Diabetes can affect your eyes in a number of ways. In the short term, high blood glucose levels can cause blurred vision. This is due to temporary changes to the shape of the eye’s lens. When your blood glucose levels are stable again, your vision should return to normal.

Diabetes also increases your risk of more serious eye problems. This includes:

• Diabetic retinopathy. This is one of the most common complications of diabetes. Over time there is damage to the tiny blood vessels of the retina at the back of the eye. This can lead to bleeding, the growth of abnormal new blood vessels and fibrous tissue. Vision loss can occur if left untreated.
• Diabetic macular oedema. When the blood vessels in the macula (the central part of the retina) leak fluid, it can cause swelling. This can make it difficult to read, drive and recognise faces.
• Cataract. Most people will develop cataract as they age. Diabetes can lead to earlier onset and faster progression of cataract.

Almost 1.9 million Australians have diabetes. On average, one in three of these people have some level of diabetic retinopathy.

Regular eye checks are key to detecting the early stages of diabetic retinopathy. But about half of all Australians with diabetes do not get the eye checks they need.

Anyone with type 1 or type 2 diabetes is at risk of developing diabetic eye disease.

Risk is higher:

• the longer you have diabetes
• if blood glucose is above the levels recommended by your doctor for long periods of time
• if you have high blood pressure
• if your cholesterol is high.

Smoking increases your risk of developing a range of eye diseases. It can also make managing your diabetes more difficult.

There are often no symptoms of diabetic eye disease in the early stages.

Symptoms may not appear until the disease is in its advanced stages and vision loss occurs. Treatment of advanced stages of the disease is often more difficult.

Regular checks and early treatment are the keys to maintaining the best vision.

Some of the late-stage symptoms of diabetic retinopathy and diabetic macular oedema include:

• Blurred, distorted or patchy vision that isn’t corrected with prescription glasses. You may notice it’s more difficult to read, watch TV or recognise faces.
• Glare sensitivity
• The sudden onset of a smudge in the vision of one eye or an increase in objects that appear to float across vision (floaters). These may have a red or brown tinge.

If you have diabetes, it’s important to get your eyes checked at least every two years – even if you have no symptoms. You will need to have checks more often if your eye healthcare provider has found signs of diabetic eye disease.

If you notice any changes in your vision, visit your eye healthcare provider as soon as possible.

An eye healthcare provider (optometrist or ophthalmologist) can diagnose diabetic eye disease. They will take a photo of the back of your eye to check the blood vessels and may give you eye drops to enlarge your pupils. This is often accompanied by a quick check at a special microscope (slit-lamp). The eye check typically takes less than 30 minutes.

If you have diabetes, it’s important to let your eye healthcare provider know. Routine eye checks for people without diabetes may not be adequate for you.

Your GP or diabetes specialist can help you to manage your diabetes, blood pressure and cholesterol levels.

Diabetic retinopathy is commonly treated with retinal laser treatment by an ophthalmologist. This can reduce the risk of diabetic retinopathy getting worse and can limit further vision loss. If you have advanced diabetic retinopathy, you may require surgery.

Eye injections are now the main treatment for macular oedema – they can often improve vision. Repeated treatments are usually needed for best outcomes.

Most vision loss from diabetic eye disease can be prevented, as long as it’s caught early enough.

If you have diabetes, it’s vital to have your eyes checked at least every two years. Sign up at keepsight.org.au to receive free reminders when you’re due for your next eye check.

More frequent eye checks are recommended for:

• Indigenous Australians
• people who have had diabetes for many years
• women who are pregnant or planning a pregnancy
• people who have complications from diabetes, like foot ulcers or kidney problems (nephropathy).

Your eye healthcare provider will recommend a check-up schedule that’s best for you.

Keeping your blood sugar, blood pressure and cholesterol under control will also reduce the risk of diabetic eye disease.

CERA researchers are devoted to investigating how to better understand, detect and manage diabetic eye disease.

A few key projects include:

• Ways to more conveniently check for signs of diabetic eye disease, using artificial intelligence tools.
• Increasing participation in screening to detect diabetic eye disease through initiatives like KeepSight.
• Measuring the impact of diabetic eye disease in Australia.
• Understanding why some people are at higher risk of diabetic eye disease than others.
• Improving methods to detect people at higher risk of progressing to advanced disease.
• Ways to better manage diabetic eye disease when there is higher risk of progression, such as during pregnancy or cataract surgery.
• How to predict response to treatment for people with advanced disease.
• Testing potential new treatments for diabetic retinopathy and diabetic macular oedema.

Diabetic eye disease research spans many different research teams at CERA. Some of the Principal Investigators involved in these programs include Professor Mingguang He, Associate Professor Lyndell Lim, Associate Professor Peter van Wijngaarden, Associate Professor Wilson Heriot and Dr Stuart Keel.

CERA collaborates with the St Vincent’s Institute, St Vincent’s Hospital Melbourne, the Baker Institute and other leading research groups. Diabetes Australia Victoria has been a member of CERA since 2012. Associate Professor Peter van Wijngaarden is also a founding steering committee member of KeepSight.