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If you've been diagnosed with diabetes, you've probably heard warnings about protecting your eyes. But between managing blood sugar, medications, and everything else, it's easy to feel overwhelmed. Here's what you actually need to know about keeping your eyes healthy.

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Woman Wearing Hijab

Why Diabetes Affects Your Eyes

Your eyes rely on a delicate network of tiny blood vessels to keep your retina – the light-sensitive tissue at the back of your eye – healthy and functioning. Think of your retina as the film in a camera, capturing the images you see every day.

When blood sugar levels run high over time, these small blood vessels can become damaged, a condition known as diabetic retinopathy. They might start to leak fluid or blood into the surrounding tissue, or they can become blocked, cutting off the blood supply to parts of your retina.

https://en.wikipedia.org/wiki/File:Fundus_-_diabetic_retinopathy.png

A fundus image showing several signs of diabetic retinopathy:hard exudates (scattered
yellowish dots), microaneurysms (bulges off some blood vessels),
and small haemorrhages (blurry red dots)

Non-Proliferative Diabetic Retinopathy

The most common form of diabetic retinopathy is called non-proliferative, or NDPR for short. The special support cells, called pericytes, that wrap around your blood vessels like scaffolding become damaged and die off, leaving vessels weakened. They can often then leak blood or fluid into the retina causing blurry or distorted vision or even dark spots. Fortunately, NDPR can be treated, and the vision disturbances are usually temporary.

Sometimes, retinal blood vessel damage leads to a buildup of fluid, called edema. This happens in the centre portion of the retina, called the macula. If macular edema affects vision, treatment may be needed to reduce swelling and prevent lasting vision loss. Macular edema can happen in both non-proliferative and proliferative diabetic retinopathy.

https://en.wikipedia.org/wiki/File:Fundus_Proliferative_retinopathy_EDA01.JPG

Proliferative retinopathy, an advanced form of diabetic retinopathy, occurs when abnormal new blood vessels and scar tissue form on the surface of the retina.

Photo Credit: National Eye Institute, National Institutes of Health

Proliferative Diabetic Retinopathy

Sometimes, blood vessels can become completely blocked, starving parts of your retina of the oxygen they need. Your body's response is to grow new blood vessels to compensate. This sounds helpful, but these new vessels grow on the surface of the retina rather than within it.

These abnormal vessels are also extremely fragile, causing them to bleed into the gel inside your eye, causing sudden vision loss. The bleeding usually clears eventually, but it can also lead to scar tissue that pulls on your retina, potentially causing it to detach.

The new blood vessels can, in some cases, block the flow of fluid out of the eye. This leads to a buildup of pressure in the eyeball which can damage the optic nerve, leading to glaucoma.

Diabetic Macular Oedema

Your macula is the central part of your retina responsible for sharp, detailed vision – the kind you use for reading, driving, and recognizing faces. When damaged blood vessels leak fluid into this area, it causes swelling (called oedema) that blurs your central vision.

This can happen with both proliferative and non-proliferative diabetic retinopathy.

Preventing Problems

The good news is there's plenty you can do to protect your sight.

As you will know, the most important things are to keep your blood sugar, blood pressure, and cholesterol as well-managed as you can. Studies show that managing blood glucose can reduce the risk of diabetic retinopathy progression by significant amounts ─ with some research suggesting blood sugar control could reduce microvascular complications including eye disease by 25 percent.

This doesn't mean achieving perfect control every single day (that's unrealistic for most people). It's about consistent, long-term effort through a combination of diet, exercise, medication, and monitoring. Small, steady improvements add up over time.

That being said, even people with excellent diabetes management sometimes develop eye problems. Genetics, how long you've had diabetes, and other factors beyond your control all play a role. What’s important is to notice and report any changes in vision as soon as possible. Diagnosing and treating diabetic retinopathy early can reduce the risk of blindness by 95 percent.

NHS Diabetic Eye Screening Programme

Fortunately, the NHS offers regular screening for diabetic patients to help spot any issues as soon as possible.

Once you're diagnosed with diabetes, you'll automatically be invited for regular eye screening – a simple, 30-minute appointment once every two years.

