What is Diabetic Retinopathy? Symptoms & Screening

What is diabetic retinopathy?

Diabetic retinopathy is an eye condition linked to diabetes. Over time, high blood sugar can damage the small blood vessels at the back of the eye (the retina), which can affect vision.

You may not notice anything at first, but if left untreated, it can get worse and may cause permanent vision loss. Your optometrist (sometimes still called an optician) will be able to spot signs of diabetic retinopathy during an eye test – and treatment is available if needed.

Whether you’re newly diagnosed or have had diabetes for years, regular eye tests are one of the best ways to protect your sight.

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Retina
This is the light‑sensitive layer at the back of the eye where images are focused. High blood sugar can damage blood vessels in the retina.
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Damaged blood vessels
These may swell, leak or become blocked. Without enough oxygen, vision can start to blur or darken.
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Macular oedema
Swelling in the macula, the area needed for sharp vision. It’s a common reason for vision problems in diabetic retinopathy.
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Vitreous haemorrhage
Fragile new vessels can bleed into the vitreous, the clear gel in the eye. This can lead to sudden floaters or even vision loss.

What are the symptoms of diabetic retinopathy?

In the early stages, diabetic retinopathy might not affect your sight at all. That’s why many people don’t realise there’s a problem until the condition has progressed.

What does diabetic retinopathy look like? When symptoms do appear, they can vary depending on which part of the eye is affected. You might notice:

Blurred Vision
Floaters and flashes
Patchy or missing areas in your vision
Cloudy vision
Tunnel vision, where your side vision starts to narrow
Difficulty seeing at night
Halos around lights
Faded colours symptoms may come and go or get worse over time.

Symptoms may come and go or get worse over time.

In severe cases, sudden vision loss can happen, often from bleeding or retinal detachment. This is rare but serious.
If you notice these changes, book a diabetes eye check as soon as you can. Early treatment can help.

Types of diabetic retinopathy

Diabetic retinopathy is often divided into two main types, based on how advanced it is and the changes in the eye.

Non‑proliferative diabetic retinopathy (NPDR)

This early stage involves damaged tiny blood vessels in the retina that leak fluid or blood. Mild cases affect a few vessels. Moderate to severe cases show more swelling, bleeding and damage.

NPDR may not cause symptoms but can progress over time without regular eye checks.

Proliferative diabetic retinopathy (PDR)

The advanced stage. The body grows new fragile vessels that leak easily. This may cause scar tissue and lead to retinal detachment.

Diabetic Maculopathy

Without treatment, it can result in major sight loss or blindness. Diabetic macular oedema (DMO) can appear at any stage. Fluid builds up in the macula, which controls sharp central vision. It may blur vision and needs care.

What are the stages of diabetic retinopathy?

Diabetic retinopathy develops slowly. The longer you live with diabetes and the harder it is to control blood sugar, the more it can progress.

1. Background retinopathy

Earliest stage. Small bulges form in blood vessels. You may not notice symptoms, but routine eye checks can detect it.

2. Pre‑proliferative retinopathy

More vessels are affected and may be blocked. Vision may still be fine, but it needs monitoring.

3. Proliferative retinopathy

New vessels grow but are fragile and may bleed. This raises the risk of major vision loss.

4. Diabetic macular oedema

Can happen at any stage. Fluid leaks into the macula, causing swelling and blurry sight.

Regular diabetes eye checks help catch it early.

What causes diabetic retinopathy?

Diabetic retinopathy occurs when high blood sugar damages small blood vessels in the retina, the part of the eye that detects light and sends messages to the brain. Over time, this can make vessels swell, leak or block. The retina then lacks oxygen, which can harm vision. Poor blood sugar control increases the risk. High blood pressure, cholesterol and the length of time with diabetes also matter.

What the experts say about diabetic retinopathy

Our expert optometrists regularly see patients with signs of diabetic retinopathy, often before they’ve noticed anything themselves. Here, one of our optometrists shares how they spot early changes, what happens during an eye test, and how they work with patients to protect their sight.

Sometimes it’s just about closer monitoring. Other times, it’s helping someone understand what their results mean and referring them for specialist care. Whatever the stage, we’re here to guide you every step of the way.

Who is most at risk of diabetic retinopathy?

Anyone with type 1 or type 2 diabetes can develop diabetic retinopathy. The risk increases the longer you have diabetes, especially if blood sugar is not well controlled.

Other risk factors include:

High blood pressure that strains blood vessels
High cholesterol that affects blood flow and oxygen supply
Smoking that lowers circulation and increases damage
Pregnancy, as hormone shifts may raise risk
Missing eye checks, as early signs are easy to miss

Regular diabetes eye checks are key. Keeping blood sugar, pressure and cholesterol on track and having yearly eye checks lowers risk.

How is diabetic retinopathy tested and diagnosed?

At your eye check, your optometrist will ask about your eye health, any changes, and how you manage your diabetes. This helps us understand your risk and plan the right checks.

We’ll do several painless tests to check for early signs:

Visual acuity test

You’ll read a letter chart so we can check your vision and look for changes.

Tonometry

Measures the pressure in your eye.

Dilated eye exam

Drops may be used to widen your pupils so we can clearly see the retina and optic nerve.

Digital retinal photography

A quick scan takes detailed pictures of the back of your eye.

OCT scan

Creates 3D images of the retina to check for swelling or damage. If we find signs, we’ll explain what’s happening and refer you for specialist care if needed. These checks are quick and help protect your sight.

Treatment for diabetic retinopathy

If diabetic retinopathy is caught early, you may not need treatment straight away, but regular eye tests are important to monitor it.

If you’ve noticed blurred vision, floaters or problems with your sight, it’s a good idea to book an eye check.

Treatment will depend on the stage and type of retinopathy. Your eye specialist will explain your options and answer any questions.

How is diabetic retinopathy treated?

You might be referred to an eye specialist for one of the following:

Laser treatment

Laser treatment seals leaking blood vessels and stops new ones from growing to help protect the retina and prevent further vision loss.

There are two main types:

Focal laser photocoagulation – targets a specific affected area
Pan‑retinal photocoagulation – treats the wider peripheral retina

Laser treatment is done under local anaesthetic at an outpatient clinic. Your pupils will be widened with drops, and a special lens will keep your eye open. You may feel a mild pricking sensation in some areas, but most people don’t find it painful. The whole procedure usually takes 20–40 minutes.

After treatment, your vision may be blurry for a few hours, and you’ll be sensitive to light, so bring sunglasses and arrange for someone to drive you home. It may take several sessions and a few months to see the full benefit.

Eye injections

Injections, delivering anti‑VEGF drugs, help reduce swelling in the macula and stop abnormal blood vessel growth. Sometimes steroids are used instead.

The injection is given under local anaesthetic, using a fine needle. You may need monthly injections at first, with fewer as your condition stabilises.

Side effects can include floaters, mild irritation, or watery eyes, but the treatment is safe and can improve vision in many people.

Eye surgery (vitrectomy)

In more advanced cases, surgery may be needed to remove blood or scar tissue from inside the eye. This is called a vitrectomy.

It’s usually done under local anaesthetic and sedation. You’ll go home the same day or the next, wearing an eye patch for a few days. It can take several months for your vision to settle afterwards.

Risks like infection or retinal detachment are rare. The surgery is considered safe and helps improve or stabilise vision in most patients.

Together we can dramatically reduce rates of diabetes‑related vision loss and blindness across Australia.

Routine eye tests are very important for people with diabetes to ensure their eyes are healthy because diabetic retinopathy can occur without any visible warning signs.

To help Australians with diabetes keep up with their eye tests, Specsavers worked with Diabetes Australia, the Australian Government and other key eye health industry organisations to develop and fund KeepSight, a national eye check reminder program for people with diabetes.

So far, we’ve registered more than a million eye tests to the program, helping Australians protect their vision.

Learn more about KeepSight by visiting their website.

Is diabetic retinopathy preventable?

You can’t always prevent diabetic retinopathy, but there’s a lot you can do to lower your risk and slow it down. Managing your diabetes well and having regular eye checks makes a real difference. Here are six things that help protect your eyes:

1. Keep your blood sugar in check.

The better your control, the lower the risk of damage to the blood vessels in your eyes.

2. Manage your blood pressure.

High pressure puts extra strain on the delicate vessels in the retina.

3. Watch your cholesterol.

Raised cholesterol can affect blood flow to your eyes.

4. Don’t smoke.

Smoking reduces circulation and speeds up damage to blood vessels.

5. Go to all your diabetes check‑ups.

This includes foot checks, blood tests and other health reviews.

6. Get regular eye checks.

A yearly diabetes eye test or eye screening helps spot any changes early, when treatment works best.

Even if you already have early signs of diabetic retinopathy, these steps can still help stop it getting worse.

Driving and diabetic retinopathy

Diabetic retinopathy, especially in later stages, can affect safe driving. Early on, vision is often fine, but advanced stages can cause black spots, blurred vision or narrow side vision, all making driving harder.

Here’s what to know:

Visual impact

Sight changes can affect reaction times, how you see signs or hazards, and your judgement, especially in poor light.

Driving standards

Check with state authorities about vision rules for drivers. If your sight doesn’t meet the standards, you must stop driving and tell them. You also need to tell them if you’ve had laser treatment in both eyes, have proliferative retinopathy or are advised to stop after a screening or hospital visit.

Ophthalmologist advice

If you’re unsure, speak to your optometrist or eye doctor. They’ll assess your vision and advise you. Support and next steps, if you can’t drive, use public transport, taxis or local help.

Common questions: Diabetic retinopathy

Did you know?

Eye tests are bulk billed to Medicare, so there are no out‑of‑pocket expenses for you*.

Book an appointment See more eye conditions

Written with care and checked for accuracy

Dr Joseph Paul

B.Optom PhD

Dr Joseph Paul studied optometry at the University of Melbourne, graduating in 2011. He then completed a PhD in retinal structure and function at the University of Melbourne and a post‑doctoral position in optic nerve bioenergetics at the Centre for Eye Research Australia.

Alongside this work, Dr Joseph has practised in a wide range of public, private and corporate optometry practices across Victoria over the past decade. He is Head of Professional Services at Specsavers Australia and New Zealand.

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