Diabetic retinopathy: what are the stages?

Written by: Mr Atul Bansal
Published: | Updated: 08/12/2023
Edited by: Laura Burgess

Diabetic eye disease is a condition that occurs in people who have diabetes and causes progressive damage to the retina, which in turn can lead to sight-threatening complications if left undetected.

We’ve asked one of our expert eye specialists, Mr Atul Bansal, to explain everything you need to know about diabetic retinopathy. He discusses how both type 1 and type 2 diabetics are prone to the condition, whether you’re allowed to drive if diagnosed with the eye disease and how it’s treated.

How does diabetes cause retinopathy?

The presence of high sugar in the blood alters the metabolism of cells within the tissue in different places in the body. Where diabetes affects small blood vessels in the retina, it causes them to leak and a slow process of damage then occurs. This sets off a change in the chemical environment of the retina. The greater the level of damage and depending on the location of the changes, the vision may be affected to different degrees.

What are the different stages to diabetic retinopathy?

The condition has been classified such that diabetics may have:

  • No diabetic retinopathy
  • A relatively mild stage
  • A moderate stage
  • A severe stage
  • Vision-threatening changes

Can both type 1 and type 2 diabetics develop retinopathy?

Yes, they can. They both have slight variations but type 1 and type 2 diabetics are prone to developing these changes. It is important for patients with diabetes to attend a diabetic retinopathy screening. This has been set up to pre-emptively look for vision threatening changes and promptly refers these patients to their local hospital eye services.

The screening is done annually unless there is a reason to change that. If the screening program picks up diabetic retinopathy changes that are deemed to be vision threatening, the patient is referred accordingly to their local service. In addition, patients may also be referred for a number of other reasons that are non-diabetic related but these conditions need to be investigated too.

Can the progression of diabetic retinopathy be stopped?

Yes, the whole purpose of the screening program is to pick up any vision threatening changes early enough for treatment to be offered and to stop the progression.

Are you allowed to drive if you have diabetic retinopathy?

Driving depends on meeting the criteria for the Drive and Vehicle Licensing Agency (DVLA), irrespective of the specific eye condition.

However, the ophthalmologist has an obligation to advise the patient to notify the DVLA about an eye condition, which may affect their entitlement to a driving license.

Can diabetic retinopathy be prevented?

The attempt to prevent the condition depends on the strict control of diabetes as well as blood pressure. However, the longer the condition is present the higher the risk of having diabetic retinopathy - regardless of how well the diabetes is controlled.

The effect on the eyes can be prevented or minimised by a combination of good diabetic control, monitoring blood pressure, optimising weight and exercise levels and avoiding smoking.

Can diabetic retinopathy be reversed?

Typically not. We can say that timely treatment can prevent permanent loss of vision and, in some cases, may reverse vision loss even if it is temporary.

How do you treat diabetic retinopathy?

Depending on the specific type of diabetic retinopathy damage, treatment can be with injections into the eye, laser treatment to the retina or a combination of the two. The treatment plan will depend on the specific details of the individual case.

It is difficult to predict the number of injections or laser treatment sessions that may be needed over a given period of time for any given patient.

If you have diabetes and are concerned about diabetic retinopathy, do not hesitate to book an appointment with Mr Atul Bansal now.

By Mr Atul Bansal

Mr Atul Bansal is an extremely-skilled and leading consultant ophthalmic surgeon based in Coventry and Solihull, Birmingham. He is a renowned expert in cataract surgery and glaucoma management, and has been in the field of ophthalmology for more than 29 years. 

He is very highly-regarded for his skill in cataract surgery and has performed thousands of cataract procedures. He has special expertise in complex cataract surgery and also offers cataract surgery with multifocal and toric intraocular lenses and microincision cataract surgery with an option of no injection anaesthesia. He had been the lead for cataract surgery for many years at the University Hospital Coventry and Warwickshire (UHCW) NHS Trust.

Mr Bansal is an expert in modern glaucoma lasers and surgery and offers minimally-invasive surgery (MIGS) with iStent and Trabectome, and regularly performs and teaches selective laser trabeculoplasty (SLT).

He graduated from a top medical school with a first prize and obtained excellent training, including specialist training from Oxford and Birmingham and an advanced fellowship from Manchester Eye Hospital. He was awarded the Birmingham Eye Foundation Roper-Hall Prize Medal in 2004.

He has an avid interest in research with more than 20 indexed publications in peer-reviewed journals, an MD thesis and chapters in a book on difficult cataract surgery. He is a principal investigator in randomised multicentre trials. He regularly presents at international and national meetings and has chaired a number of sessions on cataract and glaucoma surgery. He has served as the regional quality lead for the postgraduate training for the School of Ophthalmology, Health Education West Midlands, for many years. He has been nominated three times for the Best Regional Ophthalmology Trainer award.

Mr Bansal is driven by providing service in a caring way and tailors the treatment to the patients’ individual needs. He keeps patients’ interests first and always aims for providing the highest standards of quality and safety.

He practices privately at BMI The Meriden Hospital in Coventry and the Spire Parkway Hospital in Solihull, Birmingham.

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