Diabetic Retinopathy: Symptoms, Stages, Treatment and Integrative Support

Diabetic retinopathy is damage to the small blood vessels of the retina, the light-sensitive layer at the back of the eye, caused by diabetes^1,2. It is a leading cause of blindness in working-age adults in the US^3,2. In 2021, an estimated 9.6 million Americans, about 1 in 4 people with diabetes, had some retinopathy, and 1.84 million had a form that threatens sight³. Early retinopathy has no symptoms, so a regular dilated eye exam is the only way to find it in time^1,4. Good control of blood sugar, blood pressure and cholesterol lowers the risk and slows it down^4,5,6. When retinopathy threatens sight, eye injections, laser treatment and surgery can stop it getting worse and protect vision^1,4. Treatment does not undo all the damage, so diabetic retinopathy is managed rather than cured^1,2.

This page explains what diabetic retinopathy is, its stages and symptoms, and the warning signs that need same-day care. It covers what raises the risk, who needs an eye exam and how often, and how the eye is checked. It then sets out what treatment can do today: blood sugar and blood pressure control, injections, laser, implants, surgery and fenofibrate. It answers whether diabetic retinopathy can be reversed, lists what is in clinical trials, and ends with where integrative care can and cannot fit alongside your eye doctor and diabetes team.

Diabetic retinopathy at a glance

On this page

• What is diabetic retinopathy?
• Symptoms
• Causes and risk factors
• Eye exams and diagnosis
• Treatment today
• Can it be reversed?
• New treatments in clinical trials
• Living with diabetic retinopathy
• Where integrative care fits
• Outlook
• Frequently asked questions
• Sources

What is diabetic retinopathy?

The retina lines the back of the eye and turns light into signals that the brain reads as images. It is fed by a network of tiny blood vessels. Over time, high blood sugar damages these vessels. They can leak fluid or bleed, and some close off completely¹. To make up for the blocked vessels, the eye grows new ones, but these new vessels are fragile and leak or bleed easily¹. Doctors now describe diabetic retinopathy as a disease of both the blood vessels and the nerve cells of the retina^4,15.

There are two main stages^1,4:

• Nonproliferative diabetic retinopathy (NPDR) is the earlier stage. Tiny bulges called microaneurysms form in the vessel walls, and small bleeds and leaks appear. Doctors grade it as mild, moderate or severe as more vessels become blocked^16,15.
• Proliferative diabetic retinopathy (PDR) is the advanced stage. The retina starts to grow new, abnormal blood vessels. These can bleed into the gel that fills the eye, form scar tissue, and pull the retina out of place^1,15.

Our article on the four stages of diabetic retinopathy explains how doctors grade each stage.

Diabetic macular edema (DME) can happen at any stage. Fluid leaks into the macula, the small central part of the retina used for reading and recognizing faces, and blurs central vision^1,4. Over time, about 1 in 15 people with diabetes develop it¹. Our page on diabetic macular edema covers it in detail.

The longer someone has diabetes, the more likely retinopathy becomes. In a large pooled analysis, 21% of people who had had diabetes for less than 10 years had some retinopathy, against 76% of those who had had it for 20 years or more⁷. Almost everyone with type 1 diabetes will eventually have some nonproliferative retinopathy, and most people with type 2 diabetes will too¹⁷. The sight-threatening proliferative stage is much less common^17,15.

Symptoms of diabetic retinopathy

Early diabetic retinopathy usually has no symptoms^1,2. Damage to much of the retina can happen before vision changes, and even people with sight-threatening retinopathy may notice nothing^2,4. This is why regular eye exams matter so much.

When symptoms do appear, they can include^2,1:

• blurred vision, or vision that slowly gets worse;
• floaters: spots or dark strings drifting across your vision;
• shadows, or dark or empty areas in your vision;
• trouble seeing at night.

Blurred vision that comes and goes with high or quickly changing blood sugar is usually caused by the lens of the eye swelling, not by retinopathy. It is brief, and it is not the same problem². If blurry vision lasts more than a few days or keeps coming back, get your eyes checked².

Signs that need prompt care

See your eye doctor within a few days if your vision is getting blurry or you notice a few new floaters^2,1.

