The severity of diabetes-related complications can be life-threatening, while others are sufficiently debilitating to curtail daily activities and quality of life. Diabetes-related eye diseases are one such complication. They include diabetic retinopathy (DR), diabetic macular edema (DME), cataracts and glaucoma. All can lead to vision loss, affecting a person’s career, causing financial difficulties and interfering with daily diabetes management.
DR and DME are two of the most common and preventable conditions affecting eyesight.
DR affects over one in three people with diabetes and can cause vision loss, low vision or blindness. The condition usually affects both eyes and results when high glucose levels damage blood vessels in the retina. These damaged blood vessels can swell and leak or stop blood flow, causing blurred or distorted vision. Sometimes, new blood vessels grow, but they are abnormal and can cause further impairment. Other symptoms include the onset of colour blindness or colours appearing faded, poor night vision (night blindness), small dark spots (eye floaters) or streaks in vision, and trouble reading or seeing faraway objects.
Over time, about 1 in 15 people with diabetes will develop DME, a further complication of diabetic retinopathy that affects the middle of the eye. The blood vessels in the macula, located in the retina’s centre at the back of the eye, can become blocked. At first, vision changes can go unnoticed. However, DME can cause central vision to become blurred.
I have had blurry vision since I was diagnosed with type 2 diabetes in 2013. However, I have never been diagnosed with DR so far, as there are no DR units in my state,” Chimezie Anyiam, IDF Blue Circle Voice (Nigeria).
People with any type of diabetes can develop DR, with the risk increasing the longer people live with the condition. Although it can develop at any stage of DR, the risk of DME increases with the severity of diabetic retinopathy.
Some conditions associated with DR that can lead to DME include high glucose and blood pressure, lipid imbalance (dyslipidemia), obesity, sleep apnoea and pregnancy. Nonetheless, lifestyle modifications, including a healthy diet, regular physical activity and weight management, can help maintain healthy blood glucose levels and prevent the worsening of diabetic retinopathy and the development of DME.
Additionally, women with diabetes who become pregnant or develop gestational diabetes are at high risk of developing DR. In both cases, they should have comprehensive eye exams to monitor their condition during pregnancy.
Treating DR and DME depends on the severity of the condition. Laser surgery and intravitreal — injections into the space in the back of the eye called the vitreous cavity — are the primary methods. In some cases, combination therapy using both treatments may be necessary. Eye surgery, known as a vitrectomy, is another treatment option for blurred vision due to leaking blood vessels.
Early detection, regular screenings and appropriate diabetes management are crucial to prevent vision loss and improve the quality of life for people with diabetes. Regular screening for DR, focusing on DME, is recommended for all people with diabetes. Ideally, trained healthcare professionals would perform basic screenings and make appropriate referrals to ophthalmologists when necessary. Still, the screening pathway requires multi-directional communication involving the person with diabetes, the primary care provider and the ophthalmologist.
I deal with several comorbid issues, but DR is the one that affects me the most. If it wasn’t for the skills of my optometrist and ophthalmologist, I could have been blind before I hit 50. I have challenges, but I can still see at 52,” Michael Donohoe, IDF Blue Circle Voice (United States).
In low- and middle-income countries, obstacles to screening are prevalent. Barriers include long waiting periods for appointments and on the day of the visit, and financial burdens associated with health insurance premiums, medical consultations, treatment and necessary supplies. Additionally, the limited availability of services in rural areas or outside major cities and academic institutions often requires extended travel times.
Support groups and educational resources can provide assistance and information. However, healthcare professionals are central to informing people with diabetes on risk factors, symptoms, treatment options and the need for ongoing management of their condition. Policy and advocacy are the path to mitigating the impact of diabetic retinopathy. Effective policy ensures that healthcare professionals can provide access to screening, prevention and treatment to preserve vision and improve the well-being of people with diabetes.
The International Diabetes Federation has gathered a wealth of information, including podcasts, webinars, policy briefs, and educational materials, for diabetes advocates to use in their advocacy work to promote prevention, screening and treatment policies.
Moreover, the IDF School of Diabetes offers free courses designed for people with diabetes and healthcare professionals, providing comprehensive knowledge on the risk factors, treatment, and management of diabetes-related eye complications.
We encourage you to take the time to discover the material below to enhance your understanding and advocacy efforts.
In this episode of D-Talk, Dr Covadonga Bascaran and Professor Sehnaz Karadeniz join host Phyllisa Deroze to discuss diabetic retinopathy (DR). Their discussion delves into the landscape of DR screening, prevention and available treatments to preserve vision.
Learn more about the joint IDF/IAPB policy brief, “Diabetic retinopathy: a call for global action”, in this online event where a panel of diabetes experts and stakeholders explore the economic, social and psychological impact diabetic retinopathy (DR) has on people with diabetes. You will also learn how policy can impact DR prevention, screening, and treatment and integrate this learning into your advocacy work.
This course presents the complications, risk factors and pathophysiology of diabetic retinopathy (DR), classification of stages and screening for DR and diabetic macular edema. The course also addresses the recommended diagnostic tests and management strategies for DR. Learn more here.
The International Diabetes Federation and the International Agency for the Prevention of Blindness (IAPB), and a team of experts developed a set of clinical practice recommendations for the effective management of DME. These recommendations serve as a decision support tool for general practitioners, opticians, ophthalmologists, hospital physicians and other clinicians involved in managing diabetic eye disease. They result from a collaborative and evidence-based process incorporating the most up-to-date advancements in DME management. Download
