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Advice for people with diabetes and their families

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Diabetes and eye problems (diabetic retinopathy)

Diabetes can affect your eyes in many ways. Some people go on to develop an eye complication called diabetic retinopathy. If you don’t get this eye problem treated in time, it can lead to sight loss. 

This is a frightening fact. Losing your sight could affect your career, your family life and your independence. That’s why it’s vital that you are aware of the different types of diabetic retinopathy and know what to do to keep your eyes healthy, such as having regular eye screenings.
 

Diabetes can lead to serious eye complications, such as diabetic retinopathy. Diabetes is the leading cause of preventable sight loss in the UK.

You can prevent sight loss and we’re here to help. We’ve got more information about the steps you can take to prevent diabetic retinopathy, and we’ve also got advice about managing eye problems you have now, to stop them getting worse. 

What is diabetic retinopathy and what causes it?

Diabetic retinopathy is an eye disease that people living with diabetes are more at risk of developing.

If your blood glucose (sugar) levels and blood pressure are consistently high, you can seriously damage your blood vessels. There are lots of important blood vessels in your eyes, which help supply blood to the seeing part of the eye called the retina.

When these blood vessels are damaged, they can get blocked, leak or grow randomly. This means the retina can’t get the blood it needs and so can’t work properly. This means you won’t be able to see properly.

There are lots of things you can do to keep your blood sugars and your blood pressure in your target range. The more you do this, the lower your risk of developing serious problems with your eyes. 

And if you do begin to develop eye complications, they can nearly always be treated to avoid long term problems - as long as they’re spotted and diagnosed in time. 

Types of diabetic retinopathy

Diabetic retinopathy usually develops in stages. When you get your eye screening results, you should see a letter and a number which tells you the type of retinopathy you may have. For example, an ‘R’ stands for retinopathy and the number tells you how much damage, if any, has been done.

These letters and number may be different depending on where you live in the UK, so speak to your healthcare team if you're not sure. Here are the four types:

Stage one: background retinopathy

This is sometimes called background retinopathy. It means your eye sight isn’t affected yet but you need to prevent the problem getting worse. You might hear this called R1 when you get your eye screening results.

Stage two: non-proliferative retinopathy

The damage is more serious and you’ll need to get your eyes screened more often to check for any changes. You might hear this called R2.

Stage three: proliferative retinopathy

This means you’re now at a very high risk of losing your sight and you’ll be offered treatment. You might hear this called R3.

Diabetic maculopathy

This is a different type of retinopathy that affects the middle of the eye, which may mean that you won’t be able to read or drive. You might hear this called M0 if there's no maculopathy found in your eyes, or M1 if fluid is starting to build-up in your eye and is affecting your sight.

Treating diabetic retinopathy

Background and non-proliferative retinopathy are known as early stage retinopathy and there are lots of things you can do yourself to prevent it from getting worse. 

Proliferative retinopathy and maculopathy are more advanced. We have more information about how to treat advanced eye problems, and your healthcare team will also go through your treatment options with you.

Preventing diabetic retinopathy

It’s very unlikely that someone with diabetes will suddenly wake up blind - the damage is gradual. Because of this, it’s possible for most people to prevent diabetic retinopathy from getting worse. 

You can keep your eyes healthy by taking these steps: 

Get your eyes screened 

Eye screening is a way of spotting eye problems before you notice any changes to your sight. 

Diabetic retinopathy can be quite advanced before it starts affecting your sight, so getting your eyes screened every year is essential. That way, you can get the right treatment in time.

Everyone living with diabetes and who’s over 12 years old is entitled to an NHS diabetes eye screening once a year (also called retinal screening). It’s one of your 15 Healthcare Essentials and a vital diabetes health check. Eye problems are very rare in children younger than 12 years old, so that’s why they don’t automatically get this check.

Because of coronavirus, some eye screening appointments are postponed. It's a good idea to call ahead to see if your appointments are happening. 

What to expect at your eye screening

You’ll usually see a nurse, who will explain what’s going to happen during the eye test.
The nurse will put drops in your eyes to make your pupils larger, so they can see the retina more clearly. This doesn’t hurt, but the drops may sting a bit and make your vision blurry for a few hours.

