Managing eye problems when you have diabetes

You can prevent your eye disease getting worse – but you need to act now. 

Diabetic eye screening is so important because you may not realise you have a problem with your eyes, and if a problem with your eyes is picked up early, taking the right steps can stop it getting worse.

Whatever the result, whatever the result, managing your diabetes is really important. In the early stages of diabetic retinopathy, controlling your diabetes can help prevent eye problems developing. In the more advanced stages, when your vision is affected or at risk, keeping your diabetes well managed can help stop the condition getting worse. Your healthcare team will talk to you about the different treatment options. 

Managing background (stage 1) and pre-proliferative retinopathy (stage 2)

You may have been told you have background or pre-proliferative retinopathy. Pre-proliferative retinopathy means that more severe and widespread changes are seen in your retina, including bleed into the retina. The retina is a light-sensitive layer of tissue at the back of the eye and is important for vision. It converts light into electrical signals, which are sent to the brain which turns them into the images you see.

All the same advice on preventing retinopathy applies here - whether you have signs of eye problems or not, managing your diabetes is critical to reduce the chances of the problem progressing. 

• Keep blood sugar, cholesterol and blood pressure at your target levels - your healthcare team may give you blood pressure tablets even if you don’t have high blood pressure.
• Get your eyes screened as advised - to check for any changes in your eyes. This maybe every three to six months if you have pre-proliferative retinopathy to monitor your eyes.
• Take your diabetes medication - to manage your blood sugar levels.
• Keep to a healthy weight by eating well and moving more.
• Stop smoking - smoking increases your blood pressure and your blood sugar levels, making it harder for you to manage your diabetes.

All these things can reduce your risk of more damage and so prevent or delay your eyes from getting worse. And it’s not just about eye problems, the more you do these things, the lower your risk of developing serious problems with your feet, heart and kidneys too.

And you can get support with all of this, you’re not alone. We’ve made a checklist of the essential checks and services you’re entitled to when you have diabetes. These are your 15 Healthcare Essentials and they’re all free.

Diabetic retinopathy usually only requires specific treatment when it’s threatening or affecting your vision.

What is diabetic maculopathy?

Diabetic maculopathy is a type of diabetic retinopathy, also known as diabetic macular oedema (DMO). In diabetic maculopathy the blood vessels in the part of the eye called the macula (the central part of your retina at the back of your eye which is responsible for seeing fine details and central vision) can become blocked. 

Blood vessels that enlarge to compensate for blocked blood vessels become leaky and this leaked fluid builds up in the macular causing swelling. At first, you may not notice changes to your vision. Over time patients develop poor central vision and are unable to read or drive, but the vision to the side usually remains normal. If this is detected there is a high risk your vision could be affected, and you may be advised to have more frequent testing. 

How is diabetic maculopathy treated?

In the early stages of diabetic maculopathy, no treatment is required. If advanced, laser therapy or eye injections may be carried out. However, it may be at a stage and you may be referred to a hospital specialist to discuss treatments that can help stop the problem getting worse.

How is proliferative retinopathy (stage 3) treated?

Laser and surgery can be used to treat advanced diabetic retinopathy that is threatening or affecting your sight.

Your diabetes healthcare team or ophthalmologist (eye specialist) will discuss with you about the most appropriate treatment for you. You can find out more about these treatments by clicking on the links below:

• laser treatment
• eye injections 
• eye surgery 

Like any medical procedure, there are potential risks and these should be discussed with you before you consent to treatment. However, it is important to remember these treatments can help your sight.

Laser treatment

Laser treatment is used to treat the growth of new blood vessels at the back of the eyes (retina) in the advanced stages of diabetic retinopathy (proliferative retinopathy) and to stabilise some cases of maculopathy. Treatment can help stabilise the changes in your eyes caused by your diabetes and stop your vision getting any worse, although it won't usually improve your sight.

Several sessions may be required. The full effects of laser therapy only occur after several months. This is why you may be asked to return to clinic three or four months after laser therapy. 

What to expect when you have laser treatment

• The treatment will take place as an outpatient. 
• They’ll give you eye drops to widen your pupils.
• A special contact lens is then put on your eye to hold your eyelids open.
• It isn’t usually painful but you may feel a sharp sensation when certain areas are treated. 
• The treatment will take around 30 minutes.

