C L E A R L Y
Diabetic retinopathy
Diabetic Retinopathy: Protecting Your Vision with Regular Eye Screening
What is Diabetic Retinopathy (DR)?
Diabetic Retinopathy (DR) is a complication of diabetes that affects the eyes. It occurs when high blood sugar levels damage the tiny blood vessels in the retina—the light-sensitive tissue at the back of the eye.
In its early stages, DR usually causes no noticeable symptoms or vision changes. This is why regular eye screening is the single most important step you can take to prevent sight loss.
The Global and Regional Burden of DR
Diabetic Retinopathy is a significant public health challenge worldwide, with varying prevalence rates depending on location, ethnicity, and the effectiveness of local screening programs.
| Region | Statistic | Source |
| India | Estimated national prevalence of any Diabetic Retinopathy is 12.5% of the diabetic population, with 4.0% having vision-threatening DR (VTDR). | SMART India (2022) [1.10] |
| India | The total number of people with DR is predicted to increase from 4.21 million in 2020 to 6.08 million by 2030 in urban India. | Research on India’s DR burden [1.8] |
| UK | The prevalence of DR among people with Type 2 Diabetes is approximately 30%. | Observational Cohort Study (2021) [1.3] |
| UK | In 2009-2010, diabetic eye disease was the second leading cause of certifiable blindness in working-age adults (14.4%), a drop from the leading cause a decade earlier, largely credited to the national screening program. | BMJ Open (2014) [2.5] |
| UK (Ethnicity) | People of South Asian ethnicity in the UK with Type 2 Diabetes have a higher prevalence of both any DR (42.3%) and sight-threatening DR (10.3%) compared to white Europeans (38.0% and 5.5% respectively). | DRIVE UK (2012) [1.2] |
Causes and Risk Factors
Diabetic Retinopathy is caused by persistently high blood glucose levels. The higher and longer your blood sugar is elevated, the greater the risk of damage to the retinal blood vessels.
Primary Risk Factors:
• Duration of Diabetes: The longer you have diabetes, the higher the risk.
• Poor Glycaemic Control (High HbA1c): Inadequate management of blood sugar is the strongest predictor of DR development and progression.
• High Blood Pressure (Hypertension): Poorly controlled blood pressure significantly increases your risk.
• High Cholesterol: High levels of fat in the blood further damage blood vessels.
• Pregnancy: Diabetic women should have more frequent screenings, as pregnancy can accelerate DR progression.
The Stages of Diabetic Retinopathy
DR progresses in stages, which is why early detection is crucial:
| Stage | Description | Key Feature | Visual Symptoms |
| Background (Mild Non-Proliferative DR) | Tiny bulges (microaneurysms) appear in the blood vessels, which may leak fluid. | Microaneurysms, small haemorrhages | None. Sight is usually unaffected. |
| Pre-Proliferative (Moderate/Severe Non-Proliferative DR) | More extensive damage, including blocked blood vessels, causing more significant bleeding and leakage. | Blocked capillaries, ‘cotton wool spots’ | Vision may start to blur slightly. |
| Proliferative Diabetic Retinopathy (PDR) | This is the advanced, sight-threatening stage. In response to poor blood supply, the retina grows new, fragile, abnormal blood vessels. | Neovascularisation (new vessel growth) | Severe blurring, sudden vision loss, floaters, shadows. |
| Diabetic Macular Oedema (DMO) | Fluid leaks into the macula (the central part of the retina responsible for sharp, central vision). | Swelling of the macula | Blurring, difficulty reading, distorted vision. |
The Critical Role of Regular Eye Check-ups
The UK’s success in reducing diabetes-related blindness is primarily attributed to its nationwide screening programme. In countries like India, where systematic screening is challenging, DR remains an emerging and serious cause of vision loss. Early detection through screening is the best defence.
Your regular diabetic eye screening appointment is designed to find problems at the Background stage, long before you notice any symptoms, when treatment is most effective at preventing blindness.
What to Expect at Your Screening:
1. Dilating Drops: Drops are put in your eyes to make the pupil wider, allowing the doctor or screener a clear view of the retina.
2. Retinal Photography: A specialised camera is used to take pictures of the back of your eyes. This is quick and painless.
3. Grading: These images are then carefully examined by trained professionals to check for any signs of damage.
Key Actions to Protect Your Vision
YOU can take control of your eye health.
• NEVER wait for symptoms: By the time you notice blurred vision or floaters, the disease is already at a more advanced stage.
• Prioritise your annual screening. This appointment is mandatory for all people with diabetes. If you are pregnant or have advanced DR, you may be called more frequently.
• Maintain strict blood sugar control (HbA1c). Good blood sugar management can prevent DR from starting or slow down its progression significantly.
• Manage your blood pressure and cholesterol. Work with your doctor to keep these levels within the target range.
• Do not rely on a standard sight test at an optician. While beneficial for other eye conditions and checking your prescription, it is not a substitute for the specialised, high-resolution retinal photography provided by a dedicated Diabetic Eye Screening service.
Crucial Message:
Diabetic Retinopathy is the leading cause of preventable sight loss in working-age people.
If caught early by attending your regular screening, sight loss from DR is almost entirely preventable.
Bibliography / References
1. Prevalence of diabetic retinopathy in India stratified by known and undiagnosed diabetes, urban-rural locations, and socioeconomic indices: results from the SMART India population-based cross-sectional screening study. The Lancet Diabetes & Endocrinology. 2022.
2. Ethnic Variations in the Prevalence of Diabetic Retinopathy in People with Diabetes Attending Screening in the United Kingdom (DRIVE UK). PLOS One. 2012.
3. A comparison of the causes of blindness certifications in England and Wales in working age adults (16–64 years), 1999–2000 with 2009–2010. BMJ Open. 2014.
4. The United Kingdom has one of the most effective diabetic retinopathy screening programmes in the world. UCL Discovery. 2020.
5. Ethnic Disparities in the Development of Sight-Threatening Diabetic Retinopathy in a UK Multi-Ethnic Population with Diabetes: An Observational Cohort Study. PMC. 2021.
6. Diabetic Retinopathy. Diabetes UK (Patient Information).