Your eyes do a lot for you every day — but if you have diabetes, they can be at risk. Diabetic retinopathy is a common eye disease that can damage the small blood vessels in the back of your eye and make it harder to see. Sometimes the damage is permanent, but with early treatment and good blood sugar control, you may be able to slow it down — or even see better.

In this article, we’ll explain what diabetic retinopathy is, why it can affect your eyesight, and which treatments may help slow down or stop it. We’ll also talk about ways to manage your health to keep your eyes as strong as possible.

What Is Diabetic Retinopathy?

The retina is the light-sensitive tissue at the back of the eye. It collects the entering light and passes it along to the optic nerve. This connection sends what you see to your brain to be processed. If your retina is damaged, your brain can’t make sense of the information from your eyes.

In people with type 1 and type 2 diabetes, high blood sugar levels can damage the delicate blood vessels in the retina. This is known as diabetic retinopathy. In the early stages of diabetic retinopathy, the walls of the retina’s smaller blood vessels weaken and form tiny bulges, called microaneurysms. They can also begin leaking fluid into the retina itself. This causes swelling.

When the center of the retina, called the macula, swells, this is called diabetic macular edema. The macula helps you see clearly. Diabetic macular edema is a complication of diabetes.

As larger blood vessels in the retina become blocked, new blood vessels grow to compensate. However, these new but fragile vessels can lead to a more advanced stage called proliferative diabetic retinopathy. The new vessels can bleed into the eye, making it harder to see. The new blood vessels can turn into scar tissue that pulls your retina away from the back of your eye, causing retinal detachment.

Can Diabetic Retinopathy Be Reversed?

Once the tiny blood vessels in the retina are damaged, they usually can’t heal on their own. However, if you control your blood sugar and get the right treatment, your vision might still get a little better — especially if there’s swelling or bleeding in your eye. The best plan is to monitor your eye health and take steps early to treat diabetic retinopathy. Be sure to let your eye doctor know you have diabetes so that they can check your eye health often. Many people with mild and moderate nonproliferative diabetic retinopathy don’t need treatment at first, so careful monitoring is important.

Many people with mild and moderate nonproliferative diabetic retinopathy don’t need treatment at first, so careful monitoring is important.

With nonproliferative diabetic retinopathy, you can slow your vision loss by getting your blood glucose levels under control. According to the American Academy of Ophthalmology, this may even bring back some vision. You can work with your diabetes specialist or endocrinologist to make sure you’re following the best treatment plan. This includes a healthy lifestyle, like eating a healthy diet, taking insulin or diabetes medication, and exercising regularly.

In most cases of proliferative diabetic retinopathy, the treatment goal is to stabilize vision and prevent further damage. In some instances, medication or surgery can actually improve vision, particularly if there are complications like bleeding in the vitreous (the gel-like substance in the eye) or traction retinal detachment. It’s essential to follow your diabetes management plan and work closely with your eye doctor to preserve as much of your vision as possible and potentially avoid surgery.

It’s important to understand that eye damage and vision loss aren’t always the same. Even if the damage in your eye is unchanged, your vision may improve if swelling goes down or bleeding clears up.

Can You Stop Retinopathy From Progressing?

You can’t undo the damage, but you can keep diabetic retinopathy from getting worse. Watching your blood sugar and blood pressure, having regular eye checkups, and getting fast treatment when needed can help protect your sight and slow down the disease.

Treatment Options for Slowing Disease Progression in Diabetic Retinopathy

Currently, no treatment will fully reverse diabetic retinopathy, but some therapies may reverse retinal damage to a certain extent. Many of these treatment options also work for diabetic macular edema.

No treatment will fully reverse diabetic retinopathy, but some therapies may reverse damage to a certain extent.

Some DiabetesTeam members have had success with their diabetic retinopathy treatments. “In 2019, I had diabetic retinopathy in both eyes,” one member said. “I had laser therapy done at a series of visits. I also had cataract surgery done in both eyes. I now have 20/20 vision.”

