Diabetic Retinopathy Treatment in Jacksonville, Florida
Diabetic retinopathy is damage to the blood vessels of the retina caused by diabetes. Its most dangerous feature is that it is silent. Vision usually stays normal until the disease is already advanced — which is why it is found on an examination, not by how your eyes feel.
About one in four American adults with diabetes has diabetic retinopathy — roughly 9.6 million people. About 1.8 million have the vision-threatening form. It is the most common cause of vision loss in people with diabetes, and the Centers for Disease Control and Prevention estimates that more than 90 percent of that vision loss can be avoided with early detection and treatment.
This matters locally. An estimated 12.8 percent of adults in Duval County have diabetes, above the Florida average.
What diabetic retinopathy is
The retina is the light-sensing tissue at the back of the eye, and it depends on a dense network of very small blood vessels. Persistently high blood sugar damages the walls of those vessels. They leak, they close off, and the retina responds to the resulting lack of oxygen by growing fragile new vessels that bleed.
Retina specialists describe the disease in stages:
Non-proliferative diabetic retinopathy (NPDR)
The earlier phase. Vessel walls weaken and form small outpouchings called microaneurysms; blood and fluid leak into the retina; some capillaries close. Graded mild, moderate, or severe depending on how much of the retina is involved. Most people at this stage see perfectly well.
Proliferative diabetic retinopathy (PDR)
The advanced phase. Enough of the retina has lost its blood supply that the eye begins growing abnormal new vessels. These vessels are structurally poor. They bleed into the vitreous, and they can pull on the retina as they contract, causing a tractional retinal detachment. PDR is the stage that causes severe, sudden vision loss.
Diabetic macular edema (DME)
Fluid collecting in the macula — the small central part of the retina used for reading, driving, and recognising faces. DME can occur at any stage, including in eyes that are otherwise only mildly affected, and it is the most common reason people with diabetes lose reading vision. The National Eye Institute estimates that about 1 in 15 people with diabetes will develop it.
Symptoms — and why waiting for them is the mistake
Early diabetic retinopathy has no symptoms at all. When symptoms do appear, they can include:
- Blurred or fluctuating vision
- Difficulty reading or seeing fine detail
- New floaters — specks, strands, or a sudden shower of them
- Dark or empty areas in your vision
- Colours appearing washed out
- Vision that is worse on some days than others
A sudden shower of floaters, a curtain or shadow across your vision, or an abrupt loss of vision needs to be seen the same day. Those are the symptoms of a vitreous haemorrhage or a retinal detachment.
Screening: how often you actually need to be examined
Because the disease is silent, screening intervals are set by your type of diabetes rather than by symptoms. The American Diabetes Association's Standards of Care recommend:
| If you have | First dilated eye exam | Then |
|---|---|---|
| Type 1 diabetes | Within 5 years of diagnosis | Yearly. Every one to two years may be reasonable if there is no retinopathy on at least one annual exam and blood sugar is well controlled. |
| Type 2 diabetes | At the time of diagnosis | Same as above. |
| Pre-existing diabetes and pregnancy | Before pregnancy, or early in the first trimester | Every 3 to 12 months if there is no or mild retinopathy; every 1 to 3 months if it is severe. Monitoring continues through pregnancy and for a year afterwards. |
| Any retinopathy already present | — | At least yearly, and more often if it is progressing. |
Gestational diabetes alone does not require a screening eye exam.
A note on the automated cameras now appearing in primary care offices: they work, they are FDA-cleared, and they are a genuine improvement over no screening at all. But they are trained to detect diabetic retinopathy specifically. They are not a substitute for a dilated examination, which is also how a retinal tear, a melanoma, or glaucoma gets found.
How we examine and image the eye
Diagnosis begins with a dilated examination. We image the retina in our office on the same visit using:
- Optical coherence tomography (OCT) — a cross-sectional scan that measures macular swelling in microns, well before it is visible to the eye or to the patient
- OCT angiography — maps retinal blood flow and areas of capillary closure without an injection or dye
- Ultra-widefield fundus photography — captures the far periphery, where diabetic changes often appear first
- Fluorescein angiography — shows leaking vessels and non-perfused retina, and identifies new vessel growth definitively
More about our imaging and diagnostic testing.
