Diabetic Retinopathy (Eye Damage Caused by Diabetes)
By Dr. Nejmi Öztürk, ophthalmologist and eye surgeon working in the diagnosis and treatment of retinal diseases, at HG Hospital in Kahramanmaraş, Türkiye — dilated retinal examination, intravitreal injection, argon laser and vitrectomy
- Diabetic retinopathy develops when high blood sugar damages the fine blood vessels of the retina (the light-sensing layer at the back of the eye); at the start it causes no symptoms.
- In type 2 diabetes a dilated retinal examination is done at diagnosis, in type 1 diabetes 5 years after diagnosis; it is then repeated at least once a year.
- Treatment covers blood sugar control, intravitreal injections (anti-VEGF and steroid), argon laser and, when needed, vitrectomy.
- At HG Hospital in Kahramanmaraş, diagnosis and treatment are carried out by Dr. Nejmi Öztürk; insurance coverage is clarified at the consultation.
What is diabetic retinopathy?
Diabetic retinopathy is the disease that develops when diabetes damages the small blood vessels of the retina (the nerve layer lining the back wall of the eye that makes vision possible). Many patients know it simply as “diabetic eye disease”. It becomes more common the longer diabetes has been present and the higher blood sugar has run.
Blood sugar that stays high for a long time weakens the vessel walls. This damage impairs vision in three ways:
- Leakage: Fluid and fats leak from the weakened vessels and the retina swells. When the swelling is in the macula (the center of vision), it is called diabetic macular edema; vision becomes blurred.
- Blockage: The capillaries close off and the retina does not receive enough oxygen.
- New vessel growth: The oxygen-starved retina releases a growth substance called VEGF. This substance produces fragile new vessels that bleed easily. These vessels can bleed into the eye (a “diabetic eye bleed”, or vitreous hemorrhage) and can pull the retina away from its place.
What are the stages of diabetic retinopathy?
Diabetic retinopathy is grouped into two main stages: non-proliferative (early stage, no new vessels) and proliferative (advanced stage, new vessels present). Diabetic macular edema can occur at any stage.
| Stage | What happens in the eye? | Effect on vision |
|---|---|---|
| Mild to moderate non-proliferative | Small bulges in the vessel walls (microaneurysms), dot hemorrhages, mild leakage | Usually no symptoms |
| Severe non-proliferative | Widespread hemorrhages and vessel blockage; areas starved of oxygen | There may be no symptoms; close follow-up is needed |
| Proliferative | New vessels; bleeding into the eye; traction on the retina and detachment | Sudden blurring, black spots; risk of advanced vision loss |
| Diabetic macular edema (at any stage) | Fluid build-up and swelling at the center of vision | Blurred and wavy vision, difficulty reading |
What are the symptoms, and who is at risk?
Diabetic retinopathy usually begins while vision is still good; it causes no symptoms until the disease has progressed. So the thought “there is nothing wrong with my eyes” should not delay an examination. As it progresses, the following symptoms may appear:
- Blurred, wavy or distorted vision; difficulty reading
- Black spots, threads or cobweb-like shapes floating in your field of vision
- A sudden drop in vision, or vision closing off like a curtain (this can be a sign of bleeding inside the eye)
- Difficulty seeing at night, colors looking faded
- Vision that changes during the day (linked to swings in blood sugar)
Who needs regular eye examinations?
Everyone diagnosed with diabetes should have regular dilated retinal examinations. How often depends on the type of diabetes and on the findings in the eye:
- Type 2 diabetes: A dilated retinal examination is done as soon as the diagnosis is made, because the disease may already have been present for years by then.
- Type 1 diabetes: Examinations begin from the 5th year after diagnosis.
- Afterwards: Once a year if there is no retinopathy; every 3–6 months, depending on the stage, if there is.
- Pregnancy: Women with diabetes should be examined when planning a pregnancy or in the first 3 months of pregnancy, checked every 3 months during pregnancy and again within 1 year after the birth. Routine screening is not needed for diabetes that appears only during pregnancy (gestational diabetes).
