Diabetic Retinopathy & Advanced Diabetic Eye Disease
Diabetic Retinopathy occurs because longstanding diabetes affects the small blood vessels that supply the retina, the light-sensitive layer at the back of the eye. These changes can lead to leakage, swelling (diabetic macular oedema), and obliteration of the blood vessels (ischaemic retina). In more advanced stages, fragile new vessels grow on the retina (proliferative diabetic retinopathy), and, without adequate treatment, they can cause bleeding and scarring.
In the very early stages diabetic retinopathy may cause no symptoms. As the disease progresses common issues include blurred or fluctuating vision and reduced clarity. In more advanced forms bleeding inside the eye (diabetic vitreous haemorrhage) can cause dark spots or recurrent floaters, and the formation of scarring can pull on the retina, leading to more severe visual loss from tractional retinal detachment.
Although diabetic retinopathy is a serious condition, modern treatments, including laser, intravitreal injections and specialised vitrectomy can stabilise the disease at many stages. The key is timely assessment and proactive management using the right tools for each stage.
As Diabetic Retinopathy progresses to the stage of proliferative disease, abnormal vessels develop on the surface of the retina, a process called retinal neovascularisation. These abnormal fragile vessels may bleed into the vitreous cavity, causing shadows, cobwebs or sudden loss of vision. This is known as diabetic vitreous haemorrhage. Repeat bleeding is common if the abnormal vessels remain active and pulled by the vitreous gel.
In more advanced cases, scarring may develop on the surface of the retina. This tissue later contracts creating traction that lifts the retina off its normal position, leading to tractional retinal detachment. This is the most serious complication and can lead to severe and permanent visual loss.
Specialist eye care is critical to stabilise the condition and preserve the vision. Even in very complex cases, stabilising the eye and preventing further deterioration is often achievable. Vision may gradually recover once the retina is secure.
Treatment for advanced diabetic retinopathy needs to be tailored to the stage of the disease.
In early proliferative diabetic retinopathy laser is normally sufficient, but more severe complications may require a vitrectomy aiming to clear the blood-stained vitreous gel and release traction from the retina.
Laser Treatment
Panretinal photocoagulation is used to reduce abnormal vessel growth and stabilise proliferative diabetic retinopathy.
Intravitreal Injections
Commonly used for diabetic macular oedema, they are very efficient to cause abnormal vessels to regress and stabilise retinopathy. They are commonly used in preparation for surgery.
Diabetic Vitrectomy
Vitrectomy is the main treatment for diabetic vitreous haeomorrhage and tractional detachment of the retina. During surgery the blood-stained vitreous gel is removed and scar tissue is carefully released using techniques such as delamination and segmentation. These are delicate, highly skilled steps designed to release traction while keeping the retina safe. Intra-operative laser is commonly applied for more precise and effective disease control.
Whenever appropriate, diabetic vitrectomy can be combined with cataract surgery to improve visibility and allow for safe completion of the operation.
Surgery for advanced diabetic eye disease can be very demanding, but modern techniques have significantly improved outcomes. The aim is to protect vision, prevent further deterioration and give the retina the best possible opportunity to recover.
Living with diabetes can sometimes feel overwhelming and symptoms of advanced diabetic eye disease can become devastating. Our approach is calm, structured, and case-based. We explain the condition clearly, outline realistic expectations, and guide you through each step of your treatment.
Although the disease can place significant challenges, many patients stabilise well with timely intervention. Even in most complex cases requiring diabetic vitrectomy, modern surgery offers a meaningful chance to preserve or improve vision.
If you have been told you have diabetic retinopathy, diabetic vitreous haemorrhage or tractional retinal detachment, we are here to assess your eye thoroughly and recommend the safest, most effective plan.
Your questions answered
Can diabetic retinopathy improve on its own?
Diabetic retinopathy does not normally reverse without treatment. However, early stages can stabilise with good systemic control. More advanced changes typically will require medical or surgical treatment.
Can I have severe retinopathy if I have no symptoms?
Yes. Some people may have proliferative retinopathy without any change in their vision. Laser may be still recommended even if sight feels normal.
What causes sudden bleeding in the eye?
Fragile new vessels (retinal neovascularisation) may bleed easily filling the eye with blood and causing sudden loss of vision. Sometimes this clears on its own, but persistent or recurrent diabetic vitreous haemorrhage often requires vitrectomy surgery to remove the blood and stabilise the retina.
Is tractional retinal detachment serious?
Tractional retinal detachment happens when scar tissue forms and pulls the retina away from its normal position. This is a serious complication and normally requires vitrectomy surgery with delicate scar tissue removal (delamination and segmentation) to prevent permanent visual loss.
Is diabetic vitrectomy safe?
Vitrectomy for diabetic eye disease can become complex, but is well-established procedure. While risks exist, outcomes improve greatly with modern techniques, surgeon’s experience and comprehensive care.
How soon do I expect vision to improve after surgery?
Every eye is different. If bleeding was the main problem improvement may be seen quite quickly. If there was traction or detachment, recovery is usually slower.