Diabetic retinopathy
The eye functions like a camera. The retina can be compared to the camera film, a light-sensitive layer inside the eye that captures light and transmits images to the brain.
Diabetic retinopathy is a retinal disease that develops in patients with elevated blood sugar levels. Chronic hyperglycemia damages the blood vessels of the retina, leading to bleeding, ischemia, tissue necrosis, abnormal new vessel formation (neovascularization), and fluid leakage, all of which result in reduced vision.
Who is at risk of diabetic retinopathy?
Diabetic retinopathy is one of the most serious complications of diabetes and a leading cause of vision loss.
The longer a patient has diabetes, the higher the risk. Often, diabetes may have been present for years before diagnosis.
Juvenile diabetes is increasingly common today, meaning that even young people are at risk.
Regular monitoring of blood sugar is essential.
An ophthalmological examination should be scheduled as soon as diabetes is diagnosed by a physician.
Around 80% of patients with diabetes for more than 10 years show signs of retinopathy.
Nearly all patients with diabetes for more than 25 years develop lesions.
Importantly, 90% of cases could be prevented with regular eye examinations and timely treatment.
Video: The importance of protecting the vision of diabetics
It is crucial to regulate blood sugar, blood pressure, and cholesterol. The higher the blood sugar levels, the greater the risk.
Simple glucose measurements fluctuate with food intake and are not reliable on their own.
Glycated hemoglobin (HbA1c) provides the average blood sugar level over the previous 3 months and should ideally remain below 6.3%.
Additional risk factors include hypertension, high cholesterol, anemia, and smoking.
What are the symptoms?
In the early stages, diabetic retinopathy is usually asymptomatic, even when the disease is progressing.
Fluid leakage from microaneurysms can cause localized or generalized retinal edema, particularly macular edema, the most common cause of vision loss in diabetics.
Vision may fluctuate with blood sugar levels; high glucose causes lens swelling (osmotic effect), leading to temporary myopia and blurred vision.
In advanced proliferative retinopathy, fragile new vessels may bleed into the vitreous.
Small hemorrhages appear as moving black spots, thread-like structures, or spider webs (especially noticeable against bright backgrounds).
Larger hemorrhages may cause dark scotomas or even complete vision loss.
Importantly, diabetic retinopathy is painless. The exception is neovascular glaucoma, a rare but severe complication in which high intraocular pressure causes intense eye pain, photophobia, and vomiting.
In very advanced cases, scar tissue can contract and cause retinal detachment, which may result in permanent vision loss if the macula is affected and not treated promptly.
An essential element of any surgical procedure, especially cosmetic surgery, is providing the patient with sufficient time for information.
When should diabetics be examined?
According to the American Academy of Ophthalmology:
Patients with diabetes but no signs of retinopathy: once a year.
Mild to moderate non-proliferative retinopathy: every 6–9 months.
Severe non-proliferative retinopathy: every 3 months.
Proliferative retinopathy: every 2 months or more frequently if needed.
Pregnant women with retinopathy: at least every 3 months, as progression can be rapid during pregnancy.
Diagnostic Tests for Diabetic Retinopathy
Every patient diagnosed with diabetes should undergo a comprehensive ophthalmological examination, including:
Measurement of visual acuity
Slit-lamp examination of the external structures of the eye (before dilation, to check for possible iris neovascularization)
Fundoscopy with dilated pupils (to assess the retina in detail)
Measurement of intraocular pressure
At the EYE-LID Ophthalmology Center, Dr. Nikolaos Trakos employs some of the most advanced diagnostic systems worldwide, offering state-of-the-art imaging for the early detection, monitoring, and treatment planning of diabetic retinopathy.
Optical Coherence Tomography (OCT)
OCT provides high-resolution, cross-sectional imaging of the retina, especially the macular region. It can detect even subtle changes in retinal structure and is essential for the diagnosis and monitoring of diabetic macular edema.
Earlier TD-OCT devices had a resolution of ~10 µm.
Newer SD-OCT systems improved resolution to 1–3 µm, with 40,000 scans per second and 3D rendering.
At the Eye-Lid Center, the latest-generation OCT performs 130,000 scans per second, with high penetration and exceptional accuracy. The test is painless, rapid, does not require dilation, and causes no visual discomfort afterward.
Retinal Angiography
Traditionally, fluorescein angiography has been used to visualize the retinal vasculature. This involves injecting fluorescein dye into a vein, followed by retinal photography. It remains one of the most important methods to assess:
Areas of leakage or hemorrhage
Ischemic regions at risk of neovascularization
The overall extent of disease progression
At the Eye-Lid Center, patients now benefit from OCT Angiography (Angio-OCT), a modern, dye-free alternative that avoids injections and allergic reactions. The exam is quick (under 3 seconds), completely non-invasive, and provides highly accurate 3D visualization of the retinal vascular network.
Why choose Dr. Trakos?
Dr. Trakos’ contribution to the field of anterior segment and cataract surgery, as well as to the treatment of vision problems, has changed the lives of many people by improving their sight and quality of life
Treatment Options
Depending on the severity of lesions, the main therapeutic approaches include:
1. Intravitreal injections
Injections of anti-VEGF agents (e.g., Avastin, Eylea, Lucentis, Beovu) directly into the eye.
VEGF (Vascular Endothelial Growth Factor) promotes abnormal neovascularization and increases vascular permeability, leading to edema.
Anti-VEGF drugs block its action, reducing retinal swelling and preventing fragile, leaky vessels from forming.
The procedure is performed under topical anesthesia, is painless, and takes only a few seconds.
2. Laser photocoagulation
A laser cauterizes abnormal retinal vessels, preventing further growth.
The goal is to stabilize vision and reduce the risk of severe vision loss.
3. Cryotherapy
Used when extensive vitreous hemorrhage makes laser treatment impossible.
Freezing therapy helps shrink abnormal vessels until further treatment can be applied.
4. Vitrectomy
A microsurgical procedure used in advanced proliferative retinopathy.
The surgeon removes the cloudy vitreous and replaces it with a clear solution, restoring the passage of light to the retina.
Regardless of treatment, strict control of blood sugar levels and regular ophthalmological follow-up are essential.
Other Ocular Manifestations of Diabetes
Besides diabetic retinopathy, diabetes may cause or accelerate:
Glaucoma – increased intraocular pressure damaging the optic nerve.
Diabetics have higher risk of chronic open-angle glaucoma (often asymptomatic).
They are also predisposed to neovascular glaucoma, a severe condition where abnormal iris vessels obstruct the drainage angle, sharply raising eye pressure.
Cataracts – appear earlier and progress faster in diabetics. Special surgical considerations are required when cataract surgery is performed in patients with diabetic retinopathy.
Dry eye and corneal complications – reduced corneal sensitivity and higher rates of epithelial apoptosis.
Optic neuropathy – nerve signal dysfunction may occur even without overt retinopathy.
Ocular motor nerve palsy – in some cases, double vision (diplopia) may be the first sign leading to a diabetes diagnosis.
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