- Diabetes affects 72 million adults globally, with 65 million cases in India alone
- Diabetic retinopathy damages retinal blood vessels, causing gradual vision loss
- Risk rises with duration of diabetes and uncontrolled blood sugar or other conditions
Diabetes is often associated with complications such as heart disease, kidney damage, and nerve problems. However, one of its most serious yet frequently overlooked consequences affects the eyes. According to a study in Indian Journal of Opthalmology, it is estimated that around 72 million of the global adult population (around 8.2%) has diabetes and about one-fifth of all adults with diabetes lives in the South-East Asia. In India, around 65 million people have diabetes. Diabetic retinopathy, a condition caused by prolonged high blood sugar levels, is among the leading causes of vision loss in adults worldwide. The condition develops gradually, often without causing any noticeable symptoms in its early stages, making regular eye examinations essential for people living with diabetes. The encouraging news is that diabetic retinopathy is largely preventable and treatable if detected early. Timely diagnosis, good blood sugar control, and appropriate treatment can significantly reduce the risk of permanent vision loss.
What Is Diabetic Retinopathy?
Diabetic retinopathy is an eye disease that occurs when persistently high blood sugar damages the tiny blood vessels of the retina, the light-sensitive tissue located at the back of the eye. The retina converts light into signals that are sent to the brain, allowing us to see clearly. When these delicate blood vessels become damaged, they may leak fluid or blood, swell, or eventually become blocked, interfering with normal vision.
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"Diabetes is a lifestyle disease that often affects your body in many ways. One of the areas that can have a major impact is our eyes," explains Dr. Aditya Kelkar, Director, NIO Super Specialty Hospital, Pune.
"Diabetic retinopathy is a serious eye condition that develops when high blood sugar levels damage the tiny blood vessels in the retina. Any damage to the retina can gradually lead to impaired vision and, if left untreated, permanent vision loss," Dr. Kelkar adds.
Who Is Most At Risk?
Both people with Type 1 and Type 2 diabetes can develop diabetic retinopathy. However, the likelihood increases with the duration of diabetes. Dr. Kelkar says the risk becomes significantly higher when diabetes remains uncontrolled for several years or when it is accompanied by other health conditions.
"People with Type 1 or Type 2 diabetes are at higher risk of developing diabetic retinopathy. The chances increase the longer diabetes persists, especially if blood sugar, blood pressure, or cholesterol levels remain uncontrolled," he explains. Other factors that may increase the risk include smoking, obesity, kidney disease, pregnancy in women with diabetes, and poor adherence to diabetes medications.
Why Early Detection Is Difficult
One of the biggest challenges with diabetic retinopathy is that it usually develops silently. In its initial stages, most people experience no pain or noticeable changes in vision. "Patients often notice no changes in their vision during the early stage, leading to delayed diagnosis," says Dr. Kelkar.
Because the disease progresses gradually, many individuals assume their eyesight is normal until the retina has already suffered significant damage. This is why ophthalmologists strongly recommend annual comprehensive eye examinations for everyone living with diabetes, even if they have no visual complaints.
Warning Signs You Should Never Ignore
As diabetic retinopathy advances, symptoms begin to appear. These warning signs should prompt an immediate consultation with an eye specialist. According to Dr. Kelkar, common symptoms include:
- Blurred or fluctuating vision
- Floaters or dark spots drifting across the field of vision
- Difficulty seeing colours clearly or faded colour perception
- Poor night vision
- Blank or dark areas in the visual field
"Because these symptoms develop slowly, many patients miss them until significant damage has already occurred," he cautions. Ignoring these warning signs can allow the disease to progress to advanced stages, where treatment becomes more complicated.
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The Two Stages Of Diabetic Retinopathy
Diabetic retinopathy generally progresses through two major stages. Non-Proliferative Diabetic Retinopathy (NPDR). This is the early stage of the disease. High blood sugar weakens the retinal blood vessels, causing them to leak small amounts of blood or fluid into the retina. Fluid accumulation may lead to swelling, particularly in the macula, the part of the retina responsible for sharp central vision. Patients may experience mild blurring, although many remain symptom-free during this stage.
Proliferative Diabetic Retinopathy (PDR)
This represents the advanced stage of the disease. "When diabetic retinopathy progresses, abnormal new blood vessels begin to grow on the retina. These fragile vessels can bleed into the eye, leading to severe vision loss and other complications," explains Dr. Kelkar. Without treatment, proliferative diabetic retinopathy can result in retinal detachment, glaucoma, and irreversible blindness.
How Is Diabetic Retinopathy Treated?
Treatment depends on the severity of retinal damage. Dr. Kelkar says several highly effective treatments are now available that can slow disease progression and preserve vision. "Anti-VEGF injections or steroid injections help reduce retinal swelling. Laser therapy can seal leaking blood vessels and shrink abnormal vessel growth, while vitrectomy surgery may be required in advanced cases to remove blood from the eye and restore retinal function." The choice of treatment depends on whether the patient has diabetic macular oedema, retinal bleeding, or advanced proliferative disease. Early intervention generally produces better visual outcomes than delayed treatment.
Can Diabetic Retinopathy Be Prevented?
The good news is that diabetic retinopathy is often preventable. Maintaining stable blood sugar remains the most effective strategy for reducing the risk of retinal damage. Good control of blood pressure and cholesterol also plays an important role in protecting eye health. Dr. Kelkar emphasises that lifestyle modifications are equally important. "With good sugar control combined with regular exercise, a healthy diet, and an annual eye check-up, diabetic retinopathy can often be avoided."
People with diabetes should also avoid smoking, take prescribed medications regularly, monitor their blood sugar levels, and never skip routine retinal examinations. Diabetic retinopathy is a potentially sight-threatening complication of diabetes, but it is not inevitable. Because the disease often develops without early symptoms, regular retinal screening is just as important as monitoring blood sugar levels. Early diagnosis, timely treatment, and healthy lifestyle habits can significantly reduce the risk of permanent vision loss. For anyone living with diabetes, protecting the eyes should be an essential part of long-term diabetes care.
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