I have diabetes but my vision is fine. Do I really need an eye screening?
I hear this question in some form almost every week, usually from someone whose physician has sent them to me and who is quietly wondering whether the visit is necessary. The answer is yes, and the reason is simple: diabetic retinopathy is silent until it is serious.
Good vision today tells you almost nothing about the health of your retina. That sounds strange, so let me explain why.
Why your vision can be fine while damage is happening
Diabetes slowly weakens the small blood vessels of the retina, the light-sensing layer at the back of the eye. Those vessels can leak, close off, or grow abnormally. In the early and even moderate stages, this happens away from the centre of your vision, so you notice nothing. You read, drive, and work normally while the changes quietly progress.
By the time vision blurs, the disease has usually reached the macula, the small central area we read with, or bleeding has occurred inside the eye. Treatment at that stage still helps, but it works far better, and preserves far more sight, when we start earlier. In my years of practice since 2001, the patients who lose vision to diabetes are almost never the ones who came for regular screening. They are the ones who waited for a symptom.
What a diabetic eye screening actually involves
It is a gentle, unhurried examination. We dilate your pupils with drops, which takes about twenty to thirty minutes to work, and then examine the retina thoroughly. Where needed, we take an OCT scan, a painless imaging test that shows the retinal layers in fine cross-section and picks up swelling at the macula long before you would notice it yourself.
The drops blur your near vision for a few hours, so bring someone to drive you home, or plan for it. That is the only inconvenience. There is no pain and no injection in a screening visit.
Who needs it, and how often
If you have type 2 diabetes, you should have a dilated retinal examination at the time of diagnosis, because the diabetes may have been present, unnoticed, for years before it was found. If you have type 1 diabetes, screening usually begins about five years after diagnosis.
After that, once a year is the usual rhythm if the retina is healthy. If we find early changes, we may ask to see you every three to six months. Pregnancy, poorly controlled sugars, high blood pressure and kidney disease all raise the risk, and we adjust the schedule accordingly. A routine comprehensive eye check-up is not a substitute, the retina must be examined properly, with dilated pupils.
What happens if we find something
Most of the time, early changes need no treatment at all, only closer follow-up and better sugar control, which remains the single most powerful medicine for the diabetic eye. Your physician and I work as a team here.
If the disease progresses, we have effective treatments. Laser is used to seal leaking areas or to quieten the retina when abnormal vessels threaten to grow. For swelling at the macula, intravitreal injections of medicine into the eye, done under numbing drops and far less frightening than they sound, can dry the swelling and often improve vision, not merely hold it steady.
And I will be honest with you about the limits of what we do here. If retinopathy reaches the advanced stage where surgery inside the eye, a vitrectomy, is required, that is the work of a vitreoretinal surgeon. We do not perform it, and I will not pretend otherwise. We refer those patients promptly to a trusted retinal surgery centre and stay involved in their care afterwards. My training at Aravind taught me that knowing when to refer is as much a part of good surgery as operating.
The habit that protects your sight
Think of the annual retinal examination the same way you think of your HbA1c test, not as something you do when there is a problem, but as the thing that makes sure there never is one. Silent disease needs scheduled checking. That is the whole argument, and it is a strong one.
If you have diabetes and have not had a dilated retinal examination in the past year, book a diabetic eye screening or message us on WhatsApp. The surgeon who examines you is the one who looks after your eyes throughout.