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Diabetic Retinopathy

Microvascular complication of diabetes mellitus characterized by progressive damage to retinal capillaries leading to ischemia, neovascularization, macular edema, and vision loss, requiring annual screening, glycemic control, and stage-based treatment with anti-VEGF, laser photocoagulation, or vitrectomy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göz Hastalıkları department. Book Appointment →

What is Diabetic Retinopathy?

Diabetic retinopathy (DR) is a microvascular complication of type 1 and type 2 diabetes resulting from chronic hyperglycemia-induced damage to retinal capillaries, with pericyte loss, basement membrane thickening, microaneurysm formation, and breakdown of blood-retinal barrier. Pathogenesis involves polyol pathway, advanced glycation end-products (AGEs), oxidative stress, protein kinase C activation, and inflammation, ultimately leading to capillary nonperfusion, retinal ischemia, and VEGF-driven neovascularization.

Stages include mild NPDR (microaneurysms only), moderate NPDR (microaneurysms + dot/blot hemorrhages, cotton-wool spots), severe NPDR (4-2-1 rule: hemorrhages in 4 quadrants OR venous beading in 2 quadrants OR IRMA in 1 quadrant), and PDR (neovascularization of disc [NVD], elsewhere [NVE], vitreous hemorrhage, tractional retinal detachment, neovascular glaucoma). Diabetic macular edema (DME) is classified as center-involved (CI-DME) or non-center-involved.

Diagnosis requires dilated fundus examination, OCT (gold standard for DME, measures central subfield thickness), fluorescein angiography (capillary nonperfusion areas, microaneurysms, neovascularization), wide-field imaging, and OCT angiography. Screening recommendations include annual eye exam from diagnosis (T2DM), 5 years post-diagnosis (T1DM), with closer follow-up based on severity and pregnancy status. Optimal glycemic control (HbA1c <7%), BP control (<140/90), and lipid management slow progression.

Symptoms

Asymptomatic in early stages (NPDR)
Blurred or fluctuating vision (DME)
Floaters or 'cobwebs' (vitreous hemorrhage)
Sudden vision loss (vitreous hemorrhage, retinal detachment)
Dark spots or 'curtain' in vision
Difficulty with night vision
Color vision changes

Risk Factors

Long-standing diabetes (>10 years T1DM, >5 years T2DM)
Poor glycemic control (HbA1c >7%)
Hypertension (>140/90)
Hyperlipidemia
Pregnancy (acceleration risk)
Diabetic nephropathy (microalbuminuria)
Smoking and obesity

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Annual screening for all diabetic patients
  • Sudden vision loss or floaters in diabetic patient
  • New blurring or distortion of central vision (DME suspicion)
  • Pregnancy in diabetic woman (1st trimester eye exam)
  • Worsening blood sugars or proteinuria
  • Pre-laser/anti-VEGF assessment
  • Postoperative monitoring after vitrectomy

Treatment Methods

01
Optimal glycemic control (HbA1c <7%, individualized targets)
02
Blood pressure control (<140/90 or <130/80 if proteinuria)
03
Lipid management with statins (if indicated)
04
Intravitreal anti-VEGF (ranibizumab, aflibercept, bevacizumab) for DME and PDR
05
Panretinal photocoagulation (PRP) for PDR or severe NPDR
06
Focal/grid laser for non-center-involved DME (selected cases)
07
Pars plana vitrectomy for non-clearing vitreous hemorrhage or tractional detachment

Which Department to Visit?

You can visit our Göz Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.