When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Diabetic retinopathy

Last reviewed: 1 Nov 2023
Last updated: 16 Nov 2023



History and exam

Key diagnostic factors

  • diabetes
More key diagnostic factors

Other diagnostic factors

  • microaneurysms
  • cotton wool spots
  • intraretinal hemorrhage
  • lipid exudates
  • macular edema
  • venous beading
  • intraretinal microvascular abnormalities
  • optic disk neovascularization
  • retinal neovascularization
  • preretinal or vitreous hemorrhage
  • retinal detachment
Other diagnostic factors

Risk factors

  • longer duration of diabetes
  • poor glycemic control
  • elevated lipid levels
  • hypertension
  • renal disease
  • ethnicity
  • pregnancy
  • cataract surgery
More risk factors

Diagnostic investigations

1st investigations to order

  • optical coherence tomography
  • fundus photography/wide-field fundus photography
More 1st investigations to order

Investigations to consider

  • fluorescein angiography/wide-field fluorescein angiography
  • optical coherence tomography scanning
  • B-scan ultrasonography
More investigations to consider

Treatment algorithm


nonproliferative diabetic retinopathy

proliferative diabetic retinopathy

iris neovascularization

advanced proliferative diabetic retinopathy


macular edema unresponsive to intravitreal anti-VEGF therapy

macular edema with anteroposterior vitreomacular traction

chronic macular edema, macular ischemia, chronic macular detachment, optic atrophy secondary to neovascular glaucoma



Jonathan Dowler, MD, FRCS, FRCOphth
Jonathan Dowler

Consultant Ophthalmic Surgeon

The London Clinic




JD declares that he has no competing interests.


Dr Jonathan Dowler would like to gratefully acknowledge Dr Robin Hamilton, a previous contributor to this topic. RH declares that he has no competing interests.

Peer reviewers

Adrienne W Scott, MD


Wilmer Eye Institute

Bel Air

Associate Professor of Ophthalmology

Johns Hopkins University School of Medicine




AWS has received grant support and consulting honoraria from Genentech/Roche. She has also received consulting honoraria from Allergan/AbbVie Inc., Novartis, Regeneron, Bausch and Lomb, and Alimera Sciences.

  • Diabetic retinopathy images
  • Differentials

    • Ocular ischemic syndrome
    • Radiation retinopathy
    • Retinal venous occlusion
    More Differentials
  • Guidelines

    • Standards of care in diabetes - 2023
    • Comprehensive adult medical eye evaluation: preferred practice pattern
    More Guidelines
  • Patient leaflets

    Diabetes type 2: should I take insulin?

    Diabetes type 2: what treatments work?

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer