Retinopathy 

Retinopathy starts in the background. Tiny bulges develop in the capillaries that supply the back of the eye, which may leak slightly but do not usually affect the vision. If diabetes control is not improved, the pre-proliferative stage follows and the blood vessels become more damaged, causing more bleeding into the eye. 

Finally, the proliferative stage sees the formation on the retina of scar tissue and new blood vessels, which bleed easily and impair eyesight. At this stage there can also be retinal detachment and/or maculopathy (leakage or blockage of the blood vessels in the central part of the retina). Treatment options include laser therapy, anti-VEGF (vascular endothelial growth factor) injections, steroid implants and vitreoretinal surgery.

Staying healthy and keeping diabetes under control can help reduce the risk of developing retinopathy, but within 20 years of diagnosis, two-thirds of type 2 diabetics and almost all type 1 diabetics will have some degree of the condition. Regular screening is essential, as is being alert to symptoms such as eye pain, redness, floaters, worsening eyesight or vision loss. 

People with diabetes are also at increased risk of developing other eyesight problems such as cataracts and glaucoma, which can lead to impaired vision.

Diabetic eye screening is offered at diagnosis and also:

• Every two years for people at low risk of sight loss (no identified diabetic retinopathy on two successive screening tests)
• At least annually for all other people with diabetes.

Eye screening uptake is generally high but lower among young people. Target uptake overall is 85 per cent. Eye screening is offered from the age of 12 years. However, when in their late teens, young people tend to be less likely to attend, so screening rates are lower. 

The current annual screening interval for people with a high risk of sight loss will continue but work is underway to change from one year to two-year screening intervals for people classed at low risk of developing sight threatening retinopathy. 

As already mentioned, patients are considered as low risk if they have no identified diabetic retinopathy on two successive screening tests. This change is being made after a large observational study showed that it was safe to invite people in this low risk group for screening every two years rather than each year.