Get care right away. Call your eye doctor now or go to an emergency room if you have^18,1,19:

• a sudden shower of new floaters, or dark spots or streaks that look like cobwebs;
• flashes of light;
• a dark shadow or "curtain" over part of your vision;
• sudden loss of vision;
• a painful, red eye with blurred vision.

Call 911 if sudden vision loss comes with weakness or numbness in the face, arm or leg, or trouble speaking. These can be signs of a stroke²⁰.

Bleeding into the eye (vitreous hemorrhage) sometimes clears on its own, but it still needs treatment right away¹. After an eye injection, call your eye doctor right away if you have pain, more redness, light sensitivity or worse vision²¹.

What causes diabetic retinopathy, and who is at risk?

Diabetic retinopathy is caused by high blood sugar over time^1,4. Several things raise the risk or speed it up⁴.

Years with diabetes. The longer you have diabetes, the higher the risk^7,22.

Blood sugar. In the Diabetes Control and Complications Trial, people with type 1 diabetes who kept tighter control had a 76% lower risk of developing retinopathy. In those who already had it, progression slowed by 54%⁵. In type 2 diabetes, the ACCORD trial found retinopathy progressed in 7.3% of people with intensive glucose control against 10.4% with standard control over 4 years²³. But that very tight target (an A1C below 6%) was stopped early because more people died, so your diabetes team will set a safe goal for you²⁴. The benefit of good control lasts for years afterward^25,4.

Blood pressure. In the UK Prospective Diabetes Study of people with type 2 diabetes and high blood pressure, tighter blood pressure control cut the risk of retinopathy getting worse by about a third (34%)⁶. Very low blood pressure targets (systolic under 120) added no further benefit for the eyes^23,4.

Cholesterol and other blood fats. Statins are linked to less sight-threatening retinopathy⁴. The cholesterol drug fenofibrate is covered under treatment below.

Kidney disease. Kidney damage from diabetes goes along with a higher risk of retinopathy and of it getting worse^4,15.

Pregnancy. In women with type 1 or type 2 diabetes before pregnancy, retinopathy can worsen during pregnancy and for up to a year after it^8,4. In the Diabetes Control and Complications Trial, the risk of worsening was 1.6 to 2.5 times higher during pregnancy⁸. Gestational diabetes on its own does not appear to raise the risk during pregnancy, according to the American Diabetes Association⁴.

Race and ethnicity. In a US survey with eye photographs (2005 to 2008, adults aged 40 and older), 38.8% of Black adults with diabetes had retinopathy, against 26.4% of white adults²².

Smoking. The evidence on smoking and retinopathy is mixed, but quitting is still advised for eye and general health^26,2.

When blood sugar falls quickly. A fast drop in blood sugar can make retinopathy worse for a while. In the Diabetes Control and Complications Trial, this "early worsening" affected 13.1% of people on intensive insulin treatment, against 7.6% on standard treatment. In about half, it had settled by 18 months. The long-term benefits of good control far outweighed it²⁷. The same can happen with GLP-1 medicines such as semaglutide (Ozempic). Its label reports retinopathy complications in 3.0% of people on the drug against 1.8% on placebo over 2 years. In people who already had retinopathy, the figures were 8.2% against 5.2%²⁸. Large real-world studies have not found a higher risk than with other diabetes medicines^29,30. A dedicated trial is due to finish in 2027³¹. The American Diabetes Association advises checking the eyes when these treatments are started or stepped up⁴. Do not stop a diabetes medicine without talking to your doctor.

How diabetic retinopathy is diagnosed

Diabetic retinopathy is diagnosed by an ophthalmologist or an optometrist during a dilated eye exam^4,1. This is different from a routine check for glasses².

