For millions of Indians living with diabetes, the greatest threat to their eyesight often arrives quietly. There is no pain. No sudden warning. No obvious change in vision. Yet, tiny blood vessels inside the eye may already be getting damaged. By the time blurred vision appears, permanent harm may already have taken place.Doctors say this is exactly why diabetic retinopathy deserves far more attention than it currently receives. It is one of the leading causes of blindness among working-age adults across the world, but unlike many eye diseases, much of the vision loss it causes can be prevented. The key lies in keeping diabetes under control, getting regular retinal screening, and seeking treatment before symptoms begin.The Indian Council of Medical Research (ICMR) has repeatedly highlighted the growing burden of diabetes in India, making regular screening for diabetes-related complications increasingly important. ICMR’s INDIAB Study estimates that over 101 million Indians are living with diabetes, making India one of the countries with the largest diabetes burden globally.
Why diabetes slowly damages the eyes, even when everything seems normal
Diabetic retinopathy begins in one of the most delicate parts of the body, the retina. This thin layer of tissue at the back of the eye converts light into signals that allow people to see.When blood sugar remains high for months or years, the tiny blood vessels supplying the retina become weak. Some start leaking fluid or blood. Others become blocked, cutting off oxygen supply. In response, the eye may grow fragile new blood vessels that bleed easily and further damage vision.The dangerous part is that this damage usually happens silently.Many people assume that if they can read a newspaper or drive comfortably, their eyes must be healthy. Unfortunately, diabetic retinopathy does not work that way. Vision may remain perfectly normal during the early stages while damage quietly progresses inside the eye.This is why eye specialists often describe diabetic retinopathy as a “silent thief of sight.”
The biggest mistake? Waiting until vision becomes blurry
Experts say one of the biggest reasons people lose vision is because they seek medical attention only after symptoms appear.Dr Vishali Gupta, President of the Vitreo Retina Society India and Head of Retina at PGIMER, Chandigarh, explained why awareness remains the missing link.“Diabetic retinopathy exemplifies why chronic disease management can no longer function in isolated medical silos. In India, where over 21 million people are at risk, blindness from diabetes is a shared responsibility of our entire healthcare ecosystem, not just eye specialists.”She stressed that lack of awareness continues to delay diagnosis.“A lack of awareness around diabetic retinopathy is one of the biggest barriers to preventing blindness. Because early-stage retinopathy develops without symptoms, waiting until vision drops means intervention is already too late.”According to Dr Gupta, preventing blindness starts much earlier than most people realise.“Preventing blindness begins long before a patient sees an ophthalmologist, it starts with strict diabetes control, routine screening, and standardized referral pathways.”She added that every physician caring for people with diabetes should actively remind patients about annual retinal examinations.“India continues to carry one of the world’s highest burdens of blindness, much of which remains preventable through early detection and timely treatment. Integrating retinal screening directly into primary care and diabetes clinics is no longer optional; strengthening these care pathways must become an urgent national public health priority.”The message is simple. Do not wait for blurry vision to book an eye appointment. The best time to detect diabetic retinopathy is before it begins affecting eyesight.
Saving eyesight starts with controlling diabetes, not just visiting an eye doctor
Many people think eye diseases are treated only inside an eye hospital. Diabetic retinopathy is different. Every healthy choice made throughout the day plays a role in protecting the eyes.Keeping blood sugar within the target range remains the strongest defence. But diabetes rarely affects just one organ. High blood pressure, unhealthy cholesterol levels, obesity, smoking and kidney disease can all increase the risk of diabetic eye damage.That means protecting eyesight often begins with habits that may seem unrelated to vision, taking medicines regularly, staying physically active, eating a balanced diet, avoiding tobacco, getting enough sleep and attending follow-up appointments.Doctors also recommend that every person with diabetes undergo a comprehensive dilated retinal examination at least once a year, or more frequently if advised by an ophthalmologist. Pregnancy, long-standing diabetes or previously diagnosed retinopathy may require closer monitoring.
Why annual retinal screening could become as routine as checking blood sugar
Experts believe retinal screening should become a routine part of diabetes care rather than a specialised service people seek only after developing symptoms.Dr R Kim, Chief Medical Officer at Aravind Eye Hospital, Madurai, said India must now look beyond cataracts while addressing blindness, “India continues to bear one of the world’s highest burdens of blindness. While cataract has long been the primary focus, diabetic retinopathy is rapidly emerging as a leading cause of preventable vision loss, and addressing it is as much a health system challenge as an eye care priority.“He believes preventing blindness requires coordinated care instead of isolated treatment.“With diabetes on the rise, preventing vision loss requires more than specialist care. It calls for better diabetes control, routine retinal screening, timely referrals, and greater public awareness.”Dr Kim added that diabetic retinopathy deserves greater attention within India’s broader diabetes and non-communicable disease strategy.“The disease progresses silently, and many people seek care only after irreversible damage has occurred. Integrating retinal screening into the national NCD screening programme, annual health check-ups, and insurance coverage, while expanding retinal treatment under the National Programme for Control of Blindness and Visual Impairment (NPCBVI), can help shift the focus from treating blindness to preventing it.“Technology could also make a major difference.“Artificial intelligence can accelerate this transformation. AI-enabled retinal screening is already proving effective in identifying patients at risk, improving referral pathways, and extending quality screening to underserved communities. With the increasing adoption of AI-based screening, diabetic retinopathy screening can become easily accessible to all, enabling earlier diagnosis and timely treatment at scale.“He concluded with a reminder that preserving vision protects far more than eyesight.“Preventing avoidable blindness is about more than preserving sight, it is about protecting productivity, livelihoods, and independence. A truly Viksit Bharat will depend not only on treating disease, but on ensuring that every citizen has equitable access to timely, technology-enabled preventive care.”
The real goal is not treating blindness, it is making sure it never happens
Medicine has become remarkably effective at treating diabetic retinopathy with laser therapy, injections and surgery when required. But doctors agree that prevention remains the most powerful treatment of all.The future of diabetic eye care will depend on something surprisingly simple, making retinal screening as routine as checking blood sugar or measuring blood pressure.Millions of Indians already manage diabetes every day. Adding one annual retinal examination may seem like a small step, but it could mean the difference between keeping vision for life and losing it forever.Blindness caused by diabetes is not inevitable. In many cases, it is preventable. The challenge now is ensuring that people know it before it is too late.Medical experts consultedThis article includes expert inputs shared with TOI Health by:Dr Vishali Gupta, President Vitreo Retina Society India, and head-retina, PGIMER, Chandigarh.Dr R Kim, CMO Aravind Eye Hospital, Madurai.Inputs were used to explain how diabetic retinopathy can lead to preventable blindness, why regular retinal screening is crucial, and what people with diabetes can do to protect their vision.