Factors that increase the risk: long-standing diabetes, a high HbA1c (the 3-month average blood sugar), high blood pressure, kidney disease, high cholesterol, smoking, pregnancy and periods in which blood sugar is brought down very quickly.
Who is it not suitable for?
A screening examination is suitable for everyone; some treatments, however, are postponed in certain situations or a different option is chosen:
- Intravitreal injections are postponed while there is an active infection in or around the eye.
- In people who have recently had a heart attack or stroke, the decision on anti-VEGF is made together with the internal medicine or cardiology department.
- During pregnancy anti-VEGF is usually postponed; laser may be preferred if treatment is needed.
- Steroid injections are chosen with care in people with high eye pressure and in younger patients who still have their natural lens.
- If dense bleeding inside the eye or an advanced cataract (clouding of the lens) stops the laser light from reaching the retina, vitrectomy or cataract surgery may be needed beforehand.
- In people whose general health is not fit for surgery, the decision on vitrectomy is made after an anesthesia assessment.
How are the examination and tests done?
Diabetic retinopathy is diagnosed with a dilated retinal examination, in which the pupil is widened with drops. Further tests are requested to determine the stage and the need for treatment:
- Visual acuity and eye pressure measurement: Done at the start of every examination.
- Dilated retinal examination: The drops take effect in 20–30 minutes. The whole retina is examined. The effect lasts 4–6 hours; during this time near vision is blurred and light is uncomfortable, so you should not drive.
- OCT (optical coherence tomography): Takes a cross-sectional image of the retina using light. It shows whether macular edema is present and measures its thickness. It is completed in a few minutes without touching the eye and is the main tool for monitoring treatment.
- Fundus fluorescein angiography: A dye is injected into a vein in the arm and a series of photographs of the retinal vessels is taken. It shows leaking and blocked vessels and new vessel growth. The dye gives the skin a yellowish tint for a few hours and turns the urine orange for 1–2 days; brief nausea can occur. Kidney disease, a history of allergy and pregnancy must be reported beforehand.
- OCT angiography and retinal photography: Image the vessel network without dye; used for comparison during follow-up.
- Blood tests: HbA1c, blood pressure and kidney function are assessed together with your internal medicine physician or family doctor.
How is it treated?
Treatment of diabetic retinopathy proceeds in steps according to the stage; the aim is to preserve the vision you have and prevent further loss. Blood sugar control is the foundation of every step.
| Step | When is it used? | How is it done? | What to expect |
|---|---|---|---|
| Control of blood sugar, blood pressure and cholesterol | At every stage, as the basic treatment | With your family doctor and internal medicine physician; the HbA1c target is set individually | Slows progression; does not reverse damage that has already occurred |
| Intravitreal anti-VEGF injection | Macular edema involving the center; new vessel growth | Under anesthetic drops, in sterile conditions; a monthly series at the start | Reduces the swelling, can preserve and to some extent improve vision; needs to be repeated |
| Intravitreal steroid (cortisone) injection or implant | Insufficient response to anti-VEGF; eyes that have had cataract surgery | By the same method; the effect lasts for months | Reduces the edema; follow-up for cataract and eye pressure is needed |
| Argon laser photocoagulation | Proliferative stage (panretinal laser); edema not involving the center (focal laser) | Under anesthetic drops and with a contact lens; 1–3 sessions | Reduces the risk of bleeding and advanced loss; does not improve vision |
| Vitrectomy | Bleeding inside the eye that does not clear; traction on the retina and detachment | In the operating room, under local or general anesthesia | Clears the blood and reattaches the retina; the result depends on the condition of the retina |
How is an eye injection (intravitreal injection) given?
In an eye injection, the medicine is delivered through the white of the eye with a very fine needle into the gel-filled space inside the eye (the vitreous). It is an outpatient procedure and you go home the same day.
- The decision to inject is made on the basis of the examination and OCT; the procedure and its possible risks are explained and your consent is obtained.
