Most people with diabetes understand how important it is to manage their blood glucose levels.
This is because poor control of glucose levels can lead to a number of serious problems. These problems can be described under two headings:
- Microvascular disease, like eye disease (retinopathy and maculopathy) and nerve damage (neuropathy)
- Macrovascular disease, like heart disease, damage to large blood vessels and kidney failure.
Diabetes is the leading cause of preventable blindness in Australia.
A staggering 1 in 3–4 Australians with diabetes have some degree of vision affected by diabetes1.
Vision loss and blindness caused by diabetes happens when the high glucose levels in the blood damage the blood vessels in the back of the eye, which can cause the vessels to bleed uncontrollably. This condition is called diabetic retinopathy. If this occurs in the central area of vision, it is called diabetic maculopathy.
Proliferative retinopathy is an advancement of the condition where the blood vessels at the back of the eye produce new fragile vessels that can cause further bleeding. This form of diabetic retinopathy is so severe it may result in complications causing blindness.These include retinal detachment (where the retina becomes separated from the back of the eye), retinal ischemia (reduced blood flow to the retina) and widespread recurrent retinal haemorrhage (bleeding from blood vessels in the retina).
Diabetic retinopathy is often seen in people who have had diabetes for at least 5-10 years2. However, eye disease can affect anybody diagnosed with diabetes.
Those who are most vulnerable include:
- people with poor glucose control3
- people with existing heart or kidney disease3
- people who smoke4
- people who lead an inactive lifestyle5
- people with Type 1 diabetes6.
“Anyone who has been diagnosed with diabetes should be taking a team approach to diabetes management,” advises Annette Parkes-Considine, a diabetic educator from the Hunter Diabetes Centre in Newcastle, NSW. Ideally, this primary team will include your family doctor or GP, an endocrinologist (a doctor specialising in conditions like diabetes), a diabetes educator, a dietician, podiatrist and an optometrist and/or ophthalmologist (eye specialist).
Regular health and eye check-ups can help avoid some of the complications related to diabetes, including diabetic retinopathy.
“Good management of diabetes lowers the risk of developing retinopathy, and also is important to prevent it from deteriorating further,” advises Annette Parkes-Considine.
Current guidelines advise yearly eye exams by an optometrist for anyone diagnosed with diabetes. However, if you do feel changes in your vision, it is important to take note and report these early to your diabetic team. Changes may include:
- Difficulty with central vision
- Patches or dark sports in your central vision
- Floaters or spots in your vision
- Decreased vision when watching TV or driving
- Unusual vision loss.
The sooner you see an eye doctor or your diabetes health professional, the earlier these problems can be addressed. This will reduce the chance of retinopathy development.
Retinal scans and diabetes-related checks can be completed at most optometrists. Even if you have already been diagnosed with retinopathy, regular checks are important to monitor retinopathy development.
For help to remember when your next screening appointment is due, you can register with the recently launched new national diabetes eye screening program led by Diabetes Australia and Vision 2020 Australia, called KeepSight. This program provides important eye health information and sends alerts when it’s time to have an eye check.
While managing your diabetes is personal and different depending on your circumstances, there are some common approaches to control the condition. These include monitoring of blood glucose levels, taking required medications, eating a healthy, portion-controlled diet and exercising regularly.
“If you are checking your sugar levels at home and you’re not getting the numbers you know you should be getting or you’re not happy with the results …. you need to push that issue with your doctor.” Annette also says changes in your diabetes medication may be necessary, and it is important not to resist this. “Your doctor or diabetes specialist team can help you understand the best ways to take control of your condition and develop a personalised diabetes management plan.”
We encourage everyone with diabetes to visit an optometrist if you have not had your eyes checked in the last 12 months or if you are experiencing any unusual vision changes.
This is an important step in looking after yourself, your diabetes and your vision.
Nicolette Hodyl PhD is the Director of Vertex Health, a consultancy specialising in research strategy and health communication. She is the Head Writer for Hormones Australia and has over 15 years’ experience working in medical research.
Indiana Tape is an intern at Vertex Health, and currently completing a Bachelor of Communication degree at the University of Newcastle.
The medical content of this page has been reviewed by Dr Christolyn Raj, a specialist in medical retina, cataract/refractive surgery and paediatric retinal eye disease. She is an Honorary Senior Lecturer at The University of Melbourne.
- McKay R, McCarty CA, Taylor HR. Diabetic retinopathy in Victoria, Australia: The Visual Impairment Project. Br J Ophthalmol. 2000;84(8):865-870.
- Keel S, Xie J, Foreman J, van Wijngaarden P, Taylor HR, Dirani M. The Prevalence of Diabetic Retinopathy in Australian Adults with Self-Reported Diabetes: The National Eye Health Survey. Ophthalmology. 2017;124(7):977-984.
- Atchison E, Barkmeier A. The Role of Systemic Risk Factors in Diabetic Retinopathy. Curr Ophthalmol Rep. 2016;4(2):84-89.
- Cai X, Chen Y, Yang W, Gao X, Han X, Ji L. The association of smoking and risk of diabetic retinopathy in patients with type 1 and type 2 diabetes: a meta-analysis. Endocrine. 2018;62(2):299-306.
- Ren C, Liu W, Li J, Cao Y, Xu J, Lu P. Physical activity and risk of diabetic retinopathy: a systematic review and meta-analysis. Acta Diabetol. 2019.
- 6. Romero-Aroca P, Navarro-Gil R, Valls-Mateu A, Sagarra-Alamo R, Moreno-Ribas A, Soler N. Differences in incidence of diabetic retinopathy between type 1 and 2 diabetes mellitus: a nine-year follow-up study. Br J Ophthalmol. 2017;101(10):1346-1351.