Diabetic retinopathy is the most common cause of preventable sight loss in working-age adults in the United Kingdom. What makes it particularly dangerous is that early stages cause no symptoms whatsoever — vision remains normal until the disease is quite advanced. This is why annual diabetic eye screening is not optional; it is essential.
How diabetes damages the eye
High blood glucose levels damage the tiny blood vessels (capillaries) that supply the retina — the light-sensitive layer at the back of the eye. Damaged capillaries leak fluid, bleed, or become blocked. Over time, the retina responds by growing new, fragile blood vessels in a process called neovascularisation — these new vessels bleed easily and can cause tractional retinal detachment.
The stages of diabetic retinopathy
- Background (mild non-proliferative) retinopathy — microaneurysms and small haemorrhages. No symptoms. Vision unaffected. No treatment needed, but annual monitoring continues.
- Moderate/severe non-proliferative retinopathy — more extensive changes, venous beading, cotton wool spots. Closer monitoring (6-monthly). Risk of progression is higher.
- Proliferative diabetic retinopathy (PDR) — new blood vessel growth (neovascularisation). High risk of vitreous haemorrhage and retinal detachment. Treatment required.
- Diabetic macular oedema (DMO) — fluid accumulates in the macula (the part of the retina responsible for central, detailed vision). Can occur at any stage. Causes gradual central visual blurring. Highly treatable.
Treatment
- Anti-VEGF injections (e.g. ranibizumab/Lucentis, bevacizumab/Avastin, aflibercept/Eylea) — the first-line treatment for diabetic macular oedema. Injected directly into the eye in a quick clinic procedure, usually monthly initially. Highly effective at preserving and improving vision.
- Laser photocoagulation — pan-retinal laser applied to the peripheral retina for proliferative disease. Reduces the stimulus for new vessel growth. May cause some peripheral field loss but protects central vision.
- Vitrectomy surgery — for vitreous haemorrhage that does not clear, or tractional retinal detachment.
- Systemic control — every 1% reduction in HbA1c reduces the risk of retinopathy progression by around 35%. Blood pressure and lipid control also matter significantly.
Diabetic eye screening in the UK
All people with diabetes aged 12 and over in England are invited for annual diabetic eye screening through the NHS Diabetic Eye Screening Programme (DESP). The screening involves a dilated fundus photograph and does not require a referral — your GP or diabetes team will arrange it.
Screening attendance in Yorkshire varies. Please do not skip these appointments. They are the single most effective intervention available to prevent diabetic blindness.
Frequently Asked Questions
Will I definitely get diabetic retinopathy if I have diabetes?
Not necessarily. The risk of retinopathy increases with duration of diabetes and with poor glucose control. After 20 years of type 1 diabetes, approximately 95% of patients have some degree of retinopathy. However, with excellent glycaemic control, normal blood pressure, and annual screening, vision-threatening retinopathy can often be prevented or caught at a very early, treatable stage.
I have diabetes but my vision seems fine. Do I still need screening?
Yes, absolutely. Early and even moderate diabetic retinopathy causes no visual symptoms at all. By the time vision is affected, the disease is often already at an advanced stage. Annual screening detects changes before symptoms appear, when treatment is most effective.
Mr Mohamed Mohyudin
MBChB BSc MSc FRCOphth CCT — Consultant Ophthalmic Surgeon, Spire Elland Hospital, Yorkshire. GMC 7039600.
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