Diabetic Eye Disease
DR is the leading cause of blindness in working-age adults in the UK.
It reflects chronic hyperglycaemia–driven retinal microvascular damage and is often asymptomatic until advanced stages.
The DESP 📸 (Diabetic Eye Screening Programme) offers annual retinal photography to people with diabetes aged ≥12 years for early detection and prevention of sight loss.
🔬 Pathophysiology (Leak → Ischaemia → Neovascularisation)
- Chronic hyperglycaemia → polyol (sorbitol) pathway, oxidative stress.
- Pericyte loss + basement membrane thickening → microaneurysms 🩸.
- Capillary leakage → haemorrhages, hard exudates, DME 🎯.
- Capillary closure → retinal ischaemia → ↑ VEGF 🌱.
- VEGF-driven neovascularisation → fragile vessels, haemorrhage, fibrosis, detachment.
📊 Stages of DR – At a Glance
| Acronym |
Stage |
Key Features |
Investigations |
Management |
| DR 👓 |
Background DR |
- Microaneurysms (earliest sign)
- Dot/blot haemorrhages
- Hard exudates
|
Digital fundus photography; slit-lamp biomicroscopy |
- Optimise HbA1c 📊, BP ⚖️, lipids
- Annual DESP attendance
|
| NPDR 🔬 |
Non-Proliferative DR |
- Cotton wool spots
- Venous beading
- IRMA
|
Fundoscopy ± fluorescein angiography; OCT 🖥️ for macular oedema |
- Systemic control intensification
- Anti-VEGF or focal/grid laser for DME
- Review every 3–6 months
|
| PDR 🚨 |
Proliferative DR |
- Neovascularisation (disc/elsewhere)
- Pre-retinal or vitreous haemorrhage
- Fibrovascular tissue → tractional detachment
|
Fundoscopy, OCT, fluorescein angiography |
- Pan-retinal photocoagulation (PRP 🔦)
- Intravitreal anti-VEGF 🌱
- Vitrectomy if non-clearing haemorrhage
|
| DME 🎯 |
Diabetic Macular Oedema |
- Macular thickening
- Blurred/distorted central vision
|
OCT (gold standard); fluorescein angiography |
- Anti-VEGF first-line
- Steroid injections if refractory
- Focal/grid laser in selected cases
|
| ADV ⚡ |
Advanced Disease |
- Tractional retinal detachment
- Recurrent vitreous haemorrhage
- Neovascular glaucoma
|
OCT, fundus photography, fluorescein angiography |
- Vitrectomy ± anti-VEGF
- Glaucoma management
- Lifelong ophthalmology follow-up
|
🌈 Other Forms of Diabetic Eye Disease
In addition to diabetic retinopathy (DR) and diabetic macular oedema (DME), people with diabetes may develop other ocular complications that can threaten vision.
Diabetic cataract occurs earlier and progresses faster than age-related cataract due to lens protein glycation.
Diabetic glaucoma, particularly neovascular glaucoma, results from retinal ischaemia and VEGF-driven neovascularisation of the anterior chamber angle, causing raised intraocular pressure.
Ocular surface disease and refractive changes can also occur, often related to chronic hyperglycaemia and fluctuations in blood glucose.
Early recognition, regular ophthalmic review, and systemic control of blood glucose, blood pressure, and lipids are essential to prevent progression and preserve vision.
🚨 Red Flags (Urgent Ophthalmology Referral)
- Sudden painless vision loss (vitreous haemorrhage)
- Painful red eye with raised IOP (neovascular glaucoma)
- Rapid progression (pregnancy, type 1 diabetes, very poor control)
📝 Exam & Teaching Pearls
- Earliest lesion: Microaneurysms 🩸
- Main cause of vision loss: DME 🎯
- Most urgent stage: PDR 🚨
- Prevention works: Tight glycaemic, BP, and lipid control reduces progression by >30% (UKPDS)
- DESP 📸: Detects disease early, before symptoms
📚 References
