[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [The eye in systemic disease](https://durgical.com/en/ophthalmology/areas/systemic/) › Diabetes and the eye: screening and grading # Diabetes and the eye: screening and grading - Eye and systemic disease Diabetic retinopathy causes no symptoms until late, so every person with diabetes needs regular retinal screening. Found early, it is treatable. Updated Nov 5, 2026 **See it in 3D:** [Retina](https://durgical.com/en/anatomy/retina/) · [Macula](https://durgical.com/en/anatomy/macula/) · [Optic disc](https://durgical.com/en/anatomy/optic-disc/) ## Key points - Screen type 2 at diagnosis; type 1 from five years after diagnosis. - Macular oedema is the main cause of visual loss. - New vessels = proliferative = urgent. - Control glucose, blood pressure and lipids. ## What it is Diabetes damages the small vessels of the retina: they leak (macular oedema) and close (ischaemia), and the ischaemic retina grows fragile new vessels (proliferative retinopathy). It is a leading cause of visual loss in working-age adults and is silent until late. Screening with a dilated exam or retinal photographs, good control of glucose, blood pressure and lipids, and timely laser or injections prevent most blindness. ## Eye findings - Non-proliferative retinopathy: microaneurysms, dot and blot haemorrhages, hard exudates, cotton-wool spots, venous beading. - Proliferative retinopathy: new vessels on the disc or elsewhere, which can bleed or pull the retina off. - Diabetic macular oedema: the commonest cause of visual loss in diabetes; it can occur at any stage. - Other effects: earlier cataract, blurred vision with glucose swings, third, fourth or sixth nerve palsies, neovascular glaucoma. ## Step by step - Ask about blurred or fluctuating vision and measure visual acuity. - Examine the retina through dilated pupils, or take retinal photographs for remote grading. - Grade the retinopathy (none, mild, moderate or severe non-proliferative, proliferative) and look for macular oedema. ## Screening and follow-up - Type 2 diabetes: screen at diagnosis, because retinopathy may already be present. - Type 1 diabetes: screen from about five years after diagnosis (and at puberty). - Then screen at least every one to two years if there is no retinopathy, and more often if there is. - Pregnancy can worsen retinopathy: exam early in pregnancy and during it. - A very rapid fall in glucose can transiently worsen retinopathy: examine before intensifying treatment if retinopathy is advanced. ## Next step / Initial management - No retinopathy: repeat screening every one to two years and optimise glucose, blood pressure and lipids. - Mild to moderate non-proliferative retinopathy without macular oedema: ophthalmology follow-up within months. - Macular oedema: ophthalmology within weeks for OCT and anti-VEGF injections. - Severe non-proliferative or proliferative retinopathy: urgent ophthalmology for laser (panretinal photocoagulation) or injections. - Sudden loss of vision, shower of floaters or a painful red eye: same day (vitreous haemorrhage, detachment, neovascular glaucoma). ## Test yourself Think of the answer, then tap the question to see it. ## When should retinal screening start in type 2 diabetes? At diagnosis, because retinopathy may already be present. ## What is the commonest cause of visual loss in diabetes? Diabetic macular oedema. ## What defines proliferative diabetic retinopathy? New vessels on the optic disc or elsewhere on the retina, which can bleed or cause a tractional detachment. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/diabetes-and-the-eye-screening-and-grading/) ## Connections ## See it in 3D 3 The structures of Durgical's 3D anatomy where it is found. - [Retina](https://durgical.com/en/anatomy/retina/) - [Macula](https://durgical.com/en/anatomy/macula/) - [Optic disc](https://durgical.com/en/anatomy/optic-disc/) ## Related 5 - [Dilated fundus examination: when and how](https://durgical.com/en/ophthalmology/dilated-fundus-examination-when-and-how/) - [OCT, fundus photography and angiography](https://durgical.com/en/ophthalmology/oct-fundus-photography-and-angiography/) - [Intravitreal anti-VEGF injections](https://durgical.com/en/ophthalmology/intravitreal-anti-vegf-injections/) - [Visual screening in Colombia: what the RIAS ask for](https://durgical.com/en/ophthalmology/visual-screening-in-colombia-what-the-rias-ask-for/) - [Hypertension and the eye](https://durgical.com/en/ophthalmology/hypertension-and-the-eye/) ## Related conditions 5 - [Diabetic retinopathy](https://durgical.com/en/conditions/diabetic-retinopathy/) - [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/) - [Type 1 diabetes mellitus](https://durgical.com/en/conditions/type-1-diabetes-mellitus/) - [Cataract](https://durgical.com/en/conditions/cataract/) - [Gestational diabetes mellitus](https://durgical.com/en/conditions/gestational-diabetes-mellitus/) ## In Pharmacology 3 - [Bevacizumab](https://durgical.com/en/pharmacology/bevacizumab/) - [Ranibizumab](https://durgical.com/en/pharmacology/ranibizumab/) - [Aflibercept](https://durgical.com/en/pharmacology/aflibercept/) [← All of ophthalmology](https://durgical.com/en/ophthalmology/) Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once. Sources: [Diabetic Retinopathy](https://www.ncbi.nlm.nih.gov/books/NBK560805/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Diabetic Macular Edema](https://www.ncbi.nlm.nih.gov/books/NBK554384/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Guía de práctica clínica para el diagnóstico, tratamiento y seguimiento de la diabetes mellitus tipo 2 en la población mayor de 18 años](https://gpc.minsalud.gov.co/gpc_sites/Repositorio/Conv_637/GPC_diabetes/gpc_diabetes_tipo2.aspx) (Ministerio de Salud y Protección Social de Colombia, 2016). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/ophthalmology/diabetes-and-the-eye-screening-and-grading/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/diabetes-and-the-eye-screening-and-grading/