Then they’ll take a photo of both eyes – the light of the flash will be bright but it won’t hurt.
Your sight may be blurry for a while after the test, so it’s a good idea to bring someone with you to take you home. And take some sunglasses with you to wear afterwards, as everything will seem very bright. 

Your eye screening results

You’ll get a letter telling you the results within six weeks. 

If the results say you have no retinopathy, you can stick to your yearly screening. If your results say you have background changes, you may be asked to come back sooner for another check. 

If your results say you have proliferative retinopathy or maculopathy, you’ll be seen quickly by the eye specialist team and they’ll talk to you about your treatment options. 

If you’re not sure what the results mean or have any questions about what to do now, speak to your local eye screening service. Make a note of the results and get to know what they mean – it’s important you understand any changes and what you can do to prevent them getting worse.

It’s important to know that this type of eye screening isn’t the same as a regular eye test with an optician. You still need to have your regular eye tests, as they check for lots of other eye problems.

Look out for any changes to your eyesight

You might not have any symptoms of retinopathy before it starts to affect your sight. So it's important to go to your eye screening appointments. 

But some people do notice changes to their vision. These won’t be the same for everyone, but here are some of the early signs:

  • seeing floaters – these look like whispy clouds, floating in and out of your vision
  • dimmer vision – like you’re wearing sunglasses all the time
  • struggling to see when it’s dark.

If you notice any changes, or you’re struggling to see as clearly as normal, make an appointment with your doctor straight away. Don’t wait until your next screening. 

Your eyesight can also go a bit blurry if your blood sugar goes higher than usual, even for a short time. This is normal and is a symptom of high blood sugars. Get your sugar levels back to your target level and when they’ve settled, your vision should go back to normal.

Know your blood sugar levels 

Consistently high blood sugar levels make you more at risk of diabetes complications, including serious eye problems. 

Knowing what your target levels are and regularly checking your blood sugars can help you keep on top of them. This means checking your blood sugar levels at home and getting a doctor to check your HbA1c levels regularly too.

Your healthcare team should help you set your targets. The closer you get, the lower your risk of developing eye problems.

If you’re finding it difficult to keep your blood sugar levels to your target range, speak to your healthcare team for advice. Or you can call our helpline for more information and support.

Keep on top of your cholesterol and blood pressure 

High blood pressure and a lot of fat in your blood (called cholesterol) will increase your chances of getting eye problems. This is because your blood vessels can get damaged or blocked, so the blood can’t move around your eye properly.

We have advice and information to help you manage your blood pressure and cholesterol. Your healthcare team will also be able to support you with this.

Eat a healthy diet, get more active and give up smoking 

We know all these things are good for us – but it’s especially important for you as it helps keep your blood sugars in your target range. But why does being healthy make a difference? And can foods prevent diabetic retinopathy? 

No specific foods can prevent retinopathy. But there’s lots of evidence that shows eating certain foods can help with blood sugar levels, blood pressure and cholesterol. And that’s what you need to help reduce your risk of eye complications.

This sounds simple, but it’s not easy for everyone. Start small and build up – we have lots of information and support to help you make these positive lifestyle changes. Being healthy will make a real difference to preventing eye damage in the future.

Other eye problems 

Having diabetes can mean you are two times more likely to get cataracts and one and a half times more likely to get glaucoma. 

Cataracts and glaucoma are other eye problems that people with diabetes are at a higher risk of developing. They aren’t types of retinopathy, but they can both lead to blindness too. 

A cataract is when your vision gets cloudy and glaucoma is when fluid builds up in the eye. As with retinopathy, this can all be down to high blood sugar levels, so checking them and having regular eye screenings is crucial.

If your eye problems become too advanced, you may need surgery. We know this might be worrying, but we’re here to help if you have any questions or are feeling concerned. Give our confidential helpline a call and speak to one of our highly trained advisors.

If you do develop eye problems

If you do start to develop eye problems, your healthcare team can support you and talk to you about your treatment options. You can prevent them from getting worse if they’re spotted early enough.

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