Diabetic retinopathy is damage to the tiny blood vessels in the retina, the light-sensing layer at the back of the eye. High blood sugar weakens those vessels over time. They leak fluid, swell the central retina (a complication called macular edema), and in advanced disease the eye grows fragile new vessels that bleed. It is the most common cause of vision loss in people with diabetes and the leading cause of new blindness in working-age adults, according to the CDC. The disease lands harder on Black adults: in the Multi-Ethnic Study of Atherosclerosis, retinopathy was found in 36.7% of Black participants with diabetes versus 24.8% of White participants, and macular edema in 11.1% versus 2.7%.
The disparity is real, and it shows up in vision loss
The gap is not small. CDC surveillance puts diabetic retinopathy prevalence at 3.26% among non-Hispanic Black adults, the highest of any group, with vision-threatening retinopathy at 1.11%, roughly double the White rate of about 0.58%. A 2022 review in the Journal of the National Medical Association by Coney and Scott reported that Black and Hispanic adults with diabetes are nearly twice as likely as White adults to have sight-threatening diabetic retinopathy, and that DR causes about 17% of vision loss in African Americans compared with 8% in White Americans.
Three things drive the gap. Glucose and blood pressure that run high for longer damage retinal vessels faster, and hypertension is both more common and harder-controlled in many Black patients. Access to eye care is thinner, so disease is found later, when it is already harder to treat. And the screening that would catch it early happens less often. Those are the levers, and they are the same ones that move glaucoma risk in Black adults, which is why the dilated eye exam pulls double duty.
Early retinopathy has no symptoms
This is the part that costs people their sight. In its early stages, diabetic retinopathy produces no pain, no blur, no warning at all. The National Eye Institute is blunt about it: the early stages usually have no symptoms. By the time vision changes, the disease has often advanced past the point where everything can be saved. So the rule is simple. Do not wait to feel something. The exam finds the damage before you can.
When symptoms do arrive, they tend to look like this: new floaters, the dark spots or cobweb-like streaks that appear when fragile vessels bleed; vision that blurs or fluctuates, sometimes day to day as blood sugar swings; dark or empty areas in your field of view; and vision loss. Any of these means call an eye doctor now, not at your next routine visit. Tingling or numbness in the hands and feet is a separate diabetes complication, but it signals the same underlying problem of nerve and vessel damage from high blood sugar, and many people who notice numbness and tingling are overdue for an eye exam too.
Who needs screening, and when
The American Academy of Ophthalmology Preferred Practice Pattern is specific. If you have type 2 diabetes, get a dilated eye exam at the time of diagnosis, because retinopathy can already be present when type 2 is found, then at least once a year after that. If you have type 1 diabetes, start annual exams five years after onset. If retinopathy is already present, your eye doctor will want to see you more often. A dilated exam means drops that widen the pupil so the clinician can see the whole retina. A quick vision check at the eye chart does not count and will miss early disease.
Black adults get this exam less often. Across the U.S. working-age population with diabetes, annual eye exams reach about 48.9% of Black adults versus 55.6% of White adults, and a national analysis in Diabetes Care found White exam rates rose while minority rates fell over the 2002 to 2009 study window. Cost, time off work, no eye doctor nearby, and never being told the exam was urgent all play a role, and expanding insurance alone has not closed the gap.
One change is starting to chip at the access gap. The FDA has cleared autonomous AI cameras, such as LumineticsCore (formerly IDx-DR), that take retinal photos right in a primary care office and return a diabetic retinopathy result in minutes, without an eye specialist on site. At Johns Hopkins, putting one of these systems in primary care clinics was associated with more Black patients actually getting to an eye specialist, a group historically less likely to be screened and more likely to show up with advanced disease. The technology does not replace the dilated exam by an ophthalmologist or optometrist, but it can flag who needs one and get them in the door.
It is treatable when you catch it early
The reason the yearly exam matters so much is that early retinopathy responds to treatment. Controlling blood sugar and blood pressure slows the damage and can keep mild disease from progressing. For more advanced disease, anti-VEGF injections (aflibercept, ranibizumab, or bevacizumab) block the abnormal vessel growth, stop the leaking, and can slow or even reverse macular edema. Laser treatment seals leaking vessels and shrinks abnormal ones, and vitrectomy surgery clears blood and scar tissue from the eye in severe cases. The catch is timing. These treatments protect the vision you still have. Sight already lost to retinopathy often does not come back.
How to get care
If you have diabetes, put a dilated eye exam on the calendar every year, and schedule the first one the day you are diagnosed with type 2. Ask your primary care doctor whether their office has an AI retinal camera that can screen you on the spot. When you need an eye doctor, you can find a Black ophthalmologist or optometrist in our directory, clinicians who are used to caring for Black patients and will take a silent, vision-threatening disease as seriously as you do. Bring your most recent A1C and blood pressure numbers to the visit, and ask the eye doctor to tell you exactly what stage of retinopathy, if any, they see.
Frequently asked questions
Why are Black adults at higher risk for diabetic retinopathy? ▼
Higher and longer-running blood sugar and blood pressure damage retinal vessels faster, eye care is often harder to access so disease is found later, and yearly screening exams happen less often. In one multi-ethnic study, 36.7% of Black participants with diabetes had retinopathy versus 24.8% of White participants.
Can I tell if I have diabetic retinopathy without an eye exam? ▼
No. Early diabetic retinopathy has no symptoms. By the time you notice floaters, blurred vision, or dark areas, the disease has usually advanced. A dilated eye exam is the only reliable way to catch it early.
How often should someone with diabetes get an eye exam? ▼
If you have type 2 diabetes, get a dilated eye exam when you are diagnosed and at least once a year after that. With type 1 diabetes, start annual exams five years after onset. If you already have retinopathy, your eye doctor may want to see you more often.
Is a regular vision test the same as a dilated eye exam? ▼
No. A vision test at the eye chart checks how clearly you see but cannot see the retina. A dilated exam uses drops to widen the pupil so the clinician can examine the back of the eye and find early retinopathy you cannot feel.
Can diabetic retinopathy be reversed? ▼
Early disease can be stabilized and sometimes improved with blood sugar and blood pressure control, anti-VEGF injections, and laser treatment. Macular swelling can often be reduced. But vision already lost to advanced retinopathy frequently does not return, which is why early detection matters so much.
What are the AI eye cameras in primary care offices? ▼
The FDA has cleared autonomous AI systems, such as LumineticsCore, that photograph the retina during a routine primary care visit and return a diabetic retinopathy result in minutes without an eye specialist present. They help flag who needs a full eye exam and can improve access for patients who are screened less often.
