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Diabetic eye disease

Diabetic eye disease

  • About
  • Symptoms
  • FAQ

More than 1 million Australians have diabetes, a condition that carries an increased risk of developing eye complications. Diabetic eye disease includes complications such as diabetic retinopathy, diabetic macular oedema, cataracts and glaucoma.

Diabetes is the leading cause of blindness in working-age adults. People with type 1 and type 2 diabetes are at risk. It’s possible to be unaware that you have severe diabetic eye disease and suddenly go blind. Fortunately, most cases of blindness can be prevented with regular eye examinations and proper care.1

Diabetic retinopathy

The persistently high blood sugar levels that occur with diabetes can damage the retina’s small blood vessels (capillaries), which deliver oxygen and nutrients. Diabetic retinopathy affects up to a third of people with diabetes over the age of 502 and there are three main types:

  1. Non-proliferative diabetic retinopathy is the early stage in which capillary damage results in blood and fluid leaking into the retina, causing it to swell. Depending on the number of vessels affected, there is usually minimal or no effect on vision.
  2. Diabetic macular oedema occurs if swelling extends to the macula, which is the part of the retina responsible for central vision. Diabetic macular oedema (swelling) is the usual cause of vision loss related to diabetes and the level of impairment can be significant.
  3. Proliferative diabetic retinopathy is the advanced stage of the disease. In an attempt to supply the retina with more oxygenated blood, abnormal blood vessels start to grow but these are fragile and bleed easily. This can lead to the formation of scar tissue. If these new vessels bleed, the person may see ‘floaters’ or even lose all vision. This requires emergency treatment.

Cataracts

A cataract is a clouding of the lens in the eye. Left untreated, cataracts can eventually lead to blindness. People with diabetes are more likely to develop cataracts at an earlier age and suffer visual impairment faster than those without the condition.1,3

Glaucoma

This is a group of conditions that can damage the optic nerve. The optic nerve transmits signals from the retina to the brain for processing. Glaucoma is often (but not always) a result of increased pressure inside the eye. The risk of glaucoma in people with diabetes is significantly higher than that of the general population.1,4 The two main types are open-angle glaucoma (also called ‘the sneak thief of sight’) and angle-closure glaucoma (this comes on suddenly and is a medical emergency).

Diabetic eye conditions often have no signs or symptoms, particularly in the early stages. By the time someone with diabetes notices changes in their vision, the condition is quite advanced.

Signs and symptoms may include:

  • Blurry, cloudy or dim vision
  • Floaters and flashes
  • Poor night vision
  • Sensitivity to light and glare
  • Double vision, seeing halos around lights
  • Trouble reading
  • Frequent changes in spectacle and contact lens prescriptions
  • Eye pain
  • Headaches, nausea, vomiting

The Fred Hollows Foundation, which some of our doctors have worked with, has developed a sight simulator to demonstrate the visual impairment a person with diabetic retinopathy may experience.

What is diabetic eye disease?

This is a term used to describe the common eye complications seen in people with diabetes. It includes diabetic retinopathy, diabetic macular oedema, cataracts and glaucoma.
Cataract FAQs

Can I prevent diabetic retinopathy?

You can reduce your risk by having your eyes checked as soon as possible after being diagnosed with diabetes (this is called a screening test) and then at regular intervals thereafter.

Keeping the diabetes under control is the most important thing you can do – this means eating a balanced diet, getting exercise, not smoking and monitoring your blood sugar levels. You should also see your doctor regularly to have your blood pressure and cholesterol levels checked. If you experience any changes in your vision, have your eyes checked immediately.

What's the difference between diabetic retinopathy and diabetic macular oedema?

Diabetic macular oedema is a complication of diabetic retinopathy.

It occurs when the swelling involves the macula, which is the part of the retina responsible for central vision. Vision can become blurred and distorted, resulting in trouble reading, recognising faces and driving. Macular oedema (swelling) is the usual cause of vision loss related to diabetes and the level of impairment can be significant.