It’s important to note that each diabetic retinopathy case is different, and treatments that work for one person may not work for others.

Anti-Vascular Endothelial Growth Factor Therapies

Your body uses a protein called vascular endothelial growth factor (VEGF) to help create blood vessels. In diabetic retinopathy, however, VEGF can cause existing blood vessels in the retina to leak and trigger the growth of abnormal new ones. Doctors have found that targeting VEGF can help reduce leakage and prevent abnormal blood vessels from growing.

Anti-VEGF treatments are given as intravitreal injections directly into the vitreous for treating diabetic retinopathy. They stabilize vision in around 90 percent of people and may even improve vision for about a third.

Examples of anti-VEGF injections for diabetic retinopathy include:

• Aflibercept (Eylea)
• Bevacizumab (Avastin), used off-label (outside of approved use for cancer)
• Brolucizumab-dbll (Beovu), approved for diabetic macular edema but not diabetic retinopathy
• Faricimab-svoa (Vabysmo), approved for diabetic macular edema but not diabetic retinopathy
• Ranibizumab (Lucentis injection; Susvimo port delivery system)

Laser Treatment

Laser treatment offers another way to treat diabetic retinopathy. This approach uses a highly focused beam of light to create burns in the retina, a process called panretinal photocoagulation. It reduces or eliminates retinal swelling and can make abnormal blood vessels shrivel so they don’t bleed.

In the later stages, laser surgery typically won’t improve vision or reverse damage from diabetic retinopathy. Your doctor will likely tell you that this treatment will stabilize your vision instead.

Vitrectomy

The vitreous is a clear fluid that lets light pass through and travel to the retina. People with advanced proliferative diabetic retinopathy may have blood in the vitreous that makes their vision worse. In advanced proliferative diabetic retinopathy, scar tissue can also form on the retina and tug on the tissue, raising the risk of traction retinal detachment.

Your eye specialist may perform a vitrectomy to replace the blood with a sterile saline (salt) solution or a gas bubble. They’ll also remove any scar tissue from the surface of your retina. Your vision may improve once the blood is removed.

Diet

Some people wonder, “Can diabetic retinopathy be reversed with diet?” Healthy eating can’t fix the damage already done to your eyes, but it can help control your blood sugar and blood pressure. This can lower swelling in your eyes and might help you see more clearly. Cutting back on sugary foods and fast-digesting carbs is a big part of slowing down the damage diabetes can do to your eyes.

Eating more whole grains, fruits, vegetables, and nuts, while reducing salt and alcohol, may help manage hypertension (high blood pressure), which also contributes to diabetic retinopathy. Choosing foods low in cholesterol, trans fats, and saturated fats can help keep your cholesterol levels in check. By making these dietary changes, you can support your overall treatment plan and help slow or stop the progression of diabetic retinopathy.

Talk With Your Doctor About Your Diabetic Retinopathy

If you’re living with diabetes, controlling your blood sugar is the first step toward preventing damage to retinal blood vessels. Further, regular screening for eye diseases with detailed eye exams can detect problems like diabetic retinopathy in the early stages. Then, prompt treatment can help protect against vision loss or, in many cases, improve vision if some has already been lost. Diabetes can also lead to other eye conditions, including glaucoma (damage to the optic nerve) and cataracts (clouding of the eye lens). Eye exams can detect these, too.

During your visit, your eye care provider will run tests to assess your vision and the health of your eyes. They’ll grade the severity of your diabetic retinopathy and may take photos to track changes over time.

It’s also important to make an eye appointment if you notice any vision problems or new symptoms of diabetic retinopathy, including:

• Blurred vision
• Floaters (dark moving spots in your vision)
• Night blindness (difficulty seeing at night)
• Colors that seem faded
• Trouble with sharp vision, like seeing objects far away or reading the print in a book

Your doctor, endocrinologist, and ophthalmologist can work together to create the best treatment plan for you. Your eye health is extremely important, and it’s best to take steps sooner rather than later to prevent complications of diabetes.

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