Diabetes and Eye Health: What You Need to Know About Diabetic Retinopathy
Living with diabetes means keeping an eye on more than just your blood glucose levels. Your eye health matters too.
Over time, high blood glucose levels can damage the small blood vessels at the back of the eye, potentially leading to a condition called diabetic retinopathy.
The reassuring part is that diabetic retinopathy can often be detected before you notice changes to your vision. That’s why attending your diabetic eye screening appointments is such an important part of managing diabetes in the UK.
In this guide, we look at how diabetes can affect your eyesight, symptoms to be aware of, what happens at diabetic eye screening and the everyday steps you can take to help look after your eyes.
How does diabetes affect your eyes?
At the back of your eye is a light-sensitive layer called the retina. It converts light into signals that travel to your brain, allowing you to see.
Diabetic retinopathy occurs when high blood glucose levels damage the small blood vessels supplying the retina.
In its early stages, you may not notice anything different about your eyesight. This is one of the reasons regular diabetic eye screening is so important – changes can potentially be identified before you notice them yourself.
Diabetes can also be associated with other eye problems, which is why it’s important to continue having regular eye examinations with your optometrist as well as attending diabetic eye screening.
What are the symptoms of diabetic retinopathy?
One of the most important things to know about diabetic retinopathy is that early-stage diabetic retinopathy may not cause noticeable symptoms.
If the condition progresses, you may experience problems such as:
- worsening vision
- blurred vision
- shapes or dots in your vision, sometimes known as floaters
- difficulty seeing in the dark
- more significant loss of vision in advanced cases
Don’t wait for symptoms before looking after your eye health. Screening is designed to identify diabetic retinopathy before it necessarily affects your sight.
If you have diabetes and notice changes to your eyesight, contact your GP, diabetes care team or optometrist for advice.
If your eyesight suddenly becomes worse or you develop sudden blurred vision, seek urgent medical advice through an urgent GP appointment or NHS 111.
What is diabetic eye screening?
Diabetic eye screening is a specific test used to look for signs of diabetic retinopathy.
In England, people with diabetes aged 12 and over are invited for NHS diabetic eye screening.
How frequently you’re invited depends on your previous screening results. You may be invited every year, while people whose previous two screening appointments found no diabetic retinopathy may be invited every two years.
Screening arrangements can differ between England, Scotland, Wales and Northern Ireland, so always follow the information provided by your local health service.
What happens at a diabetic eye screening appointment?
A diabetic eye screening appointment generally takes around 30 minutes.
You’ll usually:
- Read letters from an eye chart so your vision can be checked.
- Have drops placed into your eyes to make your pupils larger.
- Look into a specialist camera.
- Have photographs taken of the back of your eyes.
The photographs can then be examined for signs of diabetic retinopathy.
The eye drops used during screening can temporarily blur your vision and make your eyes more sensitive to light.
Follow the instructions provided by your screening service. You should not drive until your vision has returned to normal following the drops.
FRIO tip: You may want to take a pair of sunglasses with you. Your eyes can be more sensitive to bright light for a while after the appointment.
Is diabetic eye screening the same as an eye test?
No – and this is an important distinction.
Diabetic eye screening does not replace your regular eye examination at an optician.
Diabetic eye screening specifically looks for signs of diabetic retinopathy.
A regular eye examination checks your vision and can help identify other eye conditions. The NHS therefore recommends continuing to have regular eye tests alongside your diabetic eye screening appointments.
Think of them as two different parts of looking after your eyes.
What are the stages of diabetic retinopathy?
You may hear different terminology used when receiving your screening results or speaking to your healthcare team.
Broadly, diabetic retinopathy can progress through different stages.
Background diabetic retinopathy
Small changes have appeared in the blood vessels in your eyes, but your sight may not currently be affected.
You may simply need to continue attending regular screening so that any changes can be monitored.
Pre-proliferative diabetic retinopathy
There are more significant changes to the blood vessels.
Because there is a greater risk of the condition progressing, you may need more frequent monitoring.
Proliferative diabetic retinopathy
This is a more advanced stage of diabetic retinopathy.
Abnormal new blood vessels can develop and there is a greater risk that your vision could be affected. Specialist assessment and treatment may be required.
What is diabetic maculopathy?
The macula is the central part of your retina and plays an important role in detailed central vision – such as the vision you use for reading and recognising faces.
Diabetes can affect the blood vessels around the macula. This is known as diabetic maculopathy.
As with other forms of diabetic eye disease, you may not notice symptoms during the early stages, making screening particularly valuable.
Can diabetic retinopathy be treated?
Yes. If diabetic retinopathy reaches a stage where treatment is required, several treatments are available.
Depending on your individual circumstances, these can include:
- laser treatment
- anti-VEGF injections
- steroid implants
- eye surgery
You won’t necessarily require treatment simply because early changes are found.
Your screening and ophthalmology teams will determine whether monitoring or treatment is appropriate based on what’s happening in your eyes.
How can you look after your eyes when you have diabetes?
Although there’s no way to guarantee that you’ll never develop diabetic retinopathy, managing your diabetes and attending your healthcare appointments can help reduce your risk of problems developing or progressing.
1. Manage your blood glucose levels
Keeping your blood glucose within the target range agreed with your healthcare team is an important part of reducing your risk of diabetes-related complications.
Your individual targets may differ from somebody else’s, so speak to your diabetes team about the targets that are appropriate for you.
2. Keep an eye on blood pressure and cholesterol
Managing your blood pressure and cholesterol is also important when it comes to reducing your risk of diabetic retinopathy and other diabetes-related complications.
