Diabetic Retinopathy: How to Preserve Vision with Diabetes?

What is diabetic retinopathy and why is it dangerous?

Diabetic retinopathy (DR) is one of the most serious microvascular complications of diabetes mellitus, which is a leading cause of preventable vision loss and blindness among the working-age population worldwide [3, 4, 6]. With the growth of the global diabetes epidemic, the prevalence of DR is also increasing [3]. This condition occurs when high blood sugar levels damage the blood vessels of the retina — the light-sensitive tissue at the back of the eye [1].

DR is classified into two main stages: non-proliferative (NPDR) and proliferative (PDR) [3]. At any of these stages, diabetic macular edema (DME) can develop, which also threatens vision. Progression to proliferative DR is often associated with irreversible vision loss and a rapid decline in quality of life [3]. Unfortunately, many people living with diabetes are unaware of their risk of developing DR and the need for regular screening [1].

Key aspects of prevention: control and awareness

Prevention of diabetic retinopathy is based on several fundamental principles:

• Strict blood sugar control: Uncontrolled high blood glucose levels are the primary factor leading to the development of DR [1]. Maintaining glycemic targets significantly reduces the risk of the disease's onset and progression.
• Regular eye examinations: Early detection of DR is crucial for preventing vision loss [1, 2, 4]. The International Council of Ophthalmology (ICO) emphasizes the importance of screening programs, timely referral to specialists, and adequate treatment [4].
• Patient awareness: Low levels of awareness about DR among the population are a serious obstacle to early diagnosis and treatment [1]. Studies show that although the majority of patients with diabetes (86.1%) have a positive attitude toward prevention, only 61.2% know that uncontrolled high blood sugar can lead to DR [1]. Increasing awareness of the risks and the need for screening is a critically important step.
• Blood pressure and lipid control: In addition to blood sugar levels, controlling blood pressure and cholesterol levels also plays an important role in preventing microvascular complications, including DR [7].

Screening and monitoring strategies

Effective screening is the cornerstone of preventing vision loss from DR. Screening programs should be adapted to the availability of resources in a specific country or region [4]. A systematic review conducted in the USA identified gaps in the continuum of care for patients with DR that contribute to preventable vision loss. This continuum includes the following stages [2]:

1. Diagnosis of diabetes.
2. Adherence to DR screening.
3. Diagnosis of DR.
4. Adherence to DR treatment.
5. Prevention of DR-related blindness.

Regular eye examinations performed by trained specialists allow for the detection of retinal changes before symptoms appear, when treatment is most effective [4].

Modern approaches to treating diabetic retinopathy

Even when all preventive measures are followed, DR may progress in some patients. In such cases, effective treatment methods aimed at preserving vision are available:

• Anti-VEGF therapy: Vascular endothelial growth factor (VEGF-A) plays a key role in the pathogenesis of DR, promoting the growth of abnormal blood vessels and edema [3]. Injections of drugs that block VEGF (anti-VEGF), such as ranibizumab or aflibercept, into the vitreous body of the eye are the standard of care for proliferative DR and diabetic macular edema [3]. Clinical studies show that approximately one-third of patients with DR and macular edema experience significant improvement in retinal condition after one year of anti-VEGF treatment [3].
• Incretin-based therapies: Various drugs are used to control glucose levels in patients with type 2 diabetes. Incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase-4 (DPP-4) inhibitors, have shown their effectiveness in glycemic control [5]. Some of them, such as tirzepatide, outperform placebo in glycemic control [5]. It is important to note that studies show a low risk of developing non-arteritic anterior ischemic optic neuropathy when using GLP-1 RAs compared to DPP-4 inhibitors [8].
• Laser photocoagulation: A traditional treatment method that can be used to destroy abnormal blood vessels and reduce edema.
• Vitreoretinal surgery: In some cases, with severe complications such as retinal detachment or vitreous hemorrhage, surgical intervention may be required.

What can every patient with diabetes do to protect their vision?

Active patient participation in managing their condition is a key factor in preventing DR:

• Strictly follow doctor's recommendations: Constantly monitor your blood sugar, blood pressure, and cholesterol levels.
• Visit an ophthalmologist regularly: Have eye exams at least once a year or more often if recommended by your doctor, even if you have no symptoms.
• Be informed: Learn about diabetic retinopathy, its symptoms, and the importance of early diagnosis.
• Do not ignore symptoms: If any vision changes occur (blurring, floaters, flashes of light), consult a doctor immediately.
• Lead a healthy lifestyle: A balanced diet, regular physical activity, and quitting smoking contribute to overall health improvement and diabetes control.

Remember that vision loss due to diabetic retinopathy can often be prevented with timely diagnosis and adequate treatment. Your vigilance and cooperation with doctors are the best protection for your eyes.

Sources

1. Knowledge, attitudes and practices regarding the prevention of diabetic eye complications among people living with diabetes in Limpopo province, South Africa: a cross-sectional study. (African journal of primary health care & family medicine, 2026) https://pubmed.ncbi.nlm.nih.gov/42549721/
2. The diabetic retinopathy treatment cascade and continuum of care in the USA: a systematic review. (BMJ open, 2026) https://pubmed.ncbi.nlm.nih.gov/42270111/
3. Advances in the treatment of diabetic retinopathy. (Journal of diabetes and its complications, 2019) https://pubmed.ncbi.nlm.nih.gov/31669065/
4. International Council of Ophthalmology recommendations for diabetes eye care: screening, monitoring, referral, and treatment based on resource availability. (Ophthalmology, 2018) https://pubmed.ncbi.nlm.nih.gov/29776671/
5. Efficacy and safety of incretin-based therapies in patients with type 2 diabetes mellitus: a network meta-analysis based on clinical trials. (Frontiers in pharmacology, 2026) https://pubmed.ncbi.nlm.nih.gov/42394981/
6. Diabetic retinopathy and associated factors in patients with type 2 diabetes mellitus: a cross-sectional study. (Health science reports, 2026) https://pubmed.ncbi.nlm.nih.gov/41970430/
7. Heart failure management; a perspective from diabetes care. (Diabetes research and clinical practice, 2021) https://pubmed.ncbi.nlm.nih.gov/33957144/
8. Glucagon-like peptide-1 receptor agonists and the risk of non-arteritic anterior ischemic optic neuropathy in patients with type 2 diabetes. (Diabetes care, 2026) https://pubmed.ncbi.nlm.nih.gov/41701611/

Disclaimer: The information provided in this article is for reference purposes only and cannot replace professional consultation, diagnosis, or treatment provided by a qualified medical professional. Always consult your doctor regarding any questions about your health or condition.