If you’ve been diagnosed with diabetes Type 1 or Type 2, it can take a toll on your eyesight. Over time, and if your diabetes gets out of control, it can affect the back of the eye, called the retina.
As part of the long-term care for your diabetes, you should have yearly retinal screening, where they check for early signs of damage.
Diabetes can cause problems of the eyes called retinopathy which can lead to blindness. Screenings help identify these problems early and prevent complications.
If you have any sudden visual problems, you should seek urgent help, and examining the retina may form part of the overall assessment, even if you are not yet due for your annual check-up. As with everyone – whether diabetic or not – you should seek urgent help if you develop sudden loss of vision, blurring of vision, eye pain or redness, floaters (which are shapes floating in your vision) or new difficulty seeing in dim light.
It’s important that you keep up with opticians’ appointments as usual, as they check other aspects of your vision and are able to prescribe or update glasses and contact lenses.
Your appointment is often at a local clinic or hospital. Your appointment will last about 30 minutes and you’ll be asked to do a series of tests. You might be asked first to read letters on a wall chart.
They will put drops into your eyes that dilate the pupils, making the vision a bit blurry. You’ll be asked to look at a distant point and a camera will take images of the back of your eyes, to compare year-on-year. It doesn’t actually touch your eyes.
You may want someone to accompany you to your appointment, as your vision may be blurry for the drive home, or up to 6 hours afterward. It’s a good idea to bring sunglasses to protect your eyes, as things will look quite bright after the test. Bring your usual glasses or contact lenses to the appointment, plus any lens solution.
If your eyes become painful, red or the blurring persists for more than 6 hours you should attend your nearest emergency department.
The possible outcomes indicate no damage or varying degrees of damage, which we call retinopathy. Background retinopathy means that there are some changes to your eyes. These might not affect your sight now, but left to progress, you may get further damage and eventually sight loss.
The most advanced is proliferative retinopathy, where your sight is affected, and this needs regular review by a specialist called an ophthalmologist and discussion regarding treatment.
Hopefully you will have early warning signs to get used to the idea of any retinopathy, and have had a chance to make changes. If you have neglected retinal screening for a few years, or you are newly diagnosed and have advanced diabetes, this may come as quite a shock to you. The hospital team and your doctor will offer support and guidance.
The level of retinopathy has implications for driving – your team will advise when you need to declare this to the BMV.
There are treatments available for advanced cases, but the best thing you can do is to reclaim control of your diabetes – through diet or weight modifications or medication changes. The aim should be to bring your sugar (glucose) level as close to normal as possible. This not only stops the condition from developing in the first place, but also from progressing.
Treatment is typically offered for the most advanced stage, proliferative retinopathy, when your vision is at risk, and there are three possible treatments.
Laser treatment uses laser beams to stop new blood vessels growing at the back of the eye, and this reduces any bleeding that can lead to vision damage. It is not curative, but it prevents worsening eye disease.
Eye injections work similarly to laser treatment and involve injecting a substance called anti-VEGF directly into the eyes. Steroid injections can also be given to reduce inflammation.
Thirdly, surgery may be offered if laser treatment is not appropriate, to remove blood or scar tissue from the back of the eye.
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