
Why You Can Have Perfect Vision and Still Have Diabetic Retinopathy
The most important thing to understand about diabetic retinopathy is that it typically develops silently. Damage tends to start in the peripheral blood vessels, while the macula — the small central area responsible for sharp, detailed vision — often remains unaffected until the disease reaches a moderate or severe stage.
That means someone can measure 20/20 on a vision chart and still have significant, active retinal damage. Waiting for noticeable vision changes before booking an exam means waiting too long. Annual screening is the only reliable way to catch this disease early, which is a core part of the eye disease management our doctors provide for patients living with diabetes.
Who Is Most at Risk
Anyone with Type 1, Type 2, or gestational diabetes is at risk, and risk generally increases with:
- Longer duration of diabetes — more than half of long-term diabetics develop some degree of retinopathy
- Elevated blood sugar or A1C levels
- High blood pressure or cholesterol
- Pregnancy, including gestational diabetes
- Smoking
How Often You Should Be Screened
The consistent guidance across eye health authorities is an annual comprehensive eye exam for anyone with diabetes. If retinopathy has already been diagnosed or is progressing, your doctor may recommend follow-up imaging every two to four months instead.
Timing differs slightly by diabetes type. Because Type 2 diabetes can go undiagnosed for years, screening should begin right at diagnosis. Type 1 diabetes, typically diagnosed in childhood, rarely causes retinopathy in its first several years, so screening usually starts around five years after diagnosis. From there, both groups need the same annual monitoring.
What Happens During a Diabetic Eye Exam
A diabetic eye exam includes visual acuity testing, tonometry to check eye pressure, and detailed retinal imaging. Traditionally, that imaging has meant dilating drops and a longer, less comfortable appointment.
At Lucent Family Eye Care, our OCT and Optomap imaging technology lets Dr. Yee and Dr. Sultani capture an ultra-widefield view of the retina along with a cross-sectional OCT scan that detects fluid and swelling beneath the surface — often without dilation. That combination gives a more complete picture of retinal health in one comfortable visit, which matters when the goal is catching subtle, early-stage changes before they progress.
Can Diabetic Retinopathy Be Treated?
The retinal vessel damage from diabetic retinopathy cannot be reversed, but progression can often be slowed or stopped. Tight control of blood sugar, blood pressure, and cholesterol remains the most effective long-term strategy for protecting your vision.
For more advanced disease, anti-VEGF injections, corticosteroid injections, laser photocoagulation, or vitrectomy surgery may reduce swelling, seal leaking vessels, or address bleeding and scar tissue. These are performed by an ophthalmologist or retina specialist, typically after referral.
Optometrist or Ophthalmologist?
Our optometrists handle the first line of detection: annual screening, retinal imaging, and ongoing monitoring of mild-to-moderate disease. If imaging shows signs warranting injections, laser treatment, or surgery, we refer you to an ophthalmologist for that stage of care and continue monitoring your eyes afterward.
If you have diabetes and haven’t had a comprehensive eye exam in the last year, book an appointment with our Vancouver team. Early detection is still the single best tool we have for protecting your vision from diabetic retinopathy.
Frequently Asked Questions
Diabetic retinopathy is a complication of diabetes in which chronically high blood sugar damages the small blood vessels that supply the retina. Those vessels leak fluid and blood, swell, or close off, and in advanced cases the retina responds by growing abnormal, fragile new vessels that can bleed and scar. Left unmanaged, it is a leading cause of vision loss in adults with diabetes, which is why annual screening is recommended for everyone living with the condition, regardless of how their vision currently feels.
In its earliest stages, diabetic retinopathy usually has no noticeable warning signs at all, since the initial damage tends to occur in peripheral blood vessels rather than the central macula. As the disease progresses, some people notice blurred or fluctuating vision, dark spots or floaters, or difficulty seeing at night, but by the time these symptoms appear the disease has often already reached a moderate or advanced stage. This is why an eye exam, not symptoms, is the reliable way to detect it early.
Yes. Because early damage typically affects peripheral retinal vessels rather than the macula, it is entirely possible to pass a standard vision test with 20/20 results while still having active, progressing retinopathy. Vision often does not decline until the disease reaches a moderate or severe stage or diabetic macular edema develops. This is the main reason eye doctors recommend annual retinal screening for anyone with diabetes rather than waiting for vision changes.
The general guidance is a comprehensive eye exam once a year for anyone with Type 1, Type 2, or gestational diabetes. If diabetic retinopathy has already been diagnosed or appears to be progressing, your doctor may recommend more frequent monitoring, often every two to four months, to track changes closely and catch any progression toward a more advanced stage.
A diabetic eye exam typically includes visual acuity testing, a pressure check called tonometry, and detailed imaging of the retina to look for microaneurysms, leakage, swelling, or abnormal vessel growth. Traditional exams rely on dilating drops to widen the pupil for a clearer view. At Lucent Family Eye Care, our Optomap and OCT imaging can capture an ultra-widefield view of the retina along with a cross-sectional scan of retinal layers, often without needing dilation, making the exam faster and more comfortable while still giving our doctors a thorough view.
The underlying blood vessel damage caused by diabetic retinopathy is not reversible, and there is currently no cure. However, tightly managing blood sugar, blood pressure, and cholesterol can meaningfully slow or halt its progression, and treatments such as anti-VEGF injections or laser therapy can reduce swelling and bleeding and help stabilize or improve vision in some cases. The most accurate way to think about it is management and prevention of further progression rather than reversal.
The disease process and the need for annual screening are the same for both types once screening begins, but the recommended starting point differs. People with Type 2 diabetes should begin screening at the time of diagnosis, since the condition can go undetected for years beforehand. People with Type 1 diabetes, usually diagnosed in childhood, are typically first screened around five years after diagnosis, since retinopathy rarely develops that early. From that point on, both groups follow the same annual monitoring schedule.
Your optometrist is your first point of contact for diabetic eye care. Doctors like Dr. Yee and Dr. Sultani perform the annual screening, retinal imaging, and ongoing monitoring needed to catch and track diabetic retinopathy in its early and moderate stages. If imaging shows the disease has progressed to a point requiring injections, laser treatment, or surgery, your optometrist will refer you to an ophthalmologist or retina specialist for that treatment, then continue monitoring your eyes going forward.
