Specialized diabetes eye care: Paris 13
Diabetic Retinopathy Paris 13: Screening, Monitoring and Treatment
Dr Tourabaly supports you through the screening and monitoring of diabetic retinopathy in Paris 13. Macular OCT, angiography, laser or anti-VEGF treatment in line with French HAS guidelines.
UNDERSTANDING THE CONDITION
What is diabetic retinopathy?
Diabetic retinopathy is a retinal microangiopathy: chronic high blood sugar gradually damages the small blood vessels of the retina, the thin layer of nerve tissue lining the back of the eye that is responsible for vision. It is the most common eye complication of diabetes, whether type 1 or type 2.
According to the ENTRED study (InVS, 2007-2010), about 30% of people with diabetes in France show signs of retinopathy. The risk rises with the duration of diabetes: after 20 years, nearly 90% of patients with type 1 diabetes have retinopathy to some degree (Santé publique France). The good news: early screening and regular monitoring make it possible to preserve vision in the majority of cases.
Why does diabetes affect the retina?
Chronic high blood sugar damages the walls of the retinal capillaries through several complementary mechanisms:
- Thickening of the basement membrane and loss of pericytes, which weakens the capillaries.
- Vascular micro-occlusions: areas of the retina are no longer supplied with blood (ischemia).
- Increased vascular permeability: plasma and lipids leak into the retina, causing edema and exudates.
- Neovascularization: in response to ischemia, the retina produces VEGF (Vascular Endothelial Growth Factor), which drives the growth of abnormal, fragile vessels that bleed easily.
These lesions develop silently: retinopathy is completely asymptomatic for a long time. By the time vision loss appears, the damage is often already extensive. This is exactly what makes systematic screening essential.
CLASSIFICATION
The stages of diabetic retinopathy
The international classification (ETDRS, adapted by the French HAS) distinguishes several stages based on severity and the presence of new vessels.
| Stage | Features | Visual risk | Management |
|---|---|---|---|
| Mild non-proliferative DR | Few microaneurysms | Low | Annual monitoring |
| Moderate non-proliferative DR | Microaneurysms, dot hemorrhages, exudates | Moderate | Follow-up every 6 to 12 months |
| Severe non-proliferative DR | Extensive hemorrhages, venous abnormalities, areas of ischemia | High (50% risk of progression to proliferative DR within 1 year) | Close follow-up ± preventive laser |
| Proliferative DR | Retinal or disc new vessels, risk of vitreous hemorrhage and tractional detachment | Very high: visual emergency | Prompt panretinal photocoagulation (PRP) |
| Diabetic macular edema | Thickening of the macula from capillary leakage: can occur at any stage | Loss of central visual acuity | Intravitreal anti-VEGF ± focal laser |
Diabetic macular edema (DME) is the most common cause of vision loss in people with diabetes. It can be present at any stage, including early ones, and requires specific management.
RECOGNIZING THE SIGNS
Symptoms and warning signs
Diabetic retinopathy often stays silent for several years. When symptoms do appear, they usually reflect advanced damage that calls for prompt consultation:
- Gradual decline in visual acuity, especially at near (suggestive of macular edema).
- Blurred or fluctuating vision depending on blood sugar control.
- Floaters (myodesopsia) appearing suddenly: possible vitreous hemorrhage.
- A dark veil or curtain across the field of vision: emergency, suggesting a hemorrhage or retinal detachment.
- Metamorphopsia (straight lines appearing distorted): a sign of macular involvement.
⚠️ Any sudden visual symptom in a patient with diabetes should prompt an ophthalmology consultation without delay. Outside of emergencies, scheduled annual screening remains your most effective protection: this is the stage at which treatments have the greatest impact.
SCREENING EXAMINATIONS
Screening: examinations performed at the practice
The eye assessment for a patient with diabetes includes several complementary examinations, carried out in line with the guidelines of the French HAS and the French Society of Ophthalmology (SFO):
- Measurement of visual acuity at distance and near, with optimal correction.
- Tonometry (measurement of intraocular pressure) to screen for associated glaucoma.
- Slit-lamp examination of the anterior segment (cornea, lens): diabetes also promotes cataract.
- Fundus examination after pupil dilation: the reference examination to view the entire retina.
- Color fundus photography centered on the macula and the optic disc, documented and comparable from one visit to the next.
- Macular OCT (optical coherence tomography): millimeter-scale scans of the macula to detect edema, even early on.
- OCT-A (OCT angiography): non-invasive mapping of retinal blood flow, with no injection.
- Fluorescein angiography: reserved for complex cases, it pinpoints ischemic areas before laser treatment.
This assessment takes 45 to 60 minutes on average, allowing for the time needed for pupil dilation. A detailed report is always sent to your diabetologist and your primary care physician.
MANAGEMENT
Current treatments for diabetic retinopathy
Management combines several approaches, chosen according to the stage and the presence of macular edema.
1. Blood sugar control and risk factors
Tight control of blood sugar (HbA1c), blood pressure and lipids remains the foundation of prevention. The DCCT (type 1 diabetes) and UKPDS (type 2 diabetes) trials showed that a sustained reduction in HbA1c significantly lowers the risk and progression of retinopathy. The French HAS generally recommends an HbA1c target of around 7% for uncomplicated type 2 diabetes, to be adjusted on an individual basis.
