Diabetic retinopathy causes no pain, no redness and no blurring until it is advanced — and by the time vision changes, some of the damage is permanent. The examination itself is done by an ophthalmologist. What happens here is the part that most often goes missing: working out when you are due, referring with the context that makes the report useful, and acting on what comes back.
How long the diabetes has been running, when the last retinal check was, and how control has been in between. Duration and control are the two strongest predictors of what a screen will find, and they set the interval.
To an ophthalmologist for the dilated examination — with the diabetes history, the current control and the reason for the timing attached. A referral without that context comes back as one line; with it, it comes back as an answer.
The grading is interpreted against your diabetes rather than on its own: what stage, whether the macula is involved, and what it says about how fast things are moving.
A date for the next check set by what was found, and glucose, blood pressure and lipid targets adjusted on the back of it. Those are the levers that slow progression, and they are managed here.
Set by what was last found rather than by default, so mild disease is watched more closely than none.
For the dilated examination, and for laser or injection treatment when the grading calls for it.
A grade on a form means little on its own. What matters is the stage set beside your HbA1c, your blood pressure and how long you have had this.
Glucose, blood pressure, lipids and kidney function — the levers that actually change the trajectory.
Screening is missed far more often than it is abnormal. It is asked about at follow-up rather than assumed to have happened.
Five stages, and vision is usually normal through the first three. That is the entire argument for screening before anything feels wrong.
The retina looks normal. This is the goal, and holding it is about glucose and blood pressure control rather than anything done to the eye. An annual check continues, because the whole point is to catch the first change while it is still the first change.
Microaneurysms appear: tiny bulges where capillary walls have weakened. Nothing is leaking enough to matter yet and vision is unaffected. This is a warning rather than a problem, and at this point good control can hold it here or even reverse it.
More microaneurysms, small haemorrhages, and hard exudates where fluid and fat have leaked into the retina. Some capillaries have closed off entirely. Vision is usually still normal, which is precisely why people at this stage are so often surprised by the finding.
Widespread haemorrhages and substantial capillary closure, leaving parts of the retina starved of blood. Those areas start releasing the signals that drive new vessel growth, so this is the stage immediately before things become dangerous. Ophthalmology involvement is needed here, not later.
New blood vessels grow, and they are fragile and grow in the wrong places. They bleed into the vitreous and they form scar tissue that can pull the retina off. This is the stage that causes sudden severe vision loss, and it is treatable — laser and injections work — but sight already lost usually does not come back.
Macular oedema — swelling at the centre of the retina — can occur at any of these stages and is the commonest cause of vision loss in diabetes. It is looked for separately rather than assumed from the stage.
Because retinopathy is silent for years. The retina can carry substantial damage while central vision remains perfect, and the point of screening is to find it during that window — when controlling glucose and blood pressure still changes the outcome, and when treatment prevents loss rather than trying to recover it.
Annually for most people with diabetes and no retinopathy. More often if changes are already present, if control has been poor, or during pregnancy, when retinopathy can progress unusually quickly. Type 1 diabetes is usually screened from five years after diagnosis; type 2 from diagnosis, because it has often been present undetected for years already.
No. The dilated fundus examination is done by an ophthalmologist, which is the right person to do it. What happens here is the part that decides whether it happens at all: working out when you are due, referring with the context that makes the report worth having, reading the grading against your diabetes, and changing the plan on the back of it. The bloods, ECG, 2D Echo, TMT and the foot check are done at the clinic.
Yes, for several hours, so plan the eye appointment around it. Drops widen the pupil so the whole retina can be seen rather than just the middle of it. They take about twenty minutes to work, blur near vision afterwards and leave the eyes light-sensitive — bring sunglasses and arrange for someone else to drive you home.
Early changes can stabilise and sometimes regress with good glucose and blood pressure control. Advanced changes — scarring, new vessel growth, established macular damage — can be treated to prevent further loss, but sight already lost usually does not return. That asymmetry is the entire argument for screening.
No. A refraction test measures whether you need glasses. Retinal screening is an examination of the retina itself for the specific changes diabetes causes, and it needs the pupil dilated. You may well need both, and one does not substitute for the other.
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Not an emergency service. For a medical emergency, go to the nearest hospital.
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