Diabetic Eye Disease Signs: Protecting Your Sight With Diabetes

Diabetes is one of the leading causes of preventable blindness in working-age adults. High blood sugar slowly damages the tiny blood vessels at the back of the eye, often for years before any change in vision. By the time sight is affected, the damage may be advanced. Knowing the diabetic eye disease signs, and having regular eye checks, can protect your sight for life.

How diabetes affects the eyes

The retina is the light-sensitive layer at the back of the eye. It works like the film in a camera and sends images to the brain. It has many tiny blood vessels. Over time, high blood sugar, high blood pressure and high cholesterol damage these vessels. They may leak, become blocked or grow abnormally.

Diabetes also raises the risk of cataract, a clouding of the lens, and glaucoma, a condition that damages the optic nerve.

Diabetic retinopathy

Diabetic retinopathy is the most common diabetic eye disease. It develops in stages:

• Background retinopathy: small bulges and leaks in the blood vessels. Vision is usually normal.
• Pre-proliferative retinopathy: more severe changes, with areas of the retina not getting enough blood.
• Proliferative retinopathy: new, fragile blood vessels grow and can bleed into the eye or pull on the retina, causing sudden vision loss.

Diabetic macular oedema

The macula is the central part of the retina that gives sharp vision for reading, recognising faces and driving. Fluid can leak into the macula and cause swelling, called macular oedema. This blurs central vision and is a common cause of sight loss in people with diabetes.

Why early damage is silent

In the early stages of diabetic eye disease, there is no pain and vision is often perfect. Many people feel they do not need an eye check because they see well. This is a dangerous mistake. Only an eye examination with dilated pupils or retinal photographs can detect early damage, when treatment works best.

Diabetic eye disease signs to watch for

See an eye doctor promptly if you notice:

• Blurred or fluctuating vision
• Dark spots or “floaters” drifting across your vision
• Dark or empty areas in your vision
• Difficulty seeing at night
• Straight lines that look wavy
• Faded colours
• A sudden loss of vision in one eye, which is an emergency

These diabetic eye disease signs often mean the damage is already significant. Do not wait for them before having a check.

Diabetic eye disease signs in pregnancy

Pregnancy can make diabetic retinopathy worse, especially if blood sugar was high before conception or falls very quickly once treatment is tightened. Women with diabetes should have an eye check before pregnancy or as soon as they find out they are pregnant. Further checks are usually needed during pregnancy. Report any new diabetic eye disease signs, such as blurred vision, straight away.

Cataract and glaucoma

People with diabetes tend to develop cataracts at a younger age. A cataract makes vision cloudy, faded or glary, especially at night. It is treated with a short operation that replaces the cloudy lens with a clear artificial one.

Glaucoma damages the optic nerve, often because of raised pressure inside the eye. It usually causes no symptoms until side vision is lost. Regular eye checks measure eye pressure and look at the optic nerve. Treatment with eye drops, laser or surgery can prevent further loss.

Who is most at risk?

Anyone with diabetes can develop eye disease. The risk is higher if you:

• Have had diabetes for many years
• Have poorly controlled blood sugar
• Have high blood pressure or high cholesterol
• Have kidney disease
• Are pregnant
• Smoke

People with type 1 diabetes and type 2 diabetes are both at risk. Many people with type 2 diabetes already have eye changes when they are first diagnosed.

How often to have an eye check

Most adults with diabetes should have a full eye examination at least once a year. Your eye doctor may recommend more frequent checks if changes are found. Women with diabetes who become pregnant need closer monitoring, because pregnancy can speed up retinopathy.

The examination is painless. Drops are put in the eyes to widen the pupils, and the doctor looks at the retina with a special lamp or takes photographs. Your vision may be blurry for a few hours afterwards, so do not drive yourself home.

HUBPHARM PHARMACIST’S NOTE
Some eye drops for glaucoma must be used at exact times, and some blood pressure tablets work best taken at night. Getting the timing right protects your eyes. Send your eye and diabetes prescriptions to a HubPharm pharmacist and we will put every drop and tablet into one easy daily schedule.

Ask your doctor to refer you if you have never had a dilated eye check.

Protecting your eyes every day

You can lower your risk of diabetic eye disease by:

• Keeping blood sugar in your target range
• Controlling blood pressure and cholesterol
• Taking diabetes and blood pressure medicines as prescribed  1 
• Stopping smoking
• Eating a balanced diet and staying active
• Attending every eye appointment

Learn more in our guide to preventing diabetes complications.

What happens at an eye clinic

At your appointment, the nurse will check how well you can read letters on a chart. Drops will widen your pupils. This takes about 20 to 30 minutes and may sting briefly. The doctor will examine the back of your eye or take photographs. You may be told your results the same day. If changes are found, the doctor will explain how often you need to return. Bring sunglasses, because bright light can be uncomfortable afterwards.

Treatments that save sight

When diabetic eye disease is found, treatment can slow or stop it:

• Laser treatment seals leaking vessels or shrinks abnormal new vessels
• Eye injections of medicines that reduce swelling and stop new vessel growth, given at regular intervals
• Surgery, called vitrectomy, to remove blood or scar tissue from inside the eye
• Cataract surgery to replace a cloudy lens

These treatments work best when started early. They usually protect remaining sight but cannot always restore what has been lost.

Questions to ask your eye doctor

• Do I have any signs of diabetic eye disease?
• How often should I have my eyes checked?
• Do I need treatment now?
• What symptoms should make me come back sooner?
• Is it safe for me to drive?

Write down the answers. Share them with your diabetes doctor, so that your care is joined up. Recognising diabetic eye disease signs early, and acting on them, is the best way to keep your sight.

Avoid unproven eye remedies

Never put herbal drops, breast milk, urine or other home remedies into the eyes. These can cause serious infections and blindness. Only use eye drops prescribed  2  by a qualified eye doctor or recommended by a pharmacist.

Diabetic eye disease and daily life

Living with reduced vision can be challenging. Low-vision aids, good lighting, large-print labels and phone accessibility settings can help. Tell your family and employer what support you need. Keep driving only if your eye doctor confirms your vision meets the legal standard.

Myths about diabetes and the eyes

“If I can see well, my eyes are healthy.” Early diabetic eye disease causes no change in vision.

“Glasses will fix diabetic eye problems.” Glasses correct focusing problems, not damage to the retina.

“Eye injections are dangerous.” They are done under sterile conditions with numbing drops, and serious problems are rare.

“Laser treatment makes you blind.” Laser protects remaining sight. Untreated disease is far more dangerous.

Getting help

If you have diabetes, book an eye examination this year, even if your vision seems fine. Report any diabetic eye disease signs immediately. The NHS guide to diabetic retinopathy has more information. For help with diabetes and blood pressure medicines, glucose meters or prescribed eye drops, message a HubPharm pharmacist or ask Afiya on WhatsApp.

Medicines and products in this article

#	Medicine or product	What to know
1	Blood pressure medicines Prescription only	Good blood pressure control slows diabetic eye damage.
2	Glaucoma eye drops Prescription only	Lower eye pressure. Use exactly as prescribed, one drop at a time.

 

To order any of these, or to ask a pharmacist a question first, message HubPharm on WhatsApp or visit hubpharmafrica.com. Prescription medicines are supplied against a valid prescription.

References

• NHS. Diabetic retinopathy.

• World Health Organization. Blindness and vision impairment: fact sheet.

• National Eye Institute. Diabetic retinopathy.

• World Health Organization. Diabetes: fact sheet.