2. Panretinal photocoagulation (PRP) laser
Indicated for proliferative retinopathy and certain severe non-proliferative forms, PRP applies several hundred laser spots to the ischemic peripheral areas to make the new vessels regress. The treatment is carried out over several outpatient sessions, under topical anesthesia (eye drops). Its clinical basis rests on the DRS (Diabetic Retinopathy Study).
3. Intravitreal anti-VEGF injections
Anti-VEGF drugs (ranibizumab, aflibercept, faricimab) neutralize the growth factor responsible for edema and new vessels. They have become the first-line treatment for diabetic macular edema that threatens vision, with outcomes documented by the RIDE/RISE and VIVID/VISTA studies. The injection is given in a dedicated room, under topical anesthesia, in a few minutes. An initial monthly schedule is usually needed, then spaced out according to the response.
4. Intravitreal corticosteroids
The dexamethasone implant can be an alternative or a complement to anti-VEGF therapy in certain cases of macular edema, particularly pseudophakic or treatment-resistant ones. Monitoring of intraocular pressure and the lens is required.
5. Surgery: vitrectomy
Vitrectomy is indicated in cases of persistent vitreous hemorrhage, tractional retinal detachment or tractional macular edema. It is performed in a specialized surgical setting.
HAS SCHEDULE
Recommended monitoring schedule
The frequency of ophthalmology follow-up depends on the type of diabetes, how long it has been present, and any stage of retinopathy.
- Type 1 diabetes: first assessment 3 to 5 years after diagnosis (or from puberty), then at least once a year.
- Type 2 diabetes: eye assessment as soon as diabetes is diagnosed, then annually.
- During pregnancy: assessment before conception, in the first trimester, then each trimester until delivery and within the following 6 months.
- In moderate retinopathy: every 6 months.
- In severe or proliferative retinopathy: per specialist advice, often every 2 to 4 months.
- In treated macular edema: monthly follow-up during injections, then progressively spaced out.
Source: Haute Autorité de Santé, “Screening for diabetic retinopathy by deferred reading of fundus photographs,” HAS guidelines 2010, updated 2017.
OTHER ASSOCIATED CONDITIONS
Diabetes and other eye conditions
Diabetes is not limited to the retina: it also increases the risk of other eye conditions that should be screened for during the same assessment.
- Diabetic cataract: earlier onset and faster progression than in the general population. Cataract surgery remains highly effective, with tailored preparation.
- Neovascular glaucoma: a serious complication of advanced proliferative retinopathy, requiring combined management.
- Transient ocular motor palsies (ischemic neuropathy): rapidly developing double vision that resolves spontaneously within a few weeks to months.
- Dry eye syndrome: more common in people with diabetes, often made worse by anti-VEGF injections.
PARIS 13 CONSULTATION
Diabetic eye care with Dr Tourabaly
Dr Moïse Tourabaly, a former chief resident at the Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts, provides ophthalmology follow-up for patients with diabetes at the Paris 13 and Cachan practices. The technical platform includes a non-mydriatic fundus camera, a high-definition macular OCT and an OCT-A, allowing complete screening during the consultation.
Reports are always sent to the diabetologist and the primary care physician for coordinated care. If treatment with intravitreal injection or laser is needed, referral is arranged to partner centers in the Paris region (Île-de-France).
To learn more about Dr Tourabaly’s background, see the biography and expertise page. To book an appointment, use the Doctolib platform or call the practice at 01 45 47 08 11.
FREQUENTLY ASKED QUESTIONS
Where to consult for the monitoring of your diabetes
Dr Tourabaly provides screening and monitoring of diabetic retinopathy at two consultation locations in the Paris region (Île-de-France). When treatment with laser or intravitreal injection is needed, it is arranged in partner centers.
Cachan practice
1 Ter Rue Camille Desmoulins
94230 Cachan
Consultations: Monday, Wednesday and Friday
Phone: 01 45 47 08 11
Paris 13 practice
12 Rue du Moulin des Prés
75013 Paris
Consultations: Tuesdays
Phone: 01 89 31 30 60
A location for consultation and screening (fundus photography, OCT). Appointments are booked by phone.
Frequently asked questions about diabetic retinopathy
Take care of your eyesight
An annual eye assessment protects your vision
Dr Tourabaly: ophthalmologist in Paris 13 and Cachan. Screening and monitoring of diabetic retinopathy in line with French HAS guidelines.
Sources and references
- Haute Autorité de Santé. Dépistage de la rétinopathie diabétique par lecture différée de photographies du fond d’œil : Recommandations, 2010, updated 2017.
- Société Française d’Ophtalmologie. Rapport SFO 2016 : Œdème maculaire.
- Santé publique France · Bulletin épidémiologique hebdomadaire, Prévalence et prise en charge du diabète : étude Entred.
- Yau JWY et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556-564. PMID 22301125.
- DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986. PMID 8366922.
- UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837-853. PMID 9742976.
- Inserm · Thematic file “Type 2 diabetes: a disorder mainly linked to lifestyle,” 2019.
This article is for information purposes. A personalized ophthalmology opinion remains essential for any treatment decision. Dr Tourabaly works alongside your diabetologist and your primary care physician.
Written and medically reviewed by Dr Moïse Tourabaly, ophthalmologist — former chief resident (Quinze-Vingts National Eye Hospital). Last updated: July 6, 2026