In this ‘Ask the Specialist’ Q&A forum, Dr Andrew Tsai, Senior Consultant from the Surgical Retina Department at Singapore National Eye Centre (SNEC), a member of the SingHealth group, answers your questions about diabetic retinopathy.

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Diabetic retinopathy is an eye condition that causes retina damage and vision loss in people who have long standing diabetes. 

It occurs when diabetes damages the small blood vessels in the retina, the light-sensing nerve layer at the back of the eye.

In 2022, approximately 7% of Singaporeans are affected by diabetes. And according to Diabetes Singapore, diabetic retinopathy is the most common cause of blindness in adults aged 20 to 60.

Early onset diabetic retinopathy often has no warning signs where sight may not be affected until it becomes severe.

Symptoms may include:

  • Loss of central vision when reading or driving

  • Loss of the ability to see colour and

  • Mild blurring vision

In most cases treatment will consist of laser surgery as it can prevent significant vision loss associated with diabetic retinopathy. While in other cases, medicines may 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 the last resort to save the eye.

However, while diabetic retinopathy cannot be completely prevented, vision loss can be prevented with early detection. People with diabetes (diabetics) should get their eyes checked yearly even if they experience none of the symptoms. Your doctor can make the diagnosis of diabetic retinopathy by examining your eyes and taking a photo of the back of your eye.

Worried if you're at risk of diabetic retinopathy or what can be done to prevent or treat it? Don't hesitate, ask our specialist now!

About Dr Andrew Tsai

Dr Andrew Tsai is a Senior Consultant in the Surgical Retina Department at the Singapore National Eye Centre and Clinical Assistant Professor with the SingHealth Duke-NUS Ophthalmology & Visual Sciences Academic Clinical Programme. 

Dr Tsai graduated from the Yong Loo Lin School of Medicine, National University of Singapore (NUS) with a Bachelor of Medicine and Bachelor or Surgery (MBBS) degree in 2008. He completed his Master of Medicine in Ophthalmology in 2014 and became Fellow of the Royal College of Ophthalmologists in 2015. 

He gained accreditation as a specialist in Ophthalmology in 2016 and became a Fellow of the Academy of Medicine, Singapore in the same year. He subsequently completed advanced subspecialty training in Medical and Surgical Retina in 2019. He received further training in adult and pediatric retinal diseases from Illinois Eye and Ear Infirmary, University of Illinois at Chicago and Chang Gung Memorial Hospital, Taoyuan, Taiwan where he was mentored by Prof RV Paul Chan and Prof Wei-Chi Wu respectively.

Dr Tsai believes in an evidence-based and patient-centric approach to clinical care. His current clinical practice includes adult and pediatric vitreoretinal surgery, medical retina, general cataract and comprehensive ophthalmology.

Questions and answers on diabetic retinopathy

1. Question by Menon

Hi Dr Tsai,

Thank you for this opportunity.

I wish to discuss a medical concern for my eyes.

I had angina in 1992 and was prescribed medication from SGH. Ten years later, I had another attack and had three stents inserted.

Around the same time, I was diagnosed with type 2 diabetes, which I believe was caused by the heart medicines. Since then, I have encountered three episodes of diabetes-related retina nerve issues. On two occasions, one of my eyelids shut, and on another occasion, one eyeball was not in sync. I have managed to control my diabetes relatively well.

Two years ago, I had my endoscopy and since then is struggling with IBS-D. I had to switch to a low FODMAP diet, which complicates managing my diabetes.

I'm concerned about the impact IBS-D management has on my eyes. I am now getting my eye checks at the polyclinic.

Should I be given a deeper re-assessment of my eyes? I have other medical conditions too - sleep apnea and enlarged prostrate - that also add to the challenges I now face.

Thank you so much for taking the time to go through my lead to the question on Diabetic Retinopathy concerns.

Answer by Dr Andrew Tsai

Thank you for your question. In general IBS-D does not affect the eye. The eye checks at the polyclinic will usually entail taking photos of the retina. If there are any retina issues on the photos the polyclinic will refer you to an eye specialist. 

However, if you have any other eye symptoms such as reduced vision or double vision, please highlight this to your polyclinic doctor who can then make a decision of whether to refer you to an eye specialist for further evaluation.

2. Question by Kamani

Dear Doctor Andrew,

Wanted to ask you if diabetic retinopathy is the same as what I term as CRV (Occlusion)?

My mom’s coming to 88 and has had diabetes for nearly over 55 years of her life. She is followed up by SNEC.

Is it a rise in blood sugar levels high (about like 14+++ to 20) causing this or low sugar levels (like below 3.5 levels causing this)?  

My mom is now using Libre Free to monitor for last 1 month now (I don’t know why her Geriatric Doctor was not for it) but when I asked the Family Physician at Polyclinic he was very instrumental and said Go for it!

Thank you for your time and advice.

Answer by Dr Andrew Tsai

Diabetic retinopathy is not the same condition as central retinal vein occlusion. However, having diabetes puts one at risk of central retinal vein occlusion. 

Keep blood sugar levels at normal levels will help to keep the diabetic retinopathy in check, and reduce the risk of central retinal vein occlusion.

3. Question by Siew Poh

Dear Dr,

Is it true that if diabetes is well-controlled with HbA1C at around 6-6.5, the risk of DM retinopathy is minimum and there is thus no need for DM eye screening even if the disease has been long-standing in a patient?

Thank you for your advice.

Answer by Dr Andrew Tsai

Good control of diabetes is very important to prevent eye complications. However, we do see patients with diabetic retinopathy even with good levels of HbA1C. Therefore, all patients with diabetes should receive eye checks at the polyclinic. If there is an issue the polyclinic will then refer the patient to an eye specialist for further evaluation.

Ref: I23