- The eye is numbed with anesthetic drops. The eyelids and the surface of the eye are cleaned with an antiseptic (povidone-iodine); a sterile drape and an eyelid holder are placed.
- The medicine is injected into the eye through the white part, 3.5–4 mm outside the colored part of the eye. The injection itself takes a few seconds; including preparation, the procedure is over in 10–15 minutes.
- What you will feel: Because of the anesthetic drops, most patients feel pressure at the moment of injection; there may be a brief sting. Because of the antiseptic, a burning, stinging and gritty feeling may follow for a few hours after the procedure.
- After the procedure it is checked that you can see light and that your eye pressure has not risen. You are advised to go home without driving.
Frequency: Usually a monthly “loading” injection is given for the first 3 months in a row. The interval is then extended step by step according to the OCT result (treat-and-extend), or injections are repeated whenever the edema returns. The total number of injections varies from patient to patient; in some patients treatment continues for years.
How is argon laser applied?
The laser is applied through a contact lens placed on the eye after the pupil has been dilated and anesthetic drops have been given. In the proliferative stage, hundreds of small laser spots are placed on the peripheral retina (panretinal photocoagulation); this shrinks the oxygen-starved areas and makes the new vessels regress. A session takes 10–20 minutes; you may notice bright light and an occasional aching sensation. Usually 1–3 sessions are needed. A few hours of blurring and glare are expected after the laser.
What happens in diabetic retinopathy?
First the retinal vessels leak, then they form new vessels; and what the treatment aims for.
- The vessels begin to leakHigh blood sugar gradually damages the thin vessels of the retina. Small bulges (microaneurysms) form in the vessel walls, and fluid and blood leak out. Vision is usually normal at this stage.
- New vessels formThe retina, deprived of oxygen, tries to build new vessels; but these vessels are fragile and may bleed into the vitreous. Bleeding can cause a sudden loss of vision.
- Treatment with laserThe laser treats the areas lacking oxygen and reduces the signal for new vessel growth. The aim is to preserve the vision that remains.
- Treatment with injectionIf there is swelling in the macula, an intravitreal injection is given. Treatment is usually planned as repeated sessions.
What is recovery like?
- Day 1 (injection): Stinging, burning and watering may occur. A red patch of blood may be visible on the white of the eye at the injection site; it is harmless and disappears in 1–2 weeks. You may see small floating spots. Do not rub the eye; use the drops you have been given.
- Week 1: The discomfort usually passes in 1–2 days. Increasing pain, increasing redness, a drop in vision or light sensitivity can be signs of an infection inside the eye; if this happens, go to the hospital without waiting.
- Month 1: The response of the edema is measured with OCT and the next injection is planned. Any improvement in vision comes gradually over weeks and is not the same in every patient.
- After laser: A few hours of blurring and 1–2 days of mild aching may occur. The effect of the laser settles in 2–4 weeks; a check-up is done within 1–3 months.
- After vitrectomy: Recovery is described on its own page: vitrectomy.
For patients coming from Elbistan, Afşin, Göksun and the other districts, the OCT check and the injection are scheduled for the same day, so that one trip is enough for each injection.
What you can do to protect your eyes: keep your HbA1c on target, control your blood pressure and cholesterol, stop smoking, keep your appointments and seek care without delay whenever your vision changes.
What are the risks and limitations?
- Injection risks: Infection inside the eye (endophthalmitis; rare, seen in roughly one in every 1,000–3,000 injections, and needs urgent treatment), retinal tear or detachment, a temporary rise in eye pressure, cataract (especially with steroids), a patch of blood on the surface of the eye (common and harmless), allergy to the medicine. The possible effect of anti-VEGF medicines on heart and blood vessel events is assessed with the internal medicine department in patients at risk.
- Laser risks: Reduced peripheral (side) vision and night vision, changes in color perception, a temporary increase in macular edema, rarely an effect on central vision.
- Vitrectomy risks: Described in detail on the vitrectomy page.
