Diabetic retinopathy is treated with three main tools: anti-VEGF injections, laser, and, for advanced complications, vitrectomy surgery. All three are available in Colombia and other medical-travel destinations. The harder part is not the procedure. It is the follow-up, because this is a disease you monitor for life, and some treatments only work if you keep coming back.
This guide explains the stages, what major guidelines recommend at each one, what the key trials found, and how to judge whether treatment abroad fits your situation.
The stages of diabetic retinopathy
High blood sugar damages the small blood vessels of the retina over time. The American Diabetes Association's 2026 Standards of Care describe the earliest sign as microaneurysms (tiny bulges in vessel walls), followed by retinal hemorrhages and areas of poor blood flow. Growth of new, fragile vessels marks the proliferative stage. Macular edema can happen at any stage.1
| Stage | What is happening | Usual approach |
|---|---|---|
| Mild NPDR (nonproliferative) | Microaneurysms; vision usually normal | Blood sugar, blood pressure and lipid control; regular eye exams |
| Moderate to severe NPDR | More hemorrhages and areas of poor blood flow | Prompt referral to a retina-experienced ophthalmologist; closer monitoring; laser in some severe cases |
| PDR (proliferative) | New abnormal vessels that can bleed or pull on the retina | Panretinal laser (PRP) or anti-VEGF injections; vitrectomy for complications |
| DME (diabetic macular edema) | Fluid in the macula, the center of sharp vision; can occur at any stage | Anti-VEGF first-line when it involves the center and affects vision |
The "usual approach" column reflects ADA recommendations 12.1, 12.2 and 12.9 to 12.12.1 Your own plan depends on your exam and scans.
How often you need a diabetic eye exam
Retinopathy often causes no symptoms until it is advanced, which is why screening matters. The ADA's 2026 recommendations are:1
- Type 1 diabetes: first dilated, comprehensive eye exam five years after diabetes begins.
- Type 2 diabetes: first exam at diagnosis, since the disease may have been present for years.
- No retinopathy: if one or more annual exams are clear and blood sugar is at goal, every one to two years may be considered.
- Any retinopathy: at least once a year, and more often by an ophthalmologist if it is progressing or threatens sight.
- Pregnancy with preexisting diabetes: an exam before pregnancy and in the first trimester, with possible monitoring every trimester and for a year after birth.
Retinal photography read remotely, and FDA-approved AI screening tools, are acceptable ways to screen, as long as there is a clear path to a full exam if something is found.1 The ADA also says anyone with macular edema, moderate or worse NPDR, or any PDR should be referred promptly to an ophthalmologist experienced in diabetic retinopathy.1
The ADA notes that liraglutide, semaglutide and dulaglutide have been linked to mild worsening of retinopathy in trials, and that a rapid drop in A1C can be followed by temporary worsening. It recommends checking retinopathy status when glucose-lowering is intensified this way.1 Don't stop a medication on your own; tell your eye doctor and your diabetes doctor.
Treating diabetic macular edema: injections first
Anti-VEGF drugs block a protein that makes retinal vessels leak. The ADA calls them first-line for most eyes with center-involving DME that affects vision. Focal or grid laser and steroid injections are reasonable for edema that persists despite anti-VEGF, or for eyes that can't have it.1
Which drug? The DRCR Retina Network's Protocol T trial compared aflibercept (Eylea), bevacizumab (Avastin) and ranibizumab (Lucentis) in 660 people with DME. When starting vision was fairly good (about 20/32 to 20/40), one-year gains were similar: 8.0, 7.5 and 8.3 letters. When vision was 20/50 or worse, aflibercept did better: 18.9 letters, versus 11.8 for bevacizumab and 14.2 for ranibizumab.2
Cost differs far more than results in the milder group. Older published estimates put bevacizumab at roughly $50–60 per dose, against roughly $1,850–1,950 for aflibercept.23 Prices change, so ask any clinic for a written quote per visit that names the drug.
