Diabetic 

Eye 

Disease

AN 

EDUCATOR’S 

GUIDE
Diabetic Eye Disease: An Educator’s Guide, developed by the National Eye Health Education Program 

(NEHEP), is a patient education tool for health professionals and community-based educators who 

work with people who have diabetes. A Spanish version, Enfermedad Diabética del Ojo: Una guía para 

el educador, is also available.

The National Eye Institute (NEI) conducts and supports research that leads to sight-saving treatments 

and plays a key role in reducing visual impairment and blindness. The NEI is part of the National 

Institutes of Health (NIH), an agency of the U.S. Department of Health and Human Services.

For more information about the NEI, contact: 

National Eye Institute 

National Institutes of Health 

2020 Vision Place 

Bethesda, MD 20892–3655 

Telephone: 301–496–5248 

E-mail: 2020@nei.nih.gov 

Website: www.nei.nih.gov
Introduction

Diabetes is a leading cause of blindness among 

working-age adults in the United States. Yet with early 

detection and timely treatment, diabetic eye disease 

can be controlled. The key is to get a dilated eye exam 

at least once a year. By advising people with diabetes 

to get a dilated eye exam, you can help reduce their 

risk of vision loss and blindness. 

How To Use This Guide

Diabetic Eye Disease: An Educator’s Guide is a desktop 

flipchart that has text to guide your discussion and 

illustrations for you to show to your patients. Use the 

back cover to set up an easel for the chart. 

Ask When the Patient Last Had an 

Eye Examination 

Ask if the patient has had an exam recently. If the 

patient has not had an eye exam during the last year, 

find out why. You may be able to help.

Give Referral Information

If patients do not have a regular source of eye care, 

providing a list of local eye care professionals will help 

patients take the next step—making an appointment 

for a dilated eye exam. 

Financial Aid for Eye Care

Many state and national resources regularly provide 

aid to people with vision problems. If a patient is in 

need of financial aid to assess or treat an eye problem, 

please see the list of programs provided on the NEI 

Website at www.nei.nih.gov/health/financialaid.asp.
Take care of your vision.
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i n t r o d u c t i o n

Take care of your vision.

1

Vision is an important part of your everyday 

life. If you have diabetes, you need to take 

special care to protect your vision from 

diabetic eye disease.

Take care of your vision.
People with diabetes need to know...
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In t r o d u c t i o n

People with diabetes need to know...

• You are at risk for developing diabetic 

eye disease, especially diabetic 

retinopathy, which can cause vision 

loss—even blindness.

• Getting a dilated eye exam at least 

once a year is important in finding and 

treating diabetic eye disease early.

• It is important to talk with your doctor 

about diabetes self-care.

2

People with diabetes need to know...
Who can develop diabetic retinopathy?
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RI s k

Who can develop diabetic retinopathy?

All people with diabetes—type 1 and type 

2—can develop diabetic retinopathy, the 

most common diabetic eye disease. The 

longer you have diabetes, the more likely it is 

that you will develop diabetic retinopathy.

Optional information: 

More than half of people with type 1 diabetes have some 

retinopathy after 10 years of diabetes. Almost one-third of 

people with type 2 diabetes have some retinopathy at the 

time they are diagnosed.

3

Who can develop diabetic retinopathy?
How does diabetes damage your eyes?

Damaged

blood

vessels

A closer

look
How does diabetes damage your eyes?

Damaged

blood

vessels

A closer

look

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C o m p l i c at i o n s

How does diabetes damage your eyes?

A healthy retina is needed for good vision. The 

retina is at the back of the eye. It is the part 

of the eye that can sense light. Over time, high 

blood sugar, blood pressure, and cholesterol 

can damage the tiny blood vessels in your 

retina. These blood vessels may swell and 

become blocked. New, weaker blood vessels may 

form. When these changes occur, a person has 

developed some level of diabetic retinopathy. 

Optional information:

People with diabetes are also at risk for these other diabetic 

eye diseases: 

• Cataract: A clouding of the lens, the part of your eye that 

focuses light rays on the retina.

• Glaucoma: A group of diseases that can damage the eye’s 

optic nerve. The optic nerve is the part of your eye that 

sends information from your retina to your brain to tell 

you what you are seeing.

4
How can diabetic retinopathy cause vision loss?

Left untreated,

diabetic retinopathy

can cause vision loss.

Diabetic retinopathy can damage 

your eyes even before you see 

changes in your vision.
How can diabetic retinopathy cause vision loss?

Left untreated,

diabetic retinopathy

can cause vision loss.

Diabetic retinopathy can damage 

your eyes even before you see 

changes in your vision.

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c o m p l i c at i o n s

How can diabetic retinopathy cause vision loss?

Diabetic retinopathy can damage your eyes 

even before you see changes in your vision. 

Left untreated, diabetic retinopathy can 

cause vision loss.

5
Why is a dilated eye exam important?
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d e t e c t i o n

Why is a dilated eye exam important?

There are no warning signs for diabetic 

retinopathy. A dilated eye exam allows 

the eye care professional to see the early 

signs of the disease and help you before 

your vision is affected. Finding and 

treating diabetic retinopathy early can 

help protect your vision.

6

Why is a dilated eye exam important?
What happens when you get a dilated eye exam?

RAY OF LIGHT

PUPIL

RETINA

OPTIC NERVE

RAY OF LIGHT

PUPIL

RETINA

OPTIC NERVE

Portion 

of retina 

that can 

be seen

through

undilated 

pupil.

Portion 

of retina 

that can 

be seen

through

dilated 

pupil.

UNDILATED PUPIL DILATED PUPIL
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d e t e c t i o n

What happens when you get a dilated eye exam?

A dilated eye exam from an eye care 

professional is the best way to tell if you 

have diabetic retinopathy, before it affects 

your vision. This exam includes—

• Pupil dilation: Drops will be put in your 

eye to dilate (widen) the pupil. Your 

eye care professional will use a special 

magnifying lens to look at your retina and 

other parts of your eye. 

• Visual acuity: A test during which you 

are asked to read an eye chart to measure 

how well you see at different distances.

• Tonometry: A test to measure the 

pressure inside your eye.

7

Get a dilated eye exam. 

RAY OF LIGHT 

PUPIL 

RETINA

OPTIC NERVE 

RAY OF LIGHT 

PUPIL 

RETINA 

OPTIC NERVE 

Portion 

of retina

that can 

be seen 

through 

undilated 

pupil.

Portion 

of retina

that can 

be seen 

through

dilated 

pupil.

UNDILATED PUPIL DILATED PUPIL
What can you do to protect your vision?

Take your medications

as prescribed by your doctor.

Reach and maintain

a healthy weight.

Add more physical activity

to your daily routine.

Control your ABCs—

A1C, blood pressure, and 

cholesterol levels.

Kick the smoking habit.
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s e l f - c a r e

What can you do to protect your vision?

Get a dilated eye exam at least once a 

year, and...

Keep TRACK of your diabetes:

T: Take your medications as prescribed by 

your doctor.

R: Reach and maintain a healthy weight.

A: Add more physical activity to your daily 

routine.

C: Control your ABCs—A1C*, blood 

pressure, and cholesterol levels.

K: Kick the smoking habit.

*A1C is a simple lab test that measures your average 

blood glucose level over the last 3 months. It is the 8 best way to know your overall blood glucose control.

What can you do to protect your vision?

Take your medications

as prescribed by your doctor.

Reach and maintain

a healthy weight.

Add more physical activity

to your daily routine.

Control your ABCs—

A1C, blood pressure, and 

cholesterol levels.

Kick the smoking habit.
How is diabetic retinopathy treated?

Retina

Damaged 

blood vessels

Blood vessels

after treatment

A CLOSER LOOK
How is diabetic retinopathy treated?

Retina

Damaged 

blood vessels

A CLOSER LOOK

Blood vessels

after treament

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t r e at m e n t

How is diabetic retinopathy treated?

If you develop diabetic retinopathy, your 

eye care professional will know when and 

how to treat the damage to your eyes. 

Often, laser surgery (using a special beam 

of light) is performed to treat the damaged 

blood vessels inside the eye. 

9

Optional information: 

Note: The optional information below may not be necessary to share with 

the patient at this time. Pictures of these treatments are available on 

the National Eye Institute Website at www.nei.nih.gov. 

The picture on this page shows the results of scatter 

laser treatment. There are other treatments for the 

different ways that diabetic retinopathy can damage the 

eyes. These include treatments for— 

Macular edema: This occurs when the weak blood vessels 

in the center of the retina leak fluid within the macula. The 

macula is the central part of the retina responsible for straightahead vision. Macular edema is treated with focal laser surgery. 

Vitreous bleeding: The vitreous is the large space in the 

center of the eye. It is filled with a clear gel-like fluid. If this 

fluid becomes clouded by blood from damaged blood vessels, 

a person may need an eye operation called a vitrectomy. The 

cloudy fluid is replaced with a clear salt solution that is similar 

to vitreous fluid. 
Making the most of your vision...
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v i s i o n r e h a b i l i tat i o n

Making the most of your vision...

Treatment may not restore vision already lost to 

diabetic retinopathy. In this case, a person may 

have low vision. People with low vision find it 

difficult to do everyday tasks, even with regular 

eye glasses, contact lenses, medicine, or surgery. 

The good news is that vision rehabilitation can 

help people make the most of their remaining 

vision and maintain independence.

Vision rehabilitation can—

• Make home and work surroundings safer and 

more convenient.

• Make it easier to travel alone. 

• Show you how to use visual and adaptive 

devices.

If you develop low vision, your eye care 

professional can refer you to a specialist in 

low vision who can help you make everyday 10 activities easier.

Making the most of your vision...
Remember—get a dilated eye exam.

Take your medications

as prescribed by your doctor.

Reach and

maintain a 

healthy weight.

Add more physical 

activity to your

daily routine.

Control your ABCs—

A1C, blood pressure,

and cholesterol levels.

Kick the smoking habit.
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s u m m a r y

Remember—get a dilated eye exam.

• Diabetic retinopathy has no warning signs. 

• Get a dilated eye exam at least once a year. 

• Keep TRACK of your diabetes:

T: Take your medications as prescribed by 

your doctor.

R: Reach and maintain a healthy weight.

A: Add more physical activity to your daily 

routine.

C: Control your ABCs—A1C, blood pressure, 

and cholesterol levels.

K: Kick the smoking habit.

11

Remember—get a dilated eye exam.

Take your medications

as prescribed by your doctor.

Reach and

maintain a 

healthy weight.

Add more physical 

activity to your

daily routine.

Control your ABCs—

A1C, blood pressure,

and cholesterol levels.

Kick the smoking habit.
Make Your Vision

a Health Priority.

www.nei.nih.gov
NIH Publication No. 2642

Revised 12/05