- Limitations: Nerve cells that have died do not come back; in the advanced stage vision may not fully recover. Treatment does not replace blood sugar control. Injections need to be repeated regularly; stopping treatment can allow the edema to return. Not every patient responds in the same way.
How do the treatment options compare?
| Feature | Anti-VEGF injection | Argon laser | Vitrectomy |
|---|---|---|---|
| When? | Macular edema, new vessel growth | Proliferative stage, edema away from the center | Bleeding that does not clear, traction on the retina |
| Anesthesia and setting | Drops; outpatient | Drops; outpatient | Local or general; operating room |
| Need for repetition | Monthly series, then at intervals | 1–3 sessions, more if needed | Usually one operation; a further procedure may be needed |
| Effect on vision | Can preserve and improve | Preserves; does not improve | Clears the blood; result depends on the retina |
| SGK coverage (insured patients) | Generally covered | Generally covered | Generally covered |
In people with diabetes a cataract can develop at an earlier age; before cataract surgery the retina is assessed and, if necessary, the edema is treated beforehand. For other conditions, see the retinal diseases page.
Diabetic retinopathy treatment in Kahramanmaraş
At HG Hospital in Kahramanmaraş, Türkiye, the diagnosis of diabetic retinopathy, intravitreal injections, argon laser photocoagulation and vitrectomy are carried out by Dr. Nejmi Öztürk. The necessary tests (OCT, angiography) are planned after the examination. For blood sugar and blood pressure management, the hospital’s internal medicine department and your family doctor are involved; your eye findings are shared with you in writing.
HG Hospital is a private hospital contracted with the Turkish social security institution (SGK); patients with valid SGK coverage may use it, although a private-hospital co-payment may apply. Retinal treatments for diabetes (injections, laser, vitrectomy) are generally within SGK coverage. Patients without SGK coverage, such as international patients and visitors from abroad, pay privately or through their private or travel health insurance; the hospital checks coverage before treatment. Fee information is given by the hospital after the examination, and insurance coverage is clarified at the consultation.
Everyone with a diagnosis of diabetes in Kahramanmaraş city center and its districts is advised to have a dilated retinal examination once a year, even if their vision is good. You can ask your family doctor to remind you of your annual eye check.
Dr. Öztürk sees patients only at HG Hospital in Kahramanmaraş. For patients coming from Elbistan, Afşin, Göksun, Ekinözü and Nurhak, the examination, tests and injection are grouped into the same day; for a long-term injection schedule, the travel plan is worked out together with the patient. For details, see the patients from Elbistan and the surrounding area page.
Dr. Nejmi Öztürk sees patients at HG Hospital in Kahramanmaraş, Türkiye. For patients travelling from other districts or from abroad, examination, tests and treatment planning can be arranged for the same day.
Hospital switchboard (within Türkiye): 444 46 46 · E-mail: info@nejmiozturk.com · HG Hospital, Üngüt Mevkii, Prof. Dr. Necmettin Erbakan Blv. No:209, Onikişubat / Kahramanmaraş, Türkiye
Frequently asked questions
How often should a person with diabetes have an eye examination?
In type 2 diabetes a dilated retinal examination is done as soon as the diagnosis is made; in type 1 diabetes, 5 years after diagnosis. If there is no retinopathy, it is repeated once a year. If there is retinopathy, a check every 3–6 months depending on the stage, and monthly checks during a course of treatment, may be needed.
What is a diabetic eye bleed, and does it clear on its own?
A diabetic eye bleed (vitreous hemorrhage) is bleeding from the fragile new vessels on the retina into the gel-filled space inside the eye. Vision suddenly becomes blurred or black patches appear. Small bleeds can clear within weeks; but unless the new vessels that caused the bleed are treated, the bleeding recurs. If the blood does not clear, vitrectomy may be needed.
What is an eye injection, and how many times is it given?
An eye injection delivers a medicine that stops the vessels leaking (anti-VEGF or steroid) into the eye through a fine needle. In most patients it is given monthly for the first 3 months, after which the interval is extended according to the OCT result. The total number depends on the patient’s response; some patients need injections at intervals for years.
