13th February 2025

Diabetic retinopathy

Diabetes is the leading cause of vision loss in the working age population in the UK. Diabetic retinopathy (DR) is a chronic, progressive disease caused by prolonged hyperglycaemia affecting the retinal microvasculature.

It is potentially sight threatening through two mechanisms:

1. Retinopathy = neovascularisation leading to intraocular haemorrhage causing global vision loss
2. Maculopathy = localised damage to the macula causing loss of central vision

Patients with diabetes should be offered eye screening annually.

Classification of DR

Many classifications of DR exist but commonly include:

Table 3 Classification of diabetic retinopathy

Management of DR

General management of DR includes adequate control of blood glucose, correcting hypertension and promoting smoking cessation. Proliferative DR can be managed by panretinal photocoagulation. Maculopathy can be managed by focal or grid photocoagulation, intravitreal steroids or anti-VEGF.

Complications of DR

Patients with proliferative DR are at risk of tractional retinal detachment, which is caused by contraction of the fibrous gel after haemorrhage and fibrosis.

Advanced retinal ischaemia can precipitate rubeosis iridis (neovascularisation affecting the iris), which can result in secondary glaucoma if the drainage channels are blocked.

Furthermore, patients with diabetes are more likely to have cataracts, retinal vein occlusion or ischaemic optic neuropathy.