The biggest risk factors for developing diabetic retinopathy include blood sugar levels and age, as well as genetic risk.

Diabetic retinopathy is a sight-threatening eye condition that people can get when they have diabetes. When your blood sugar is too high for too long, it damages blood vessels all over your body, including in your eyes. The condition can cause the vessels to weaken, bleed, leak fluid, or grow where they shouldn’t.

Bleeding or leaking vessels cause vision difficulties in your retina, the part of your eye that translates light into signals that your brain can interpret. The fluid can also cause swelling in your macula, a part of the retina that makes your vision sharper.

Although your symptoms may be unnoticeable at first, they may worsen over time.

Here’s what to know about risk factors for diabetic retinopathy and ways to prevent, identify, or treat it.

Several factors increase your risk for this diabetes-related complication, aside from having any type of diabetes. Risk factors may include conditions such as high blood pressure or high cholesterol.

Research also demonstrates that diabetic retinopathy occurs more frequently among people of African or Hispanic descent. One reason for this may be inequities in healthcare. Having a family history of diabetic retinopathy can also increase your risk.

The longer you have diabetes, the more likely you are to develop diabetic retinopathy.

A 2020 study of 1,008 people in China who have diabetes also showed the following risk factors:

The most significant risk factors seem to be how long you’ve had diabetes and how well you keep your blood sugar in range over time.

Long-established research, dating back to the 1990s, demonstrates that your risk of diabetes-related complications decreases the lower you maintain your 3-month average A1C result. While goals for A1C and blood sugar ranges are individualized and best decided in working with a diabetes care team, in general clinicians advise that your A1C be safely at 7.0% or below.

Despite blood sugar management, many people living with diabetes may develop some form of diabetic retinopathy at some point.

A 2016 study revealed that 44% of people with diabetes had retinopathy, while a 2017 study reported that 24.5% developed this diabetes-related complication.

As you get older, the structure of your eye changes. Your eyes typically get less nutrient- and oxygen-rich blood flow with age. Your eyes will heal from damage more slowly than your younger eyes. Your eyes will also become more vulnerable to stress and inflammation.

These changes can complicate healing and increase the damage from diabetes-related complications.

Aside from age, research notes that people with diabetes who develop other complications — including nerve damage or kidney disease related to diabetes — are at higher risk of developing diabetic retinopathy.

Yes, researchers believe that genetics do play a part in who develops diabetes-related complications, such as diabetic retinopathy.

In a 2023 study, researchers stated that high blood sugars are a strong driver of diabetes-related complications.

Other factors — including genetics — may also affect blood sugar levels, counteracting the effect in some people with diabetes so that they don’t develop complications in the same way as others.

In fact, some future diabetes complication development may even start in the early fetal timeframe during pregnancy.

This early predisposition may make a person’s vessels and nerves more vulnerable and make them more susceptible to the damaging effects of chronically higher glucose levels later in life, once diabetes develops.

Just how someone’s genes and inherited risk play into the development of diabetes-related complications remains unclear, and researchers continue to study the topic more in-depth in people who have lived with diabetes for long periods of time.

Diabetic retinopathy also can cause other vision-threatening conditions because of the damage to your eye’s blood vessels.

In the earlier stage of diabetic retinopathy, your blood vessels weaken or become blocked. Tiny bulges can form in the vessels and leak fluid into your retina. This process can cause your macula to swell and may make your vision blurry.

In the later stage, your body may sense that your eyes aren’t getting enough blood and oxygen. It creates new, flawed blood vessels that grow in the wrong places. These new blood vessels may also leak fluid or block critical eye functions.

Because of these changes, diabetic retinopathy may lead to other complications, such as:

  • Diabetic macular edema is a condition in which blood vessels leak fluid into your macula.
  • Neovascular glaucoma occurs when diabetic retinopathy causes faulty blood vessels to grow in places that block eye fluid drainage.
  • Retinal detachment happens when the condition creates scars at the back of your retina. These scars can cause the retina to pull away from your eye.

The best way to reduce your risk is to manage your blood sugar levels and get regular eye exams, especially as you age. The National Eye Institute (NIE) recommends getting a dilated eye exam at least once a year.

The NIE also recommends adopting habits that make managing diabetes easier and can improve overall health.

These habits include:

  • keeping your blood sugars and A1C results in the normal range
  • exercising regularly
  • following a diabetes-friendly meal plan
  • taking your medications as prescribed
  • managing other conditions, such as high blood pressure and high cholesterol

Diabetic retinopathy is a common and potentially serious complication of diabetes.

Being older and having high blood sugar levels over long periods of time are risk factors for this vision-threatening condition. Generally, the longer you have diabetes and the harder it is to manage, the more likely you are to get diabetic retinopathy.

Regular eye exams, managing your blood sugar levels, and adopting healthy habits lessen your chances of getting the condition and can also help you prevent it or slow its progression.