How we treat diabetic retinopathy
Anti-VEGF injections
Anti-VEGF drugs block the signal that drives leakage and abnormal vessel growth. They are the first-line treatment for diabetic macular edema affecting the centre of vision, and they also cause established diabetic retinopathy to regress. We use aflibercept (Eylea and Eylea HD), bevacizumab (Avastin), faricimab (Vabysmo), and approved biosimilars. Which agent we start with depends in part on your insurance coverage, and we will tell you plainly what that means for you.
Injections are given in the office with the eye numbed. They take a few seconds. The interval between them is not fixed for life: many patients begin monthly, then extend as the retina dries. Aflibercept 8 mg was approved in April 2026 for intervals of up to 20 weeks in patients who respond well, and faricimab can be extended to every four months in some patients. Not everyone extends, and some people do need ongoing monthly treatment — but the old picture of indefinite monthly injections is out of date.
It is worth setting out what injections realistically achieve. In the long-term follow-up of the DRCR Retina Network's Protocol T, patients treated for diabetic macular edema were still better off five years later than at the start, but had lost some of the gain made in the first two years. Treatment protects vision. It does not stop diabetes.
Focal laser
Focal or grid laser seals leaking microaneurysms. It remains the right tool for macular edema that is not involving the centre of vision, and it is often used in combination with injections rather than instead of them. We combine focal laser with injection treatment where the pattern of leakage calls for it.
Steroid treatment
Some macular edema is driven more by inflammation than by VEGF, and some eyes simply do not respond adequately to anti-VEGF. For those, a corticosteroid delivered into the eye can work when injections have not. We use the dexamethasone implant (Ozurdex), the fluocinolone acetonide implants (Iluvien and Retisert), and triamcinolone. Steroids in the eye raise the risk of cataract and of elevated eye pressure, so this is a decision made deliberately and followed closely.
Panretinal photocoagulation
We perform panretinal photocoagulation for proliferative diabetic retinopathy, and when the findings call for it we can treat the same day. Scatter laser treats proliferative disease by treating the oxygen-starved peripheral retina, which removes the drive for new vessel growth. It has been the standard treatment for proliferative diabetic retinopathy for decades and it has one large advantage over injections: it is durable. A patient who has had panretinal photocoagulation and then cannot return for a year still has the benefit of it. A patient on injections who stops coming does not.
Anti-VEGF injections are also effective for proliferative disease — the five-year results of DRCR Protocol S found comparable vision with either approach. Both remain valid, and the right choice depends heavily on how reliably a particular patient can get to appointments. That is a conversation, not a formula.
Vitrectomy surgery
Surgery becomes necessary when bleeding into the vitreous does not clear, or when scar tissue pulls the retina off — a tractional retinal detachment. Dr. Elkeeb performs vitrectomy for diabetic vitreous haemorrhage and takes on tractional retinal detachment repair, which is among the more demanding operations in vitreoretinal surgery.
More about our surgical procedures.
The part of this that is not about your eyes
Diabetic retinopathy is a diabetes complication that happens to show up in the eye. Treating the eye without addressing what is driving it is treating half the problem.
Dr. Elkeeb completed residencies in both Internal Medicine and Ophthalmology and holds board certification in both. In practice that means your retina visit also looks at blood sugar control, blood pressure, lipids, and kidney function, and that we communicate with your endocrinologist or primary care physician rather than sending you back with a note that says "see ophthalmology yearly."
Blood pressure control matters here more than most patients expect. So does kidney disease, which travels closely with retinopathy — if one is progressing, the other usually deserves a look.
If you have started a GLP-1 medication
Semaglutide, tirzepatide and related drugs have changed diabetes care, and patients ask about two things.
The first is a reported association between semaglutide and NAION, a form of optic nerve stroke. In May 2026 the North American Neuro-Ophthalmology Society and the American Academy of Ophthalmology issued a joint statement: there may be a small increased risk, causation has not been established, and even a several-fold increase in relative risk represents a small absolute risk. Their recommendation is shared decision-making with your prescriber — not stopping the medication. Do not stop a diabetes medication because of something you read on a website, including this one.
