Diabetes affects approximately 8% of Singaporeans in 2020. This incidence continues to increase with time due to lifestyle and diet.

People with diabetes (also known as diabetics) are at risk of developing Diabetic Retinopathy, the most common microvascular complication of diabetes.

It is an eye condition that causes damage to the retina, the light-sensing nerve layer at the back of the eye, resulting in vision loss for people with long-standing diabetes.

Diabetic Retinopathy often has no early warning signs and the sight may not be affected until the condition is severe.

As the disease progresses, symptoms may include:

  1. Loss of central vision when reading or driving

  2. Loss of the ability to see colour and

  3. Mild blurring vision

In most cases, laser surgery can prevent significant vision loss associated with the condition. However, many patients with diabetic eye disease may require Medicines to be injected into the eye to control swelling or new vessel growth. Other surgical procedures such as vitrectomy may be required in advanced cases where there is bleeding in the eye, scar tissue formation and retinal detachment. Surgery is usually the last resort to save vision.

It is thus important for diabetics to go for yearly eye checks even if they experience none of the above symptoms. Your doctor can make the diagnosis of Diabetic Retinopathy by examining your eyes and taking a photo of the back of your eye.

In this Q&A forum, Associate Professor Gavin Tan, Senior Consultant with the Surgical Retina Department at Singapore National Eye Centre (SNEC), a member of the SingHealth group, will answer your questions on the causes, symptoms and treatment of Diabetic Retinopathy.

This 'Ask the Specialist' forum has closed. Thank you for your interest and participation.   

1. Posted by B*****
Dr Tan,
Q1 : If a person is diabetic and has eye problem (blur vision), does it automatically mean it is diabetic retinopathy? Will diabetic retinopathy be mistaken for any other retina diseases or vice versa?
Q2 : How can diabetic retinopathy be clinically diagnosed?  Eg. must have blood vessel leak or any other things then can conclude it is diabetic retinopathy? 
Q3 : Can retina detachment for diabetic person lead to diabetic retinopathy? Is there a link? Or Can diabetic retinopathy lead to retina detachment?
Q4 : What is the treatment for diabetic retinopathy?  Or is there any treatment at all ? 
Q5 : Wha is the purpose of taking a photo of the back of the eye to check for diabetic retinopathy? What will doctor expect to see for patient with diabetic retinopathy?

Answered by Prof Tan :
Thank you for your questions B*****.
1) The most common cause for visual impairment in diabetic is still cataract. This was demonstrated by the Singapore epidemiology of eye diseases study. Diabetic retinopathy is often asymptomatic in the early stage which is why regular photographic screening at annual intervals are recommended.
Diabetics who have significant blurring of vision which cannot be corrected with new glasses should get their eyes checked. It is unlikely for diabetic retinopathy to be mistaken for other eye diseases.
2) As mentioned, most retinopathy is asymptomatic, and vision loss from diabetic retinopathy can be secondary to diabetic macular edema, vitreous hemorrhage, macular ischemia, neovascular glaucoma or traction retinal detachment. Symptoms are not specific to the disease, and there are often NO external signs or changes in appearance. Therefore, screening with retina fundus photography or an eye examination is required to detect disease.
3) There are many forms of retinal detachment. The common rhegmatogenous retinal detachment does not affect retinopathy, but can occur in diabetics. However, diabetic retinopathy can lead to tractional retinal detachment in the most severe stage of proliferative diabetic retinopathy. This can be prevented by regular screening, with patients receiving appropriate laser treatment when the retinopathy is severe.
4) The most important treatment in the early stages of diabetic retinopathy is good control of diabetes, blood sugar and blood pressure. That prevents progression to the vision threatening stages of disease. In patients who develop centre involving macular edema with visual impairment, intravitreal injections are the primary treatment; in those with proliferative diabetic retinopathy laser is required; and in the most severe stage of vitreous hemorrhage or tractional retinal detachment, vitreo-retinal surgery can be performed.
5) As diabetic retinopathy can be asymptomatic, the most effective way to detect it is by performing regular screening photography of the retina fundus ("back of the eye"). This allows detection of disease before it reaches the vision threatening stages, as there will be retinal vessels changes and hemorrhages and exudates that are characteristic of diabetic retinopathy.

2. Question posted by D****
Hi Dr, 
I am a diabetic and had also gone for cataract operation on my left eye. Currently I am also being treated for uveitis. I was told that my next check up will be in two years time. My last check up was in Nov this year. I am 71 years of age. Is it too long between checks?

Answered by Prof Tan :

The follow-up for diabetics depends on various factors such as the presence and severity of retinopathy and diabetic control. In general those without retinopathy should be getting annual fundus photography in primary care (polyclinics) and there is no need for regular follow-up with the ophthalmologist. 

However, if photography is not possible, your eye doctor may still decide to review you in the clinic at 1-2 year intervals. Those with more severe retinopathy may need closer follow-up. 

About Associate Professor Gavin Tan

Associate Professor Gavin Tan is a Senior Consultant with the Surgical Retina Department at the Singapore National Eye Centre (SNEC). He is also the Head of the Ocular Diagnostic Department at SNEC and the Academic Vice-Chair of Strategy, Innovation & Organisation Transformation with SingHealth Duke-NUS Ophthalmology & Visual Sciences Academic Clinical Programme (EYE ACP). He began his career in Ophthalmology at SNEC and completed a two-year fellowship in vitreo-retinal diseases and surgery at the centre in 2014. Under the SingHealth scholarship, Associate Professor Tan pursued further overseas training in the field of vitreo-retinal at both the Byer Eye Institute at Stanford University, USA and Jules Stein Eye Institute at the University of California, Los Angeles (UCLA).

Associate Professor Tan is involved in the development and implementation of a national diabetic retinopathy telemedicine screening program in Singapore and is studying the use of novel approaches including optical coherence tomography, automated detection of retinopathy and personalized screening intervals to improve cost effectiveness and efficacy of diabetic retinopathy screening. Besides imaging, he has research studies aimed at identifying novel biomarkers and improving treatment strategies in diabetic retinopathy. He also works in collaboration with the Endocrine and Nephrology groups at examining ophthalmic complications in diabetes and nephropathy trials.

Being passionate about eye research, Associate Professor Tan was awarded multiple grants to study Diabetic Retinopathy. His goal is to eliminate diabetic visual impairment and blindness by developing and evaluating new methods in screening, diagnosis and treatment of diabetic retinopathy with the goal of transforming clinical care and improving patient outcomes.

Ref: J22