Diabetic retinopathy

Last updated: June 9, 2023

CME information and disclosurestoggle arrow icon

To see contributor disclosures related to this article, hover over this reference: [1]

Physicians may earn CME/MOC credit by reading information in this article to address a clinical question, and then completing a brief evaluation, in which they will identify their question and report the impact of any information learned on their clinical practice.

AMBOSS designates this Internet point-of-care activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

For answers to questions about AMBOSS CME, including how to redeem CME/MOC credit, see "Tips and Links" at the bottom of this article.

Summarytoggle arrow icon

Diabetic retinopathy is a vascular disease of the retina that is usually asymptomatic in the early stages but can lead to visual impairment and blindness as the disease progresses. The majority of cases of diabetic retinopathy are detected during screening examinations. Further tests (optical coherence tomography, fluorescein angiography) may be performed to determine severity or identify complications. Management for all patients includes optimization of treatment for diabetes, managing risk factors for atherosclerotic cardiovascular disease (ASCVD), and referral to an ophthalmologist for further management and monitoring. Further treatment depends on the subtype (nonproliferative diabetic retinopathy or proliferative diabetic retinopathy), presence of macular edema, and severity of diabetic retinopathy and includes panretinal photocoagulation (PRP), intravitreal anti-vascular endothelial growth factor (VEGF) and vitrectomy.

Overview of diabetic retinopathytoggle arrow icon

Diabetic retinopathy is usually detected on routine screening, and then classified and treated based on the presence of neovascularization, retinal thickening, and disease severity. [2]

Overview of diabetic retinopathies [2][3]
Nonproliferative retinopathy (NPDR) Proliferative retinopathy (PDR) Diabetic macular edema (DME)
Examination findings (dilated comprehensive eye exam or retinal photography)
  • Clinically significant retinal thickening and edema involving the macula, associated hard exudates
  • May occur in all stages of NPDR and PDR
Vision loss
Treatment [2]

Vitrectomy may be required for patients with complications, e.g., tractional retinal detachment, vitreous hemorrhage [2]


Epidemiologytoggle arrow icon

  • After 15 years, approx. 80% of patients with type 1 diabetes will develop retinopathy. [2]
  • Among patients > 30 years old with type 2 diabetes: [2]
    • Patients not requiring insulin
      • Approx. 25% will develop retinopathy within 5 years of diagnosis.
      • Approx. 50% will develop retinopathy within 19 years.
    • Patients requiring insulin
      • Approx. 40% will develop retinopathy within 5 years of diagnosis.
      • Approx. 85% will develop retinopathy within 19 years.
  • Diabetic retinopathy is the most common cause of visual impairment and blindness in patients aged 20–74 years. [5]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Development and progression of diabetic retinopathy is associated with: [3][5]

Clinical featurestoggle arrow icon

Screeningtoggle arrow icon

  • Modalities [2][5]
  • Onset
    • Type 1 DM: within 5 years of the onset of disease [2][7]
    • Type 2 DM: at the time of diagnosis [2]
  • Interval: every year [2]

Less frequent retinopathy screening (e.g., every 2 years) may be considered in consultation with an ophthalmologist or optometrist for patients with diabetes who have a normal initial eye exam and good glycemic control. [5][7]

Diagnosticstoggle arrow icon

General principles [2][5]

Retinal findings

Findings in diabetic retinopathy [2][3]
Moderate NPDR
Severe NDPR
PDR Nonhigh-risk PDR
High-risk PDR
Clinically significant macular edema
  • Within 500 microns of the center of the macula
    • Retinal thickening
    • Hard exudates (if associated with adjacent retinal thickening)
  • Within 1 disc diameter of the center of the macula: any zone of retinal thickening ≥ 1 disc size in any area
  • If OCT has been performed, can be further categorized into: [8]
    • Center-involving DME: ≥ 1 mm diameter retinal thickening in a central subfield
    • Noncenter-involving DME: ≥ 1 mm diameter retinal thickening that does not involve a central subfield

Managementtoggle arrow icon

Approach [2][5]

Early detection and treatment of diabetic retinopathy can prevent 90% of blindness. [2]

Treatment by retinopathy subtype [2][5]

Preventiontoggle arrow icon

Advise patients to attend regular screenings as microvascular complications are usually asymptomatic until significant damage has occurred. [2]

Special patient groupstoggle arrow icon

Diabetic retinopathy in pregnancy [2][5][9]

Routine screening for diabetic retinopathy is not recommended for patients with gestational diabetes mellitus. [2][5]

Referencestoggle arrow icon

  1. Flaxel CJ, Adelman RA, Bailey ST, et al. Diabetic Retinopathy Preferred Practice Pattern®. Ophthalmology. 2020; 127 (1): p.P66-P145.doi: 10.1016/j.ophtha.2019.09.025 . | Open in Read by QxMD
  2. Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, Raveendhara R. Bannuru, Florence M. Brown, et al.. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes 2023. Diabetes Care. 2022; 46 (Supplement_1): p.S203-S215.doi: 10.2337/dc23-s012 . | Open in Read by QxMD
  3. Wong TY, Cheung CMG, Larsen M, Sharma S, Simó R. Diabetic retinopathy. Nat Rev Dis Primers. 2016; 2 (1).doi: 10.1038/nrdp.2016.12 . | Open in Read by QxMD
  4. Negi A, Vernon SA. An overview of the eye in diabetes. J R Soc Med. 2003; 96 (6): p.266-72.doi: 10.1177/014107680309600603 . | Open in Read by QxMD
  5. Rodrigues GB, Abe RY, Zangalli C, et al. Neovascular glaucoma: a review. Int J Retina Vitreous. 2016; 2 (1).doi: 10.1186/s40942-016-0051-x . | Open in Read by QxMD
  6. Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, Raveendhara R. Bannuru, Florence M. Brown, et al.. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2023. Diabetes Care. 2022; 46 (Supplement_1): p.S254-S266.doi: 10.2337/dc23-s015 . | Open in Read by QxMD
  7. $Contributor Disclosures - Diabetic retinopathy. All of the relevant financial relationships listed for the following individuals have been mitigated: Alexandra Willis (copyeditor, was previously employed by OPEN Health Communications). None of the other individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.
  8. Wong TY, Sun J, Kawasaki R, et al. Guidelines on Diabetic Eye Care. Ophthalmology. 2018; 125 (10): p.1608-1622.doi: 10.1016/j.ophtha.2018.04.007 . | Open in Read by QxMD
  9. Liu Y, Swearingen R. Diabetic Eye Screening: Knowledge and Perspectives from Providers and Patients. Curr Diab Rep. 2017; 17 (10).doi: 10.1007/s11892-017-0911-2 . | Open in Read by QxMD
  10. Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, Raveendhara R. Bannuru, Florence M. Brown, et al.. Children and Adolescents: Standards of Care in Diabetes—2023. Diabetes Care. 2022; 46 (Supplement_1): p.S230-S253.doi: 10.2337/dc23-s014 . | Open in Read by QxMD

Icon of a lock3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer