Diabetes mellitus is a disease where there is too much sugar (glucose) in the blood. It is caused by abnormal metabolism of insulin, a hormone that regulates blood sugar in the body. Unless it is treated, diabetes will damage the eyes, kidneys and other important organs in the body.

Diabetes is a major health problem in Malaysia, affecting more and more people each year. In 2015, the Malaysian Health Ministry estimated that 1 out of 6 persons (17.5%) aged 18 years and above had diabetes. Currently, Malaysia has the highest rates of diabetes and obesity in South East Asia, ranking among the highest in the world.

What is Diabetic Retinopathy?

Diabetic retinopathy is a complication of diabetes that can cause blindness. Diabetes damages blood vessels in the light-sensitive nerve layer inside the eye (retina). When damaged blood vessels leak, they cause the retina to swell. They may also get blocked, causing less oxygen to reach the retina. The longer a person has had diabetes, the more likely it is for diabetic retinopathy to develop.

Diabetic retinopathy usually affects both eyes. It is a common cause of poor eyesight in diabetes. It is also a leading cause of blindness among adults of working age.

Watch how diabetes retinopathy affected Johan's life

Types of Diabetic Retinopathy

There are 3 main ways to describe diabetic retinopathy:

1. Non-proliferative diabetic retinopathy (NPDR)

This is an earlier and less severe stage. Blood vessel damage can be seen as areas of bleeding, leaking and swelling on the retina. Patients usually do not notice any eyesight problems at this time.

Healthy retina

2. Proliferative diabetic retinopathy (PDR)

This is a later and more serious stage where abnormal new blood vessels and scar tissue form inside the eye. These new blood vessels break easily, causing bleeding into the eyeball. As the condition gets worse, patients start to have problems with their eyesight. The retina will become permanently scarred if proliferative retinopathy is not detected and treated quickly.

Bleeding and leaking on the retina

3. Diabetic maculopathy

The macula is the vital part of the retina that is responsible for sharp vision. When diabetic retinopathy affects the macula (diabetic maculopathy), patients will find it difficult to read small print or to recognise faces easily.

Bleeding into eye ball

Signs and Symptoms

At first, there are no symptoms and most patients are unaware that they have retinopathy. Later, they may experience:

  1. Spots or other shadows floating in the vision (floaters)
  2. Blurred or fluctuating vision
  3. Dark areas in the vision
  4. Flashes of light
  5. Loss of vision

How Does Diabetes Lead to Blindness?

Diabetic retinopathy damages vision in the following ways:

  • Abnormal blood vessels bleed into the clear gel inside the eye - vitreous haemorrhage. If the amount of bleeding is small, the patient may see only a few dark spots (floaters) in the vision. Severe bleeding can block vision completely.
  • The blood in the vitreous may clear on its own over weeks or months, with vision returning to the previous level. However, if fresh bleeding occurs repeatedly, the vision will remain poor.
  • Scar tissues form that pull the retina away from the back of the eye - retinal detachment.
  • Abnormal new blood vessels in the front of the eye block the normal outflow of fluid from the eyeball, causing high eye pressure - neovascular glaucoma. The high pressure damages the nerve for vision (optic nerve).

Vitreous Haemorrhage

Retinal Scarring

Diabetic retinopathy, neovascular glaucoma, or both can finally lead to blindness. Although the blind eye is usually painless, patients with neovascular glaucoma frequently experience constant eye irritation or pain.

Can I Avoid Getting Diabetic Retinopathy?

The longer a person has had diabetes, the higher the risk of developing diabetic retinopathy. Although diabetic retinopathy is not completely avoidable, you can reduce your risk of getting it, if you:

Treatment for Diabetic Retinopathy

Patients with early stages of retinopathy do not need treatment but they must be followed up regularly in case treatment becomes necessary.

Treatment is needed when patients have more severe retinopathy and are at risk of losing their sight. Various treatments are available to stop blood vessels from leaking; reverse the growth of abnormal new vessels; and remove blood or scar tissue in the eye.

It is important to know that damage from diabetic retinopathy cannot be completely reversed, and successful treatment only slows or stops it from getting worse. Patients will have some degree of permanently blurry eyesight if they receive treatment late.

If all treatments fail, as can happen in very late stages of diabetic retinopathy, the eye will go blind. Early detection and timely treatment of diabetic retinopathy reduces the risk of blindness by 95 percent.

1. What is a Diabetic Eye Examination?

A diabetic eye examination involves an examination of the retina (the light-sensitive nerve layer inside the eye).
It is not only a test of how well you can see, or a test to see if you need to wear glasses.

There are two kinds of diabetic eye examination:

2. How Can I Get a Diabetic Eye Examination?

If you live in Malaysia, these are the ways you can get a diabetic retinal examination:

You may find other retinal photography services by making local inquiries. If you know of any other services available, please contact us for listing.

3. When Should I Have a Diabetic Eye Examination?*

Most people with type 2 diabetes or non-insulin dependent diabetes mellitus (NIDDM) should have their first eye examination as soon as they are diagnosed, and then once a year.

Children with type 1 diabetes or insulin-dependent diabetes mellitus (IDDM) may have their first eye examination within 2 - 5 years after diagnosis, and then once a year.

Pregnancy can seriously worsen diabetic retinopathy. Women with diabetes are recommended to have their eyes checked and treated for any diabetic retinopathy before, or as soon as possible after, getting pregnant. The check should be repeated every 3 months throughout the pregnancy. This recommendation also applies to women with gestational diabetes in their first trimester of pregnancy. Generally, women who develop gestational diabetes after the first trimester do not need an eye examination.

You will need more frequent eye examinations once diabetic retinopathy has developed.

* Adapted from the Clinical Practice Guidelines for the Screening of Diabetic Retinopathy, Malaysian Ministry of Health, 2011.