Does the eye injection hurt?
The eye is numbed with anesthetic drops. Most patients describe pressure and a brief sting at the moment of injection. After the procedure, a burning and gritty feeling caused by the antiseptic may last for a few hours; it usually settles the same day.
Can diabetic retinopathy be cured completely?
Diabetic retinopathy is a chronic disease; treatment brings it under control but does not make it disappear. In the early stage, progression can be halted with blood sugar control. Macular edema can regress with injections; loss caused by nerve cells that have died, however, does not come back. Regular follow-up therefore continues for life.
My blood sugar is under control now; should I continue eye treatment?
Yes. Better blood sugar control slows progression, but leakage and new vessels that have already formed in the retina do not go away by themselves. The injection or laser plan is continued according to the OCT and retinal findings. In addition, retinopathy can temporarily get worse in the first months after blood sugar is lowered quickly; eye checks are done more often during this period.
Does laser treatment for diabetic retinopathy improve vision?
Panretinal laser is done not to improve vision but to prevent serious consequences such as bleeding inside the eye and retinal detachment. It preserves the vision you have. After the laser there may be some reduction in peripheral vision and night vision; this is an accepted trade-off against the risk of advanced loss.
Does diabetes cause vision loss?
Untreated diabetic retinopathy can lead to permanent vision loss. Long-standing diabetes, a high HbA1c, high blood pressure, kidney disease and smoking increase the risk. With regular examinations and timely treatment, severe vision loss can largely be prevented.
Can I drive or return to work after the injection?
On the day of the injection you are advised not to drive, because your pupil has been dilated and your eye numbed. Most patients return to work the next day. For a few days, avoid rubbing the eye and stay out of swimming pools and the sea.
I am coming from Elbistan; how do we plan the injection follow-up?
The drive between Elbistan and Kahramanmaraş takes about 2 hours. For this reason, the OCT check and the injection are booked for the same day; tests in the morning, injection the same day. After the monthly loading phase, the number of trips falls as the intervals get longer.
How much does diabetic retinopathy treatment cost?
Fee information is given by the hospital after the examination; insurance coverage is clarified at the consultation. Retinal treatments are generally within SGK coverage for insured patients, although a private-hospital co-payment may apply; patients without SGK coverage pay privately or through their private or travel health insurance.
Which doctor can I see for retinal diseases in Kahramanmaraş?
Retinal diseases are diagnosed and treated by ophthalmologists. At HG Hospital in Kahramanmaraş, Dr. Nejmi Öztürk, an ophthalmologist working in the diagnosis and treatment of retinal diseases, performs dilated retinal examinations, injections, laser and vitrectomy.
Sources
- Turkish Ophthalmological Society — todnet.org
- American Academy of Ophthalmology (AAO) — aao.org
- National Eye Institute (NEI) — nei.nih.gov
Related pages
This page is for information only; diagnosis and treatment decisions are made after an examination. The results of any surgical or interventional procedure may vary from person to person. You are advised to obtain detailed advice from your physician before any procedure.
Ophthalmologist and eye surgeon. Graduate of Erciyes University Faculty of Medicine; completed his residency at Ankara Atatürk Training and Research Hospital. With 21 years of experience in cataract and refractive surgery, strabismus, glaucoma, retina and oculoplastic surgery, he sees patients at HG Hospital in Kahramanmaraş, Türkiye. Biography and training
Dr. Nejmi Öztürk
Ophthalmologist and eye surgeon
HG Hospital, Üngüt Mevkii, Prof. Dr. Necmettin Erbakan Blv. No:209, Onikişubat / Kahramanmaraş
+90 506 377 47 68WhatsAppAppointment formHospital switchboard (within Türkiye): 444 46 46 · info@nejmiozturk.com
- Private patients and private health insurance are welcome; patients with SGK coverage may use it (conditions are confirmed by the hospital)
- Same-day examination and test planning for patients travelling from other districts or from abroad
- Getting here and patient information
- Patients from Elbistan and the region