Treating proliferative retinopathy: laser vs injections
For decades, panretinal photocoagulation (PRP) was the standard for PDR. The laser treats the outer retina so it stops sending signals that drive new vessel growth. The ADA still lists PRP as indicated for high-risk PDR and some severe NPDR, and calls anti-VEGF injections a reasonable alternative for some people with PDR.1
The trial behind that alternative is DRCR Protocol S, which randomized 394 eyes to ranibizumab or PRP. At five years:4
| Outcome | Ranibizumab | PRP |
|---|---|---|
| Mean vision at 5 years | 20/25 (gain of 3.1 letters) | 20/25 (gain of 3.0 letters) |
| Eyes with retinal detachment | 12 of 191 | 30 of 203 |
| Vision-impairing DME by 5 years (eyes without DME at start) | 22% | 38% |
| Vitrectomy among eyes with vitreous hemorrhage | 22% | 41% |
Both approaches gave very good vision in most eyes. Injections caused less side vision loss and fewer cases of macular edema and detachment. The trade-off is that injections may cost more and need more visits. Only 66% of participants completed the full five years, a reminder of how hard long-term follow-up is even in a trial.4
Panretinal laser (PRP)
- Long-lasting effect after a set of sessions
- More forgiving if you miss follow-up
- Causes more side (peripheral) vision loss
- Higher rate of later macular edema in Protocol S
Anti-VEGF injections
- Less side vision loss
- Fewer detachments and less DME in Protocol S
- Effect wears off; needs regular injections and exams
- Risky if you are lost to follow-up
When vitrectomy is needed
Vitrectomy removes the gel inside the eye. In diabetic retinopathy it is used for complications of proliferative disease, mainly a vitreous hemorrhage that won't clear on its own and scar tissue that pulls the retina away (tractional retinal detachment).15 In Protocol S, nearly half of patients in both groups had a vitreous hemorrhage at some point.4
This is real surgery, done in an operating room, with a recovery that may involve positioning and a gas bubble. You cannot fly with a gas bubble in the eye. Read vitrectomy: what to expect and flying after eye surgery before you plan any trip around it.
Why monitoring makes travel tricky
The biggest risk in treating retinopathy abroad is a gap in care afterward. A study summarized by AAO EyeNet followed 76 eyes with PDR whose patients were lost to follow-up for more than six months after treatment. At the final visit, 10 of 30 eyes treated with anti-VEGF alone had a retinal detachment, versus 1 of 46 eyes treated with PRP. Vision in the injection group was also worse at the final visit. The study was not randomized, and the authors urged caution, but they advised doctors to consider the risk of missed visits when choosing a treatment.67
Put simply: injections for PDR are a commitment to keep showing up. If you are likely to be away from any retina specialist for months, tell your doctor. That fact belongs in the treatment decision.
When treatment abroad can work
| Situation | Fit | Why |
|---|---|---|
| You live abroad or stay for months near the clinic | Often good | You can keep a regular injection and exam schedule locally |
| Second opinion or baseline imaging during a trip | Good | A single visit with records sent home fits travel well |
| A set of PRP laser sessions, with a home follow-up booked | Possible | Fewer repeat visits, but you still need ongoing exams |
| Flying in for each anti-VEGF injection | Poor | Short intervals and missed visits carry real risk |
| Vitrectomy with a gas bubble, then flying home | Poor without a long stay | Flying is unsafe until the bubble is gone |
| Sudden vision loss or a new shower of floaters | Not a travel decision | Get urgent care wherever you are |
If you are in Colombia for a long stay and want to compare retina clinics, you can request provider options.
Records to bring and to take home
- Your most recent eye exam report, with the stage of retinopathy for each eye
- OCT scans and retinal photos (files, not just printouts), plus any fluorescein angiography
- A full injection log: dates, drug, dose and which eye
- Laser treatment notes, including the type and number of sessions
- Your latest A1C, blood pressure and medication list, including any GLP-1 drug and its start date
- On the way home: every new scan, operative notes, and a written follow-up plan in English, sent to your home specialist
Warning signs and questions to ask
A sudden drop in vision, a shower of new floaters, a dark curtain or shadow over part of your vision, or severe eye pain can mean bleeding or a detachment. Don't wait for your next appointment or your flight home. After any eye injection, increasing pain, redness or blurred vision needs same-day care.
Before starting treatment, ask:
- What stage is each eye, and is there macular edema involving the center?
- Why this treatment for me: injections, laser, or both? What would change your recommendation?
- How often will I need exams and treatment for the next six months?
- If I'm away for a few months, does that change which treatment is safest?
- Which drug will you use, and why that one for my vision level?
- Will you send my scans and notes to my home retina specialist?
- Who do I call if I have a problem after I leave?
For broader checks on credentials and facilities, see our questions to ask an eye surgeon abroad.