Who needs an exam, and how often. The American Diabetes Association's 2026 Standards of Care recommend⁴:

• Type 1 diabetes: a first dilated eye exam within 5 years of diagnosis.
• Type 2 diabetes: a first dilated eye exam at the time of diagnosis, because damage may already be present^4,2.
• After that: every year. If one or more yearly exams are normal and blood sugar is in the target range, every 1 to 2 years may be enough. If retinopathy is getting worse, exams are needed more often.
• Pregnancy (type 1 or type 2 diabetes): an exam before pregnancy and in the first trimester, and possibly every trimester and for a year after the birth.
• Children and teenagers: with type 1 diabetes, a first exam after 3 to 5 years of diabetes, once they are 11 or have started puberty, then about every 2 years. With type 2 diabetes, at or soon after diagnosis, then every year⁹.

Some people with diabetic retinopathy need an exam as often as every 2 to 4 months¹. Anyone with macular edema, moderate or worse NPDR, or PDR should be referred promptly to an ophthalmologist experienced in diabetic eye disease⁴. Our article on how often you need a diabetic eye exam goes into more detail.

The tests.

• Dilated eye exam. Drops widen the pupil so the doctor can see the whole retina. It is simple and painless¹.
• Retinal photographs can detect most significant retinopathy⁴.
• Optical coherence tomography (OCT) is a quick scan that measures the thickness of the retina. It is now the standard test for macular edema³².
• Fluorescein angiography uses a special dye to photograph the retina's blood vessels, and shows where they leak or are blocked¹. OCT angiography can show blocked vessels without dye³³.
• Ultrasound is used when blood or a cataract blocks the view of the retina³⁴.

Screening with AI and remote photographs. The American Diabetes Association recommends programs that use retinal photographs read remotely, or FDA-authorized artificial intelligence (AI) software, as screening options, as long as people with findings are referred on for a full exam⁴. In April 2018 the FDA authorized IDx-DR (now called LumineticsCore), the first self-running AI diagnostic test in any field of medicine to be authorized by the FDA. It detects more than mild retinopathy and macular edema without a doctor reading the images^14,35. EyeArt (2020), AEYE-DS (2022) and iPredict-DR (July 2026) have since been cleared¹⁴. Photographs do not replace a full dilated eye exam. You still need one at the start and then every year, or more often if your eye doctor says so⁴.

Diabetic retinopathy treatment today

Treatment depends on the stage of retinopathy and on whether the macula is swollen⁴. In the early stages, your eye doctor will usually keep watch while you work on blood sugar, blood pressure and cholesterol¹. In later stages, treatment should start right away. It cannot undo damage to vision that has already happened, but it can stop vision getting worse¹.

Blood sugar, blood pressure and cholesterol

Reaching your blood sugar, blood pressure and cholesterol goals lowers the risk of retinopathy and slows it down⁴. This is the foundation of care at every stage, alongside any eye treatment⁴. Our article on preventing diabetic vision loss covers this in more depth.

Anti-VEGF eye injections

Anti-VEGF medicines block a protein called VEGF that drives leaking and the growth of abnormal blood vessels^15,4. The medicine is injected into the eye with a very fine needle after the eye is numbed²¹. Anti-VEGF injections are the first treatment for macular edema that involves the center of the macula and reduces vision, and an alternative to laser for PDR⁴.

The medicines.

• Ranibizumab (Lucentis) was approved by the FDA for all forms of diabetic retinopathy in April 2017^12,36.
• Aflibercept (Eylea) was approved for diabetic retinopathy in May 2019^12,37. A higher-dose version, Eylea HD, approved in 2023, is labelled for both macular edema and retinopathy. Since April 2026 it can be given as rarely as every 20 weeks for macular edema, after a year of good response^12,38,39.
• Faricimab (Vabysmo) and brolucizumab (Beovu) are approved for diabetic macular edema, but not for diabetic retinopathy without edema^21,40.
• Bevacizumab (Avastin) is also used for macular edema, but it is not FDA-approved for this use (off-label)⁴.
• Biosimilars are lower-cost versions of ranibizumab and aflibercept that work the same way. Most are approved for macular edema and retinopathy, but not all (Byooviz is not). The newest are Eydenzelt (October 2025), Nufymco (December 2025) and Ranluspec (June 2026)^12,41,42.

What they achieve.

