It’s easy to think of diabetes as only a blood sugar problem. But it’s a blood sugar problem that can cause real damage throughout the body, including to your retina. That’s the light-sensitive tissue at the back of your eyes. When blood sugar levels stay high for too long, the blood vessels there can swell and leak, or they can close, making it impossible for blood to pass through.

Diabetic retinopathy doesn’t usually cause symptoms at first, but over time it can lead to irreversible eye damage, including vision loss and blindness.

The Centers for Disease Control and Prevention estimates that nearly one-third of people over age 40 with diabetes have the condition. That means 4.2 million adults, according to the CDC. And 655,000 have a form of diabetic retinopathy that threatens their vision.

For BIPOC (Black, Indigenous, and people of color) that severe form can be even more prevalent: It’s more than twice as common in Mexican American individuals and almost three times as common in African Americans compared to those in the white population.

And while getting diagnosed can feel overwhelming, it’s the first step in protecting your eye health. Your optometrist and diabetes specialist can work closely with you to ensure you and your eyes get the care you need.

“Do not hesitate to ask questions and express any concerns you have,” says Kristina Buster, O.D. She’s an optometrist with Doctor’s Exchange of Idaho, P.C., located inside America’s Best Contacts & Eyeglasses in Twin Falls, Idaho. “Your diabetes care team is your support to protect your vision and health.”

These are the questions to ask and things to know if you or someone you love has recently been diagnosed with diabetic retinopathy.

1. How do eye doctors diagnose diabetic retinopathy?

In the early stages of diabetic retinopathy, you may not have any symptoms. That’s one of the reasons regular eye exams are a key part of diabetes management. Your optometrist has a unique view of what’s happening with your eyes, often finding changes before any symptoms even arise, says Dr. Buster.

The damage from uncontrolled high blood sugar often goes unrecognized by patients for months or years — it can be very sneaky that way.

“Uncontrolled high blood sugar levels can damage your body in ways that you may not see or feel at first,” says Dr. Buster. But when optometrists dilate your eyes to get a closer look at your retina, they may see swelling, signs of bleeding or oxygen deprivation, or even abnormal blood vessel growth.

“The sooner diabetes-related changes in your eyes are found, the sooner you can take appropriate steps to prevent vision loss,” says Dr. Buster.

If your optometrist spots any signs of diabetic retinopathy, they’ll typically send a report to your doctor. That way, they can coordinate care around an action plan and any recommended changes to how you manage your diabetes.

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2. What are the noticeable signs of diabetic retinopathy?

As the condition progresses, you may experience:

• Blurry vision
• Partial vision loss
• Colors seeming faded
• Floaters, which are small dark spots or streaks that “float” in and out of your field of vision 
• Poor night vision
• Blank or dark areas in your field of vision

It’s important to let your doctor and optometrist know when you notice any change in your vision — don’t wait for your scheduled eye exam. The sooner treatment begins, the better your chances of protecting your vision.

3. How is diabetic retinopathy treated?

In the early stages, your optometrist will likely monitor your eye health with more frequent exams. Some people with diabetic retinopathy may need a full eye exam (including dilation) as often as every few months. But if the condition progresses, your optometrist may suggest a consultation and possible treatment with an ophthalmologist.

This could include:

Ocular injections. “This is the most daunting procedure to many patients,” says Dr. Buster. But fear not: Your eye is pretreated with a numbing cream or drops to keep you comfortable along with a sterilization solution. Your doctor will then inject a medicine called an anti-VEGF, which stands for anti-vascular endothelial growth factor. The medication reduces swelling in the macula, a small area in the center of the retina.

According to the American Academy of Ophthalmology, this therapy stabilizes vision for 9 in 10 people who take it. And about 1 in 3 people will experience improved vision with anti-VEGF. You will need more than one injection.

Note: Depending on where you live, your optometrist may need to refer you to an ophthalmologist for this treatment.

Laser treatments. Doctors use lasers to make the blood vessels shrink and stop leaking, which reduces swelling in your retina.

Surgery. Called vitrectomy, this type of surgery involves making very small openings in your eyewall, then using a suction tool to remove some or all of the cloudy vitreous, the clear gel-like fluid that fills your eye. Removing the vitreous gel helps give your doctor better access to the back of the eye and may be done if there’s a retinal detachment or a vitreous hemorrhage (blood in the vitreous gel).

They may place a saline solution, a gas bubble, or a silicone oil into your eye to help the retina stay in its correct place. During healing after surgery, your eye replaces the saline solution or the bubble with the natural fluid the eye makes. If your doctor used an oil bubble, they’ll need to remove the oil after the eye has healed.

4. What can I do to slow the progression of diabetic retinopathy?

Managing your diabetes can have a big impact on your eye health (along with many other aspects of your physical health). Follow your diabetes management plan closely, including taking medications such as insulin exactly as prescribed, staying active, and following a healthy eating plan.

A special lab test, called an A1C, is also useful, because it gives a snapshot of your blood glucose levels over the past three months. “It’s good to know your A1C level when you come to your eye exam,” says Dr. Buster. “It helps the optometrist know how to best help you,” she says.