The second is early worsening. Bringing a very high A1c down very quickly can cause diabetic retinopathy to worsen temporarily before it improves. This is well described and it is not a reason to control blood sugar less aggressively — it is a reason to have your eyes examined around the time control changes substantially. Reassuringly, a large analysis presented in 2026 found no meaningful change in retinopathy status at 12 months in patients on tirzepatide compared with dulaglutide.
Fenofibrate
The LENS trial, reported in 2024, found that fenofibrate — an inexpensive oral cholesterol medication — reduced progression of early diabetic retinopathy by about 27 percent compared with placebo. A confirmatory US trial is under way. It is not yet standard of care, but it is a reasonable thing to ask about, and it is the kind of question the internal medicine side of this practice is well placed to answer.
When to call us urgently
- A sudden shower of new floaters
- Flashing lights
- A shadow, curtain, or dark area moving across your vision
- Sudden loss of vision in one eye
- Sudden severe eye pain with redness
Do not wait for your next scheduled appointment.
Questions patients ask
Can diabetic retinopathy be reversed?
Established damage cannot be undone, but the disease can be pushed back. Anti-VEGF treatment measurably improves retinopathy severity in many eyes, and swelling in the macula can resolve completely. What cannot be recovered is retina that has already died from lack of blood supply — which is the argument for finding it early.
Will I go blind?
Most people with diabetic retinopathy who are examined regularly and treated when treatment is indicated keep useful vision. The CDC estimates more than 90 percent of diabetes-related vision loss is avoidable with early detection and treatment. No physician can promise an outcome for an individual, and you should be wary of one who does — but the people who lose vision to this disease are overwhelmingly those who were not being followed.
Do the injections hurt?
The eye is numbed first. Most patients describe pressure rather than pain, and the injection itself takes a few seconds. Some grittiness or a red spot on the white of the eye afterwards is normal and settles within a few days.
How long will I need injections?
There is no fixed answer, and anyone who gives you one is guessing. Many patients start with a series of monthly injections and then extend the interval as the retina dries — some out to four or five months. Some are able to stop. Some need ongoing treatment. The interval is set by what your OCT scan shows, not by a schedule.
My blood sugar is good now. Do I still need eye exams?
Yes. Good control slows the disease considerably but does not remove the risk, and retinopathy that is already present can progress. The exam interval is set by what is in your retina, not by your most recent A1c.
My primary care office took a photo of my eyes. Is that enough?
It is a good screening test for diabetic retinopathy and far better than no screening. It is not a complete eye examination — those cameras are not looking for retinal tears, tumours, or glaucoma. If a camera screening flags anything, you need a dilated exam.
Getting seen
We accept urgent referrals and see urgent cases within 24 hours. Call (904) 666-5050. We see patients at 3627 University Blvd S, Suite 605, Jacksonville, FL 32216, and our staff speak English, Arabic, and French. Dr. Elkeeb operates at HCA Florida Memorial Hospital and Baptist Medical Center Jacksonville.
Referring physicians and optometrists: our referral information is here.
Sources: Centers for Disease Control and Prevention, Vision and Eye Health Surveillance System, and Lundeen EA et al., JAMA Ophthalmol 2023; National Eye Institute, Diabetic Retinopathy (updated September 2025); American Diabetes Association, Standards of Care in Diabetes — Section 12, Retinopathy, Neuropathy, and Foot Care; American Academy of Ophthalmology, Diabetic Retinopathy Preferred Practice Pattern (2024 revision); DRCR Retina Network Protocol T five-year outcomes, Ophthalmology 2020, and Protocol S five-year outcomes, JAMA Ophthalmol 2018;136:1138–48; Preiss D et al., LENS trial, NEJM Evidence 2024; NANOS and AAO joint clinical statement on GLP-1 receptor agonists and NAION, Ophthalmology, May 2026; CDC PLACES, 2025 release.
This page is general information about a medical condition and is not a substitute for examination and advice from your own physician. Do not start, stop, or change any medication based on what you read here.