Can diabetic retinopathy be cured?

Vision can often be improved by treatment, but the main goal is to stabilise your condition and prevent it from getting worse. The three main treatments of diabetic retinopathy are injections into the eye, laser treatment or vitrectomy surgery. Your doctor will recommend the most appropriate course of treatment.

How does smoking contribute to loss of vision?

Smoking is not a risk factor for diabetic eye damage, but it can damage the eye in other ways. It increases the risk of developing cataracts, blockages of retinal arteries and the wet form of age-related macular degeneration. Diabetics who smoke also increase their risk of heart attack, stroke and kidney failure.

Is the treatment painful?

Special anaesthetic eye drops are usually used to prevent pain and, for patients undergoing vitrectomy surgery, a sedative given to relieve anxiety. Following laser treatment or surgery, you may feel some mild discomfort the next day.

References

For a full list of references, visit the diabetic eye disease FAQ page.

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Diagnosing diabetic retinopathy

(including diabetic macular oedema)

Your ophthalmologist will examine both retinas after using eye drops to widen your pupils and allow a clear view of the back of each eye.

Other tests that may be performed include:

  • Optical coherence tomography (OCT), which is similar to an ultrasound. This provides detailed images of the various tissue layers that make up the retina to help identify and measure any swelling.
  • Fluorescein angiography (FA), which involves fluorescent dye being injected into the bloodstream (normally through a vein in your arm) to highlight the blood vessels in the retina. The dye will show any leakage, bleeding or abnormal growth of blood vessels.

Treating diabetic retinopathy

(including diabetic macular oedema)

Various treatments are available and vision can often be at least partially recovered. The earlier the condition is diagnosed and monitored the better, as this provides the best chance of preventing severe vision loss and/or recovering vision. Earlier stages of damage require more frequent monitoring, while treatment is necessary for sight-threatening disease.

Your ophthalmologist will explain your options and recommend an appropriate course of treatment. As with all medical and surgical procedures, these treatments carry risks (although they are rare). It’s important to weigh these risks up against the potential benefits. Your ophthalmologist will help you make an informed decision.

Eye injections

These are also referred to as intravitreal injections and involve injecting medication into the vitreous (the gel-like substance that occupies most of the space inside the eye and gives it its round shape). The medication reduces fluid and swelling in the retina by shrinking abnormal blood vessels and inhibiting growth of new blood vessels.

There are two types of injections:

  1. Anti-VEGF injections: When cells are deprived of oxygen, a protein known as vascular endothelial growth factor (VEGF) is released. Low levels of VEGF are normal, but high levels of this protein can cause the growth of abnormal blood vessels. Anti-VEGF drugs block the action of this VEGF protein and stop these abnormal blood vessels.
  2. Steroid injections: Corticosteroids have anti-inflammatory properties and are used to treat a number of conditions. When injected into the eye, corticosteroids can reduce the inflammation that occurs with diabetic retinopathy, central retinal vein occlusion and postoperative macular oedema.

Patients are given anaesthetic eye drops prior to the injection – you may feel some pressure but no pain and you won’t see the needle coming towards your eye because it is given from the side.

These injections are initially administered monthly, usually for about six months or until the condition has resolved sufficiently. Sometimes, ongoing injections are required, but the interval between injections can be extended.

Complications from eye injections are rare, but may include:

  • Infection
  • Bleeding in the eye
  • Retinal detachment
  • Cataracts
  • Persistent high pressure in the eye
  • Allergy
  • Inflammation of the eye

Retinal laser treatment

Laser treatment (photocoagulation) uses heat from a laser to seal or destroy leaking blood vessels. It is also used to destroy sick retinal tissue that is no longer functioning properly and is instead encouraging the growth of the abnormal blood vessels. Sometimes, laser treatment is used to reduce swelling at the macula. A special microscope known as a slit lamp is used together with the laser to perform the procedure.