The process is painless: you'll have eye drops to dilate your pupils, read some letters on a chart, and have photographs taken of the back of your eyes. These photos are examined by trained specialists who can spot problems long before you notice any symptoms yourself.

If any changes are detected, you'll be screened more frequently – typically annually or even more often if needed. Between appointments, keep up with your regular optician visits. If you notice sudden changes, such as new floaters, flashing lights, or vision that doesn't improve within a few days, make sure to contact your optician or GP straight away rather than waiting for your next screening.

Treatment Options and What to Expect

If screening detects changes in your eyes, your GP or screening service will refer you to a hospital eye specialist. The NHS aims to see people with macular oedema within 12 weeks, and those with bleeding from proliferative retinopathy within just two weeks. Treatment should then begin within two to four weeks of your assessment.

Actual waiting times vary by area, though if you're concerned about delays, your optician can sometimes advise on which hospital services have shorter waits. If you have private health insurance, this may also be an option – coverage varies, so it's worth checking your policy.

The main treatment for both conditions involves regular injections of anti-VEGF medication. VEGF (vascular endothelial growth factor) is a protein that promotes blood vessel growth. Whilst it's helpful for healing after injuries like heart attacks, in diabetic eyes it drives the growth of those problematic vessels and increases leaking.

The injection itself takes just a few minutes and is performed as an outpatient appointment.

One important note: if you've recently had a stroke or heart attack, your body needs VEGF to help repair blood vessels around your heart and brain, so anti-VEGF treatment must wait at least three months.

Steroids offer an alternative that works more broadly than anti-VEGF, reducing multiple chemicals that cause swelling. They're given as slow-release pellets that last around four months – however, they're not suitable for everyone.

For proliferative retinopathy, laser treatment can help by deliberately treating areas of peripheral retina – parts you don't really use for day-to-day vision. Think of it like carefully pruning a tree. This pruning reduces the chemical signals that trigger abnormal blood vessel growth while nipping the new vessels in the bud.

Laser works more slowly than injections, often taking several weeks to show results.

The key is starting treatment as soon as problems are detected. More damage means less vision to preserve, but earlier intervention gives you the best chance of maintaining good sight.

When Surgery Becomes Necessary

Occasionally, complications arise that need surgical treatment rather than injections or laser. This might sound daunting, but these procedures are well-established and highly successful.

A vitrectomy removes blood or scar tissue from inside your eye. It's usually performed as a day case under local or general anaesthetic, with recovery taking a few weeks. You'll need eye drops during this time and may need to maintain certain head positions to help healing.

Cataracts are also more common in people with diabetes and can develop faster if you're having frequent eye injections. The good news is cataract surgery is one of the most common and effective operations performed in the UK. If you need it alongside your diabetic eye treatment, your surgeon will time everything to minimise disruption to your care.

Next Steps

Managing diabetic eye health doesn't need to feel overwhelming. Here's how to make it manageable:

Don't miss your screening appointments. They're your early warning system, catching problems when they're most treatable. Mark them in your calendar and treat them as non-negotiable.

Focus on consistent diabetes management. You don't need to be perfect – just consistent. Small improvements in blood sugar, blood pressure, and cholesterol control add up to significant protection for your eyes.

Report changes quickly. New floaters, flashing lights, persistent blurred vision, or wavy lines all warrant a quick call to your optician or GP. Early action makes a real difference.

Keep your glasses up to date. Sometimes what feels like deteriorating vision is simply an outdated prescription.

Don't hesitate to ask questions. If something isn't clear, ask your eye care team to explain it differently. Understanding what's happening helps you feel more in control and makes treatment easier to cope with.

Know you're not alone. Living with diabetes can feel isolating, especially when it starts affecting your vision. Organisations like Diabetes UK and the Macular Society offer information, support groups, and someone to talk to who understands. Many areas also have eye care liaison officers who can provide practical advice and emotional support.

The reality is that diabetic eye disease is largely preventable through good diabetes management. Regular screening is there to catch any problems that do develop so that they're treatable as early as possible. You're not powerless. By staying engaged with screening, managing your diabetes as best you can, and seeking treatment promptly when needed, you're giving yourself the best possible chance of maintaining clear, functional vision for years to come.