Side effects of laser treatment

You may experience temporary worsening of vision on the day of laser therapy, which will usually go by the next day. This is caused by the bright flashing lights from the laser treatment.

Take sunglasses to wear afterwards as everything will look very bright. 

And you won’t be able to drive or get home on your own, so you’ll need someone to help you. The full effects of laser therapy only occur after several months. This is why you may be asked to return to clinic three or four months after laser therapy.

Possible complications of laser treatment

You should be told about the risks of treatment in advance. Potential complications include:

Usually, laser burns are applied over several sessions. Very rarely, you may develop blind spots in your vision or significant loss of central vision which may be permanent. This is less common with the development of more advanced lasers. 

Laser treatment helps to stop your vision from getting worse – it does not usually improve vision. 

Eye injections

If you have diabetic maculopathy, in some cases, injections of a medicine called anti-VEGF may be given into your eye. The main medicines used are called ranibizumab (Lucentis) and aflibercept (Eylea). These can help stop the problems in your eyes getting worse, and may also lead to an improvement in your vision.

What to expect when you have eye injections

• You’ll have the injections as an outpatient
• Drops are applied to numb your eye and minimise discomfort.
• The skin around your eyes will be cleaned and covered with a sheet
• A small clip will be used to keep the eye open
• A very fine needle is carefully guided into your eyeball and the injection is given by a ophthalmologist or nurse practitioner.
• Lubricating drops will be given after this injection.
• Minimal discomfort is to be expected (equivalent to having blood taken from your arm). The procedure takes five to seven minutes, but the injection itself is over in less than 20 seconds.

What to do after eye injections

You should ask someone to help you get home because your vision will be blurry for a little while. This should get better after a few hours.

The injections are usually given once a month to begin with. Once your vision starts to stabilise, they'll be stopped or given less frequently.

But you’ll still have follow-up appointments.

Possible side effects of eye injections

As with any medical procedure, there is a small risk of complications following anti- VEGF treatment. For most patients, the benefit of the treatment outweighs the small risk of injection injury. You should be told about the risks of treatment before you consent to treatment. Your ophthalmologist will advise if the treatment is appropriate for you and which anti-VEGF medicine will be used.

Steroids

Injections of steroid medication, may sometimes be given instead of anti-VEGF injections, or if the anti-VEGF injections don't help. 

An implant, containing the steroid, is injected into the back of your eye using a special applicator. The implant releases tiny amounts of the steroid over time. 

Eye surgery

If you have very advanced proliferative diabetic retinopathy, you may require surgery.

This surgery, known as vitroretinal surgery, refers to any operation to treat eye problems involving the retina, macula and vitreous fluid. These include complications related to diabetic retinopathy. Vitreoretinal surgery is usually carried out under local anaesthetic and sedation. This means you will not experience any pain or have any awareness of the surgery being performed.

It’s important to talk to your healthcare team if you’re worried about any of these treatments or side effects. They’ll be able to talk you through it and answer your questions.

Coping with losing your sight

Diabetes is the leading cause of preventable sight loss in the UK. You can prevent it by going to regular eye screening, and because there are much better treatments available for both diabetes and retinopathy.

But sight loss does happen and this is extremely difficult for anyone to deal with. This is life-changing.

Many people do find a way to cope, and carry on to live happy, rewarding lives. Know that we’re here to help you and there is expert support out there to help you through it – you’re not alone.

You can talk to the RNIB (the Royal National Institute of Blind People). They are one of the UK’s leading sight loss charities and the largest community of blind and partially sighted people. They provide a fantastic amount of practical and emotional support, including Facebook groups specifically set up to your needs. 

Some people who develop sight loss may also experience sight hallucinations, where you see things that aren’t necessarily there. This is called Charles Bonnet Syndrome (CBS).  It can occur in people with over 60% sight loss. Seeing things that aren’t there, can be very frightening. For more information on CBS visit Esme's Umbrella.  

And remember, you can give our trained counsellors a call, for more information and support, or just to chat. We’re here for you.