• Macular edema with vision loss. In the US Protocol T trial, vision improved on average by about 2 lines on the eye chart in the first year (10 to 13 letters)⁴³. After 5 years, people were still better off than at the start, but they had lost some of the gain after the trial's set visit schedule ended⁴⁴.
• Macular edema with good vision. In Protocol V, close monitoring and starting injections only if vision dropped worked as well over 2 years as starting injections straight away⁴⁵.
• Proliferative retinopathy. In Protocol S, people treated with ranibizumab or with laser both had an average vision of about 20/25 after 5 years. Injections caused less side vision loss and less macular edema, but needed many more visits^46,47,4.

How often. For macular edema, most people need an injection every 4 to 8 weeks in the first year, and fewer after that⁴. Missing visits matters. In US practice, people with macular edema had fewer injections and smaller vision gains than in trials⁴⁸. About 1 in 4 people with PDR missed follow-up for a year or more⁴⁹.

Do they hurt? Most people rate the pain as mild, around 3 out of 10, and it tends to ease with each injection⁵⁰.

Risks. A serious eye infection (endophthalmitis) happens after about 1 in 2,000 injections⁵¹. Retinal detachment and inflammation can also occur, so report pain, redness or vision loss right away^52,21. Our article on eye injections, laser and surgery for diabetic retinopathy explains each procedure step by step.

Susvimo: a refillable drug implant

Susvimo is a small refillable reservoir implanted in the wall of the eye during surgery. It releases ranibizumab continuously¹³. The FDA approved it for diabetic macular edema in February 2025 and for diabetic retinopathy in May 2025, for people who have already responded to at least two anti-VEGF injections^12,13. For retinopathy, it is refilled every 9 months¹³. In the Pavilion trial, the retinopathy grade improved by 2 or more steps in 80% of people with the implant, against 9% of those who were only monitored, at one year¹³. The implant carries a boxed warning: it has been linked to up to 3 times the rate of serious eye infection seen with monthly injections¹³.

Steroid implants

Two long-acting steroid implants are approved for diabetic macular edema: dexamethasone (Ozurdex) and fluocinolone (Iluvien)^12,53,54. They are used when edema persists despite anti-VEGF injections, or when injections are not suitable, for example during pregnancy⁴. Steroids often cause cataract and can raise eye pressure. In the Ozurdex trials, 68% of eyes with their natural lens developed cataract, against 21% with sham treatment, and eye pressure rose by 10 points (mm Hg) or more in 28% against 4%⁵³.

Laser treatment

• Panretinal photocoagulation (PRP) applies many small laser burns to the outer retina. It reduces the risk of severe vision loss from PDR by half or more^55,4. It can reduce side vision, may worsen macular edema, and is more uncomfortable than an injection^47,55,56.
• Focal or grid laser seals leaking spots near the macula. It is now mostly a second-line treatment for macular edema^4,57.

Vitrectomy surgery

Vitrectomy removes the gel inside the eye. It is used when bleeding into the eye does not clear, or when scar tissue pulls on or detaches the retina^1,58. For bleeding into the eye from PDR, the Protocol AB trial found that aflibercept injections and vitrectomy gave similar vision after 2 years (about 20/40 on average), although vision recovered faster at first after surgery⁵⁹.

Fenofibrate

Fenofibrate is a cholesterol medicine taken as a pill. In the LENS trial of 1,151 adults with early retinopathy in Scotland, retinopathy progressed far enough to need referral or treatment in 22.7% of people taking fenofibrate, against 29.2% on placebo, over about 4 years⁶⁰. It did not improve vision, and it lowered a measure of kidney function⁶⁰. The American Diabetes Association notes that in people with high blood fats, adding fenofibrate may slow retinopathy, mostly when it is early⁴. In the US it is not approved for retinopathy, so this use is off-label⁶¹. A US trial is under way³¹. Ask your diabetes doctor whether it suits you.

Can diabetic retinopathy be reversed?

Partly. The retinopathy grade can improve with treatment. In the PANORAMA trial, 58% of eyes with moderately severe or severe NPDR improved by 2 or more steps after 6 months of aflibercept, against 6% with sham (fake) injections¹⁰. But the improvement needs continued treatment to last¹⁰. In Protocol W, injections given to prevent complications did not lead to better vision after 4 years¹¹. Treatment can stop vision getting worse, but it does not always restore vision that has already been lost^1,2. Good control of blood sugar slows retinopathy but does not reverse damage that is already there^5,2.

Be wary of supplements or "natural cures" sold to reverse diabetic retinopathy or replace diabetes medicines. The FDA has warned about diabetes products that seem too good to be true⁶². Our article Can diabetic retinopathy be reversed? answers the common questions in detail.

New treatments for diabetic retinopathy in clinical trials

Several new treatments are being tested. None is approved in the US for diabetic retinopathy yet. Two of them, semaglutide and fenofibrate, are already approved for other uses and are being tested for the eyes. Phase 1 and 2 trials are small early studies; phase 3 trials are the large final trials before approval. Status is as of 19 October 2026³¹.

Some hopes have faded. Dexamethasone eye drops (OCS-01) failed in two large trials for macular edema in May 2026: they reduced swelling but did not improve vision⁷¹. Two pills for NPDR, OPL-0401 and APX3330, missed their main goals in phase 2 trials^72,73. No eye drop or pill is approved for diabetic retinopathy^71,31.

Living with diabetic retinopathy

• Keep every eye appointment. Treatment works best on schedule, and missed visits lead to worse vision^4,49.
• Know your numbers. Work with your diabetes team on your A1C, blood pressure and cholesterol⁴.
• Tell your eye doctor about medicine changes, especially when starting insulin or a GLP-1 medicine such as semaglutide^4,28.
• Plan pregnancy. If you have type 1 or type 2 diabetes, have an eye exam before pregnancy and in the first trimester⁴.
• Blood thinners. Do not stop a prescribed blood thinner on your own before injections or eye surgery; the retina team will advise. Tell them about all herbs and supplements you take^74,62.
• Stay active. Physical activity is linked to a lower risk of retinopathy, but check with your doctor before starting strenuous exercise if your eyes already have damage^75,2.
• Do not smoke².
• Ask about low-vision help. If you have lost vision, vision rehabilitation can help you make the most of the sight you have⁴.

Where integrative care fits

Netra Eye Institute is an acupuncture and Oriental medicine practice. Nothing we offer replaces eye exams, injections, laser, surgery or your diabetes medicines, and diabetic retinopathy care stays with your eye doctor, retina specialist and diabetes team. Our role is adjunctive: care that sits alongside theirs, with the evidence explained before you start.

The evidence that matters most for diabetic retinopathy is about blood sugar, blood pressure, cholesterol and keeping up with eye care^4,48. The evidence for acupuncture, herbs and Ayurveda in diabetic retinopathy itself is weak. Trials are small, mostly from China, and often without a proper comparison group. Some checked eyesight on a chart for a few months, but none tested whether these treatments prevent serious eye disease or vision loss over time^76,77,78,79.

Evidence grades describe how sure we can be about the effect on diabetic retinopathy. None means no studies; very low means small studies without proper comparison groups; low means consistent observational studies or weak trials; "not effective" means a well-run trial found no benefit. These grades are our own reading of the studies.

What working with Netra looks like. We ask first that an eye doctor has examined your eyes and set a plan for exams and any treatment. If your vision changes suddenly, see them first; that comes before anything we do. Then we:

• check that the basics are in place: your eye exam schedule, any injection appointments, and your A1C, blood pressure and cholesterol plans with your diabetes team;
• support the habits that help your diabetes care, such as sleep, stress, activity and nutrition, alongside your diabetes team;
• offer acupuncture if you choose it, with its limited evidence explained;
• where appropriate, offer Chinese herbal medicine reviewed against your diabetes medicines and any blood thinners, and never change your diabetes medicines;
• never put herbal washes or drops in the eye, and follow your retina specialist's advice around injections and surgery;
• keep your eye doctor informed, and send you back to them quickly if your vision changes.

Netra Restoration Therapy (NRT) is an adjunctive program: it is used only alongside your eye doctor's and diabetes team's care, never instead of it. It is not a treatment for diabetic retinopathy. It does not replace eye exams, injections, laser, surgery or diabetes medicines, and it does not reverse retinal damage or clear macular edema. No clinical trial of NRT in diabetic retinopathy has been published. For Ayurvedic approaches, see Ayurvedic treatment for diabetic retinopathy.

