Diabetic retinopathy is a disease of the retina that occurs in people who have diabetes. It causes progressive damage to the retina, the light-sensitive lining at the back of the eye.

There are two types of diabetic retinopathy:

Non-proliferative retinopathy (NPDR): This is the early stage of diabetic eye disease. Many people with diabetes have it. With NPDR, tiny blood vessels leak, making the retina swell. When the macula swells, it is called macular edema. This is the most common reason why people with diabetes lose their vision. If you have NPDR, your vision will be blurry.

Proliferative retinopathy (PDR): This is the more advanced stage of diabetic eye disease. It happens when the retina starts growing new blood vessels. This is called neovascularization. These fragile new vessels often bleed into the vitreous. If they only bleed a little, you might see a few dark floaters. If they bleed a lot, it might block all vision. These new blood vessels can form scar tissue. Scar tissue can cause problems with the macula or lead to retinal detachment. PDR is very serious, and can steal both your central and peripheral (side) vision.

Diabetes interferes with the body's ability to use and store sugar (glucose). The disease is characterized by too much sugar in the blood, which can cause damage throughout the body, including the eyes. Over time, diabetes damages the blood vessels of the retina. Diabetic retinopathy occurs when these tiny blood vessels leak blood and other fluids, which causes the retinal tissue to swell, resulting in cloudy or blurred vision. The condition affects both eyes.

At first, diabetic retinopathy may cause no symptoms or only mild vision problems. Symptoms may not be noticed until the late stages of the illness and can include:

• Blurred vision

• Sudden loss of vision in one or both eyes

• Black spots

• Flashing lights

• Difficulty reading or seeing detailed work

Eventually, diabetic retinopathy may result in blindness.

An ophthalmologist examines the retina and inside of the eye with an instrument called an ophthalmoscope. A dye may be injected into a vein in the arm. The dye then travels to the retina, where it can reveal leaky blood vessels.

Controlling blood sugar can slow or halt the progress of the disease, and treatments can repair existing damage. Surgery often slows or stops the progression of diabetic retinopathy, but it's not a cure.

Diabetic retinopathy is progressive and may result in irreversible loss of vision, particularly if the macula becomes affected.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• Consider entitlement to specially adapted housing under 38 U.S.C. 2101(a)(2)(A)(i) if there is visual impairment to the degree specified in 38 CFR 3.809(b)(2).

• The veteran, spouse, surviving spouse or parent will be considered in need of regular aid and attendance if he or she is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less (38 CFR 3.351(c)(1)).

• Consider entitlement to automobile allowance and/or automobile adaptive equipment if there is visual impairment to the degree specified in 38 CFR 3.808(b)(3).

• Review for entitlement to special monthly compensation under 38 CFR 3.350.

• Prior to the rating schedule change for eyes on May 13, 2018, diabetic retinopathy that was compensable was evaluated analogously (6099-6006).

• Note 1 under DC 7913 still applies. DC 6040 should only be used once diabetic retinopathy is compensable.

• For the purposes of evaluation under 38 CFR 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes

• Examples of treatment may include but are not limited to: Systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions

• For the purposes of evaluating visual impairment due to the particular condition, refer to 38 CFR 4.75, 38 CFR 4.76, 38 CFR 4.77, 38 CFR 4.78,  and  38 CFR 4.79, diagnostic codes 6061-6091.