Anaesthetic eye drops are given to numb the eye. A special lens is placed in contact with the surface of the eye to help focus the laser beam. You may feel a slight stinging sensation and see brief flashes of light when the laser is applied to your eye.

Someone will need to drive you home from the clinic after the procedure. Your eyes will remain dilated for a few hours afterwards, therefore it is important to wear sunglasses to keep bright light out of your eyes. Your vision may be blurry and your eye may be uncomfortable for a day or two following the treatment.
Complications of retinal laser treatment include:

  • Mild loss of peripheral vision (usually less than if the retinopathy is not treated)
  • Reduced night vision
  • Decreased ability to focus

Rarely, there may be bleeding, retinal detachment or an accidental laser burn that causes severe central vision loss.

Vitrectomy surgery

Surgery may be required for severe cases of diabetic retinopathy. This involves removing some of the vitreous (the gel-like substance that fills the eye and gives it its shape) and any blood so that light rays can focus on the retina again. Scar tissue from the retina can also be removed and retinal detachments repaired.

Patients are given a local anaesthetic to stop pain and a sedative to reduce anxiety. Following surgery, a pad and shield will be placed over the eye to protect it until you see your ophthalmologist the next day.

Complications of vitrectomy surgery are rare, but include:

  • Infection
  • Bleeding
  • High or low eye pressure
  • Cataract
  • Retinal detachment
  • Loss of vision

Cataracts and glaucoma

While cataracts and glaucoma are more common in people with diabetes than those without, the treatment options remain the same.

Cataracts can be fixed surgically when causing significant visual reduction and sight restored. Learn more

Glaucoma cannot be cured, but the disease can be stabilised. Options include medication (eye drops, tablets), laser treatment and surgery. Learn more

Looking after your eyes

  • Make sure you have your eyes checked by an ophthalmologist/optometrist when you are first diagnosed with diabetes. Your eyes should then be checked every 1-2 years, or more frequently if advised.
  • Keep your blood sugar, blood pressure and blood cholesterol under control, and have regular health checks to confirm this. While this will not reverse any vision damage that has already occurred, it will help prevent further deterioration of your eyes.
  • If you smoke, it’s time to quit. Smokers who have diabetes are at much greater risk of losing their sight, having a heart attack or stroke, and suffering kidney failure.
  • Get regular exercise and maintain a healthy diet. Advice from a dietician and your GP is can be extremely helpful.
  • Have your eyes checked immediately if you notice any changes in your vision.
  • Always take medications as instructed by your doctor.

References

  1. Vision 2020 Australia, Diabetes Australia and Centre for Eye Research Australia. The case for an Australian Diabetes Blindness Prevention Initiative. Available from: http://www.diabetesaustralia.com.au/wp-content/uploads/Case-for-an-Australian-Diabetes-Blindness-Prevention-Initiative.pdf (Accessed 15 September 2022).
  2. Macular Disease Foundation Australia. About diabetic retinopathy. Available from: https://www.mdfoundation.com.au/about-macular-disease/diabetic-eye-disease/about-diabetic-retinopathy/ (Accessed 15 September 2022).
  3. Kiziltoprak H, Tekin K, Inanc M et al. Cataract in diabetes mellitus. World J Diabetes 2019;10(3):140–153.
  4. Zhao YX, Chen XW. Diabetes and risk of glaucoma: systematic review and a Meta-analysis of prospective cohort studies. Int J Ophthalmol 2017;10(9):1430–1435.

 

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The information on this page is general in nature. All medical and surgical procedures have potential benefits and risks. Consult your ophthalmologist for specific medical advice.

Date last reviewed: 2024-10-22 | Date for next review: 2026-10-22

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IMPORTANT: If you are concerned about your eyes and require an urgent consultation, DO NOT use this form. Please call one of our clinics during office hours or contact your nearest emergency department.

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