Outlook

Most vision loss from diabetic retinopathy can be prevented. The National Eye Institute estimates that early detection, timely treatment and follow-up can cut the risk of severe vision loss by 95%⁹¹. Laser treatment alone halves the risk of severe vision loss from PDR^55,4. In England, a national screening program began in 2003, and diabetic retinopathy is no longer the top cause of blindness certification in working-age adults there^92,93.

Without timely treatment, the outlook is much worse: about half of people with PDR who are not treated in time become legally blind within 5 years¹⁵. In one trial, people with PDR who started with good vision and kept up treatment had about 20/25 vision on average after 5 years⁴⁶.

Diabetic retinopathy needs lifelong monitoring. Many people with macular edema still need some injections years later⁴⁴. The things that make the biggest difference are regular eye exams, acting quickly on changes, and good control of blood sugar, blood pressure and cholesterol⁴.

Frequently asked questions

Can diabetic retinopathy be reversed?

Partly. Injections can improve the retinopathy grade, but the improvement needs ongoing treatment, and lost vision is not always regained^10,11,2. Our article Can diabetic retinopathy be reversed? answers this in detail.

Can diabetic retinopathy be cured?

No. Treatment can stop it getting worse and protect vision, but it does not cure the disease, and monitoring is lifelong^2,1.

What are the stages of diabetic retinopathy?

Mild, moderate and severe nonproliferative retinopathy, then proliferative retinopathy, when abnormal new blood vessels grow^16,15. Macular edema can happen at any stage⁴. See the four stages of diabetic retinopathy.

What is the first sign of diabetic retinopathy?

Usually nothing you can notice. The earliest signs are tiny bulges and bleeds in the retina's blood vessels, which only an eye exam can find^15,1.

How fast does diabetic retinopathy progress?

It varies from person to person. In one trial, a third of eyes with moderate to severe NPDR that got only sham injections developed PDR within 2 years⁹⁴. Regular exams catch changes early⁴.

Can you go blind from diabetic retinopathy?

Yes, if it is not treated in time¹⁵. With regular exams and timely treatment, severe vision loss is uncommon^95,91.

Do eye injections hurt?

Most people rate the pain as mild, around 3 out of 10, and it eases with later injections⁵⁰.

Will I need injections forever?

Most people need fewer injections after the first year⁴. In one 5-year study of macular edema, about two-thirds of eyes still needed at least one injection between years 2 and 5⁴⁴.

Is there an eye drop or pill for diabetic retinopathy?

No eye drop or pill is approved for it. The leading eye drop failed in 2026⁷¹. Fenofibrate, a cholesterol pill, slowed early retinopathy in one trial, but it is not FDA-approved for this use (off-label)^60,61.

Does Ozempic (semaglutide) make diabetic retinopathy worse?

It may in some people. In one 2-year trial, eye complications happened in about 8 in 100 people with existing retinopathy on semaglutide, against 5 in 100 on placebo, mostly in people whose blood sugar fell fast^28,96. Large real-world studies have not found a higher risk²⁹. If you have retinopathy, have your eyes checked when you start or increase it⁴.

Can diet or natural remedies reverse diabetic retinopathy?

No diet, supplement or herb has been shown to reverse it. Fish oil capsules did not help in a large trial⁸⁴. A healthy diet helps through better blood sugar, blood pressure and cholesterol^4,86.

What is new for diabetic retinopathy in 2025 and 2026?

The FDA approved the Susvimo implant for retinopathy in May 2025. In April 2026 it allowed Eylea HD doses as rarely as every 20 weeks for macular edema. It has also approved more biosimilar injections, and cleared a fourth AI screening system in July 2026^12,13,38,14. A new long-acting injection, tarcocimab, may be submitted for approval in late 2026⁶⁴.

Can acupuncture help diabetic retinopathy?

There is no good evidence that acupuncture changes the course of diabetic retinopathy; the trials are small and low quality^76,77. Netra offers it only as adjunctive care alongside your eye doctor and diabetes team, with the evidence explained.

Sources

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