LIFESTYLE NEWS - Diabetes is not only a serious threat to general health, but can also quietly damage eyesight, potentially leading to permanent vision loss and blindness.

South Africa has more than 2.3 million working-age adults living with diabetes, approximately one in every 16 people in this age group. The condition is also a leading cause of natural deaths in the country.

The Ophthalmological Society of South Africa (Ossa) is using World Diabetes Day on 14 November to highlight a lesser-known complication of the disease: diabetic retinopathy, which can cause serious damage to eyesight before a person notices any symptoms.

The condition develops when high blood sugar levels damage the tiny blood vessels supplying the retina, the light-sensitive layer at the back of the eye.

Research indicates that approximately one in three people with diabetes already shows signs of retinopathy, placing them at increased risk of vision loss and potentially other serious health complications.

However, much of the resulting vision loss can be prevented through early detection, regular retinal examinations and timely treatment.

Why early eye examinations are essential

Ossa executive committee member Dr Johann Lamprecht describes diabetes as a “silent thief of eyesight”, because diabetic eye disease can initially develop without pain or noticeable changes in vision.

People may continue seeing clearly even while damage to the retina is progressing.

“In diabetic retinopathy, time is sight. We encourage people with diabetes to start having retinal examinations as soon as they are diagnosed and while they can still see well, as diabetic eye disease can silently damage vision before symptoms appear. The damage is often permanent or only partly reversible. By the time vision is affected, it may be too late to save it,” he says.

Lamprecht says research has shown that blindness caused by diabetes can often be prevented through early diagnosis, appropriate treatment and effective management of the condition.

Managing blood sugar and blood pressure, following prescribed treatment and adopting healthier lifestyle habits can also reduce the risk of developing diabetic eye disease or slow its progression. Early detection is also more cost-effective than treating advanced complications, which can require expensive interventions and result in significant disability.

The impact goes beyond eyesight

Losing one’s sight affects far more than the ability to see. It can undermine independence, limit employment opportunities and increase reliance on family members and caregivers.

Lamprecht says people who have lost their vision often identify independence as what they miss most. This includes being able to read books and labels, recognise familiar faces, shop independently, move around safely and continue earning a living. “Protecting sight protects jobs, families and dignity,” he says.

Vision impairment can range from blurred vision and difficulty reading to complete blindness. It can affect quality of life, employment prospects and financial circumstances, while also increasing the risk of depression and anxiety, particularly among older people.

At a national level, preventable vision loss among working-age adults also affects economic productivity and increases the burden on the healthcare system.

Lamprecht notes that diabetic retinopathy could contribute significantly to the estimated US$4.5b (approx. R76.5b) annual cost of diabetes care in South Africa.

Who needs retinal screening?

Diabetic eye disease can affect people of all ages living with either type 1 or type 2 diabetes.

Ossa recommends that:

• people with type 2 diabetes have a retinal examination when diagnosed, as damage may already be present, followed by regular examinations as advised by their healthcare professional.
• people with type 1 diabetes follow an appropriate screening schedule. Children should generally begin retinal screening from the age of 11, once they have had diabetes for two to five years.
• women with diabetes who are planning a pregnancy or are pregnant should follow a specific retinal screening schedule, as pregnancy can affect the progression of diabetic retinopathy.

Lamprecht encourages patients to ask their healthcare professionals for their retinal examination grade, which indicates the severity of any diabetic eye disease detected.

“Your retina score is the grade your diabetic eye examination gives. Ask for it, write it down, and track it alongside your blood sugar and blood pressure,” he advises.

The role of healthcare professionals

Ossa is calling for retinal screening to become a routine part of diabetes care across South Africa.

General practitioners and nurses are encouraged to refer patients for retinal examinations when they are diagnosed with diabetes and ensure that follow-up screenings take place.

Optometrists also have an important role to play, as they may be the first healthcare professionals to identify signs of previously undiagnosed diabetes.

They are encouraged to examine the retinas of patients with diabetes, remain alert to retinal haemorrhages or unexplained changes in spectacle prescriptions, and refer patients to ophthalmologists when necessary.

The society also supports expanding access to screening through artificial intelligence (AI) -assisted retinal photography, particularly in areas where specialist services are limited.

Lamprecht stresses that AI does not replace eye-care professionals but can help general practitioners, nurses and optometrists screen more patients quickly and identify those who need further assessment and treatment.

Recognising the warning signs

Diabetic retinopathy may not cause symptoms during its early stages. As the condition progresses, however, possible warning signs include:

• spots or dark, cobweb-like strings floating across the field of vision
• dark or empty areas in the field of vision
• blurred vision
• noticeable changes or deterioration in eyesight.

People living with diabetes should not wait for these symptoms before arranging an eye examination.

Lifestyle choices can help protect your sight

Managing diabetes effectively is essential at every stage of diabetic retinopathy.

Lamprecht says lifestyle changes, together with good control of blood sugar and blood pressure, can reduce the risk of developing the condition and help slow its progression. In some cases, the disease may even regress.

He recommends several everyday habits to help reduce the risk of type 2 diabetes and support better overall health:

1. Keep moving

Aim for at least 30 minutes of physical activity daily. Activities such as brisk walking, cardiovascular exercise and resistance training can help improve overall health and blood sugar management.

2. Choose nutritious foods

Reduce sugary drinks, refined carbohydrates and highly processed foods. Include more vegetables, legumes, wholegrains, healthy oils and protein in your diet.

3. Prioritise sleep

Regularly getting too little or too much sleep has been associated with an increased risk of type 2 diabetes. Adults should aim for approximately seven to eight hours of sleep a night.

4. Address chronic inflammation

Factors such as excess abdominal fat, inactivity, smoking and poor sleep can contribute to chronic inflammation and increase the risk of diabetes and damage to the body’s small blood vessels.

Adopting healthier habits and stopping smoking can help reduce these risks

People already living with diabetes should continue taking prescribed medication, attend regular medical appointments and arrange retinal examinations even when their eyesight appears normal.

Treatment can prevent further damage

Treatment for diabetic retinopathy depends on how advanced the condition is. Options may include medication injected into the eye to reduce abnormal blood vessel growth or swelling, laser treatment to limit retinal damage, and surgery in more advanced cases.

Managing blood sugar and blood pressure remains important throughout treatment

Lamprecht also cautions that rapid improvements in blood sugar control, including those associated with some GLP-1 medications, can temporarily worsen existing diabetic retinopathy in certain patients. 

People starting or changing treatment should therefore discuss appropriate eye monitoring with their healthcare professionals.

Everyone has a role in preventing avoidable blindness

Ossa says preventing diabetes-related vision loss requires a coordinated effort involving patients, families, healthcare professionals and decision-makers.

Families and caregivers can encourage loved ones with diabetes to attend regular eye examinations, while healthcare professionals should make retinal screening part of routine diabetes management.

The society is also calling for improved access to screening services, particularly in underserved communities.

Its message ahead of World Diabetes Day is simple: early detection can make the difference between preserving eyesight and living with preventable vision loss.

Check. Know. Act.

People living with diabetes who have never had a retinal examination, or who notice changes in their eyesight, should contact a healthcare professional promptly.

For more information about eye conditions or to locate an ophthalmologist, visit the Ophthalmological Society of South Africa’s website.

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