Attend your diabetes reviews and discuss your results with your healthcare team.
3. Attend your diabetic eye screening
Don’t assume that everything is fine simply because your vision hasn’t changed.
Early diabetic retinopathy can develop without noticeable symptoms.
When your screening invitation arrives, make the appointment part of your routine diabetes care.
4. Continue regular eye examinations
Your diabetic eye screening appointment and your regular eye test serve different purposes.
Continue visiting your optometrist for routine eye examinations even if you’re up to date with diabetic eye screening.
5. Don’t smoke
Smoking increases the risk of many health complications.
If you smoke and would like help stopping, the NHS offers support and stop-smoking services.
Diabetes, pregnancy and eye screening
If you already have type 1 or type 2 diabetes and become pregnant, your healthcare team will pay particular attention to your eye health.
Pregnancy can increase the risk of diabetic eye problems progressing, so additional diabetic eye screening is offered.
In England, women who had type 1 or type 2 diabetes before becoming pregnant are offered diabetic eye screening during pregnancy.
This differs from gestational diabetes. If you develop gestational diabetes during pregnancy, you would not normally be offered diabetic eye screening through this programme.
If you’re planning a pregnancy or discover you’re pregnant, speak to your diabetes and maternity teams about the additional checks you may need.
When should you seek help for changes to your eyesight?
Don’t wait until your next screening appointment if you notice a problem with your vision.
Contact your GP, diabetes healthcare team or optometrist if you’re experiencing symptoms such as:
- worsening eyesight
- blurred vision
- difficulty seeing in the dark
- other new problems with your eyes or vision
If you have diabetes and your eyesight suddenly gets worse or you suddenly develop blurred vision, seek urgent medical advice through an urgent GP appointment or NHS 111.
Changes to your vision don’t automatically mean you have diabetic retinopathy, but it’s important to get them checked.
Protecting your eye health when living with diabetes
Managing diabetes involves a lot of everyday decisions – from monitoring blood glucose and taking medication to attending appointments and planning ahead when you’re away from home.
Your eyes deserve to be part of that routine too.
Diabetic retinopathy can develop before you notice any difference to your vision, which is why regular diabetic eye screening is so important.
Managing your blood glucose, blood pressure and cholesterol, not smoking, attending your diabetes reviews and keeping up with both diabetic eye screening and regular eye examinations can all help protect your eye health.
And whether you’re heading to a healthcare appointment, commuting, enjoying a day out or travelling further afield, being prepared can make managing diabetes away from home that little bit easier.
Explore FRIO’s range of insulin cooling wallets and diabetes travel accessories designed to help you manage temperature-sensitive medication when you’re on the move.
Frequently Asked Questions About Diabetes and Eye Health
Can diabetes affect your eyesight?
Yes. Diabetes can affect the small blood vessels in the retina and cause diabetic retinopathy. Other eye problems can also be associated with diabetes, which is why both diabetic eye screening and regular eye examinations are important.
What are the first signs of diabetic retinopathy?
Early diabetic retinopathy often has no noticeable symptoms. If it progresses, you may experience blurred or worsening vision, difficulty seeing in the dark or other visual changes.
How often should people with diabetes have eye screening in the UK?
This depends on where you live and your previous results. In England, people with diabetes aged 12 and over are invited for NHS diabetic eye screening. Invitations may be every one or two years depending on previous screening results.
Do I still need to visit the optician if I have diabetic eye screening?
Yes. Diabetic eye screening specifically checks for diabetic retinopathy and does not replace a regular eye examination with an optometrist.
Can diabetic retinopathy be treated?
Yes. Depending on the severity and type of diabetic retinopathy, treatment can include laser treatment, eye injections, steroid implants or surgery. Earlier stages may only require monitoring.
Can I drive after diabetic eye screening?
Eye drops used during diabetic eye screening can temporarily blur your vision. The NHS advises that you should not drive after screening while your vision is affected. Follow the instructions provided by your screening service.
Sources and Further Reading
This FRIO UK article has been prepared using current UK health information and guidance, including:
NHS – Diabetic Retinopathy
Information on diabetic retinopathy, symptoms, screening, stages, treatment and reducing risk.
https://www.nhs.uk/conditions/diabetic-retinopathy/
NHS – Diabetic Eye Screening
Information about who is invited for screening, how often screening takes place, what happens during an appointment and screening results.
https://www.nhs.uk/tests-and-treatments/diabetic-eye-screening/
NHS England / GOV.UK – Diabetic Eye Screening Programme Overview
Official information about the NHS Diabetic Eye Screening Programme in England.
https://www.gov.uk/guidance/diabetic-eye-screening-programme-overview
GOV.UK – Diabetic Eye Screening During Pregnancy
Official information about diabetic eye screening during pregnancy.
https://www.gov.uk/government/publications/screening-tests-for-you-and-your-baby-stfyayb/diabetic-eye-screening
Diabetes UK
Additional UK information and support about diabetes, diabetic retinopathy and looking after your eyes.
https://www.diabetes.org.uk/
Topic inspiration: Diabetes Strong, Diabetes and Your Eyes: Everything You Need to Know, by Ginger Vieira, medically reviewed by Evan Button, OD. This FRIO UK article has been independently written and adapted for a UK audience using UK healthcare sources.
This article is intended to provide general information about diabetes and eye health and should not be used as a substitute for personalised medical advice. If you have concerns about your eyes, vision or diabetes management, speak to your GP, optometrist, diabetes healthcare team or another appropriate healthcare professional.
