Diabetic Retinopathy: How Diabetes Affects Your Vision

This article is written by Dr. Peggy Ng Pey Yih, Consultant Ophthalmologist, who shares her expertise to help you better understand and take care of your eye health.

What Is Diabetic Retinopathy?

Diabetic retinopathy is a common eye complication of diabetes and one of the leading causes of vision loss among Malaysian adults. It occurs when prolonged high blood sugar levels damage the small blood vessels in the retina—the light-sensitive tissue at the back of the eye that allows us to see.

The good news is that early detection and proper treatment can prevent or reduce vision loss.

How Does Diabetic Retinopathy Develop?

Over time, high blood sugar can weaken retinal blood vessels, causing them to:

• Leak fluid or blood
• Become blocked
• Grow abnormally

These changes interfere with normal vision and may worsen if left untreated.

Stages of Diabetic Retinopathy

Diabetic retinopathy usually progresses through several stages:

1. Mild Non-Proliferative Diabetic Retinopathy (NPDR)

   Small bulges (microaneurysms) form in retinal blood vessels. Vision is often normal at this stage.

2. Moderate to Severe NPDR

   More blood vessels become damaged or blocked, reducing blood supply to the retina.

3. Proliferative Diabetic Retinopathy (PDR)

   New, fragile blood vessels grow abnormally. These can bleed into the eye, leading to severe vision loss.

4. Advanced Diabetic Eye Disease

   The most severe stage of diabetic retinopathy, where extensive fibrous tissue causes traction on the retinal layer.

Diabetic Macular Edema (DME)

At any stage, fluid may leak into the macula, the central part of the retina, causing diabetic macular edema. This leads to blurred or distorted central vision and is a major cause of vision impairment in diabetic patients.

Symptoms of Diabetic Retinopathy

In the early stages, diabetic retinopathy may not cause noticeable symptoms, which is why regular eye screening is crucial.

As the condition progresses, symptoms may include:

• Blurred or fluctuating vision
• Dark spots or floaters
• Difficulty reading or seeing details
• Poor night vision
• Sudden vision loss

Any sudden change in vision requires urgent eye assessment.

Who Is at Risk of Diabetic Retinopathy?

Anyone with diabetes can develop diabetic retinopathy, especially those who:

• Have had diabetes for many years
• Have poor blood sugar control
• Have high blood pressure or high cholesterol
• Are pregnant
• Smoke

How Is Diabetic Retinopathy Diagnosed?

Diabetic retinopathy is detected through:

• Dilated eye examination
• Retinal photography
• Optical Coherence Tomography (OCT)
• Fluorescein angiography (when needed)

Regular screening allows early treatment before vision is affected.

When Should Diabetic Eye Screening Be Done?

According to the Malaysian Clinical Practice Guidelines, people with type 2 diabetes should undergo their first diabetic retinopathy screening at the time of diagnosis.

Patients should then continue with regular eye examinations to monitor disease progression and detect complications early.

Treatment Options for Diabetic Retinopathy

Treatment depends on the severity of the condition:

• Early Stages

  May only require close monitoring and good diabetes control.

• Proliferative Diabetic Retinopathy

  Laser photocoagulation

• Diabetic Macular Edema

  Anti-VEGF injections
  Steroid injections (selected cases)
  Laser treatment

• Advanced Diabetic Eye Disease

  Vitrectomy surgery (for severe bleeding or retinal detachment)

Preventing Vision Loss from Diabetic Retinopathy

You can significantly reduce the risk of vision loss by:

• Keeping blood sugar within target range
• Controlling blood pressure and cholesterol
• Attending regular diabetic eye screenings (at least once a year)
• Avoiding smoking
• Seeking prompt treatment when advised

Protect Your Vision with Regular Diabetic Eye Screening

Diabetic retinopathy is a serious but preventable cause of blindness. With regular eye examinations, good diabetes control, and timely treatment, most people with diabetes can maintain good vision throughout their lives.

Remember: clear vision starts with good diabetes control and regular eye care.

This article was written by Dr. Peggy Ng Pey Yih, a Consultant Ophthalmologist.

Book your appointment at Pantai Hospital Batu Pahat for a comprehensive diabetic eye check-up. You may also schedule an appointment through our website or via the My Health 360 app available on Google Play Store and Apple App Store.