12 per cent of people who register as blind in the UK each year have diabetic eye disease. But having diabetes does not necessarily mean you will loose your sight. Keeping your blood sugar level and blood pressure under control is very important.

What Happens?

Diabetic retinopathy is the name given to the changes in the retina, which occur over a period of time in diabetics. The retina is the back part of the eye and is made up of cells, which are sensitive to light.

It is fed by a network of blood vessels and it is changes in these which cause the difficulties with vision. The walls of the blood vessels become fragile and then start to break, leaking blood around them. Sometimes, before the walls actually break, the weakened area can be seen, by the person who examines the eye, to have ballooned out. These are called micro-aneurysms. If these break, the amount of blood which leaks out is fairly small, and the only symptoms may be a few areas of blurring or floating spots in front of the eyes. These may well disappear without treatment.

Later the blood vessels may stop carrying blood permanently, and the cells in the retina will die from lack of nourishment. This kind of loss of sight is gradual but at the present time, it is permanent. When old blood vessels close down, new but abnormal ones will grow to take their place. They are unable to nourish the retina properly, and may grow into the transparent inner part of the eye, and further affect vision.

Why are Regular eye tests are important?

Most sight loss from diabetic retinopathy can be prevented. But it is vital it is diagnosed early. You may not realise you have anything wrong with your eyes but an optician will look into the back of the eye and can detect any changes.

Your eye has a lens and an aperture (opening) at the front, which adjusts to bring objects into focus on the retina at the back of the eye. The retina is made up of a delicate tissue that is sensitive to light. At the centre of the retina is the macula, which is a small area, the size of a pin head. This is the most highly specialised part of the retina and it is vital because it enables you to see fine detail and read small print. The other part of the retina gives you side vision (peripheral vision).

Diabetes can affect the eye in many ways. Usually it involves the fine network of blood vessels in the retina - hence its name, Diabetic Retinopathy.

How can diabetes affect the eye?

Temporary Blurring
Your vision can become blurred whilst your diabetes is being controlled. This is due to the swelling of the lens of the eye. Once your diabetes is stabilised it will clear.

Cataract
This can occur in two forms. Young people with diabetes very occasionally develop a special type of cataract. Although their vision gets worse, it can be restored by surgery. Older people with diabetes can be especially prone to developing cataracts. Cataracts can be successfully removed by surgery and usually it is possible to insert a lens implant. However this is unsuitable for some people and you would be told if this is the case.

Diabetic Retinopathy
The most serious diabetic eye condition involves the retina and is called diabetic retinopathy.

Background Diabetic Retinopathy
This condition is very common in people who have had diabetes for a long time. Your doctor may be able to see abnormalities in your eyes, but there is no threat to your sight. There are two types of diabetic retinopathy, which can damage your sight. Both involve the fine network of blood vessels in the retina. They are described below.

Maculopathy
This happens when the blood vessels in the retina start to leak. If the macula is affected, you will find that your central vision gradually gets worse. You may find it difficult to recognise people's faces in the distance or to see detail such as small print. The amount of central vision that is lost varies from person to person. However the vision which allows you to get around at home and outside (navigation vision) will be preserved. It is very rare for someone with maculopathy to lose all their sight.

Proliferative Diabetic Retinopathy
Sometimes diabetes can cause the blood vessels in the retina to become blocked. If this happens then new blood vessels form in the eye. This is nature's way of trying to repair the damage so that the retina has a new blood supply. Unfortunately these new blood vessels are weak. They are also in the wrong place growing on the surface of the retina and into the vitreous jelly. As a result these blood vessels can bleed very easily and cause scar tissue to form in the eye. The scarring pulls and distorts the retina. When the retina is pulled out of position this is called retinal detachment.

• This condition is rarer than background retinopathy and is more often found in people who have been insulin dependent for many years.
• The new blood vessels will rarely affect your vision, but their consequences, such as bleeding or retinal detachment can cause your vision to get worse suddenly.
• Your eyesight may become blurred and patchy as the bleeding obscures part of your vision.
• Without treatment, total loss of vision can happen in proliferative retinopathy.
• With treatment most sight-threatening diabetic problems can be prevented if caught early enough.

The Importance of Early Treatment

Your vision may be good and you may not be aware of any changes taking place. Most sight loss in diabetes is preventable.

• Early diagnosis is vital
• Have an eye examination every year
• Do not wait until your vision has deteriorated to have an eye test

Remember, however, that if your vision is getting worse, this does not necessarily mean you have diabetic retinopathy. It may simply be a problem that can be corrected by glasses.

What is the treatment?

Laser treatment is used which aims to save the sight you have, not to make it better. The laser is a beam of high intensity light that is focused with extreme precision. Retinal haemorrhages can be sealed by a process called photocoagulation.

How is laser treatment carried out?

All treatment is carried out in an outpatient clinic and you will not have to stay in hospital. Eye drops are used to enlarge the pupils so that the doctor can look into your eye. The eye is then numbed with drops and a small contact lens is put onto your eye to stop it blinking. The eyes need to be moved in certain directions but this can easily be done with the contact lens in place.

Is it painful?

The treatment for sealing blood vessels doesn't usually cause any discomfort. However the treatment to remove new blood vessels can be a bit uncomfortable so you may be given a pain-relieving tablet at the same time as the eye drops. If the treatment does become painful, then it is possible to have an injection around the eye to numb the pain. Don't be afraid to ask for this injection, especially if you have found a previous session of laser treatment distressing.

Does laser treatment have any side effects?

The treatment for sealing blood vessels has few side effects, although you may lose a little central vision or notice the laser burns as small blank spots.

The laser treatment to remove new blood vessels is more complicated and there may be more side effects. It is quite common to lose some vision to the sides (peripheral vision), and this may mean that you will not be able to drive in future. Night and colour vision may also be reduced.

Occasionally your central vision may not be as good as before so that print isn't as easy to see. This is usually temporary but sometimes this doesn't improve.

No treatment is possible without some side effects. But the risks of laser treatment are far less than the risks of not having treatment.

What if my eye becomes painful after treatment, or if my vision gets worse?

The laser is very bright and causes a temporary reduction of sight, which may last an hour or two after the treatment. Most people have a headache after the more lengthy treatment and you can take a headache tablet for this. However if the pain is severe, or if your eyesight gets worse, you should contact your consultant straightaway. Research is continuing into diabetes-related eye conditions, and their treatment is constantly improving.

What if my sight cannot be fully restored?

Much can be done to help you use your remaining vision as fully as possible. You should ask your eye specialist or optometrist about low vision aids. It is also worth registering as partially sighted or blind through your eye specialist. This opens the door to expert help and financial benefits.