DIABETIC EYE DISEASE EDUCATION PROGRAM

Diabetes and

Healthy Eyes

Toolkit

A Flipchart for Health Promoters
NOTES FOR HEALTH PROMOTERS 1A

RISK FACTORS FOR DEVELOPING DIABETES 

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A risk factor is a condition (e.g., obesity) or any activity (e.g., 

eating in excess) that can adversely affect one’s health or that 

can increase the possibility of developing a disease.

Some risk factors can be changed. These are called modifiable 

risk factors.

There are several major risk factors for developing diabetes. 

These risk factors include— 

Family history

You are at greater risk for developing diabetes if any member 

of your immediate family has diabetes. This includes your 

father, mother, grandparents, brothers, sisters, and first 

cousins.

High blood pressure

Blood pressure higher than 140/90 mm/Hg is a risk factor for 

diabetes. For people with diabetes, blood pressure should be 

lower than 130/80 mm/Hg.

Obesity

Obesity is a strong risk factor for diabetes. Most often, obesity 

is due to overeating and lack of exercise. Regular exercise, 

such as walking at least 30 minutes five times per week, 

is strongly recommended. Following a healthy diet is also 

important for avoiding obesity. 

High cholesterol and high triglycerides

High cholesterol and high triglyceride levels are risk factors for 

diabetes. Blood tests are available to test for high cholesterol 

and high triglycerides.

Gestational diabetes 

If a woman develops diabetes during pregnancy, she is at a 

higher risk for diabetes later in life.
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RISK FACTORS FOR DEVELOPING DIABETES

Family history DIABETES High blood pressure

Obesity, high cholesterol,

and high triglycerides

Gestational

diabetes

If you have risk factors for diabetes, you 

should have your glucose levels checked.
NOTES FOR HEALTH PROMOTERS 2A

DIABETES AND EYE COMPLICATIONS

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Diabetes occurs when the body cannot or does not 

control high levels of blood glucose.

Diabetes can cause problems such as heart disease, 

kidney failure, and amputations.

Diabetes can cause diabetic eye disease, which can lead 

to vision loss or blindness.

Diabetic eye disease includes— 

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Diabetic retinopathy

Cataract

Glaucoma

Diabetic eye disease can cause permanent vision loss 

or low vision. Low vision means that even with regular 

glasses, contact lenses, medicine, or surgery, people 

find everyday tasks difficult to do. Reading the mail, 

shopping, cooking, watching TV, and writing can all 

seem challenging.

A person with diabetes is much more likely to become 

blind than a person without diabetes. 

The risk of blindness may be lessened. Later on, we will 

learn how to reduce the risk of blindness.
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DIABETES AND EYE COMPLICATIONS 

If you have diabetes, you must take 

care of your eyes.

Diabetes is caused when the body cannot or does 

not control high levels of blood glucose.

Diabetes can cause diabetic eye disease, which 

can lead to low vision or blindness.
NOTES FOR HEALTH PROMOTERS 3A

ANATOMY OF THE EYE AND ITS FUNCTION 

Here is a description of some of the main parts of the eye:

Cornea 

The cornea is the clear outer part of the eye’s focusing system 

located at the front of the eye. 

Iris 

The iris is the colored part of the eye that regulates the amount 

of light entering the eye. 

Lens 

The lens is a clear part of the eye behind the iris that helps to 

focus light, or an image, on the retina. 

Macula

The macula is the small sensitive area of the retina that gives 

central vision. It is located in the center of the retina.

Optic nerve 

The optic nerve is the largest sensory nerve of the eye. It carries 

impulses for sight from the retina to the brain.

Pupil 

The pupil is the opening at the center of the iris. The iris adjusts 

the size of the pupil and controls the amount of light that can 

enter the eye. 

Retina 

The retina is the light-sensitive tissue at the back of the eye. The 

retina converts light into electrical impulses that are sent to the 

brain through the optic nerve. 

Vitreous gel

The vitreous gel is a transparent, colorless mass that fills the rear 

two-thirds of the eyeball, between the lens and the retina.
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ANATOMY OF THE EYE AND ITS FUNCTION 

Vision is wonderful, but you could lose 

it if you have diabetes.

The main parts of the eye—

Vitreous gel

Optic nerve

Macula

Retina

Iris

Lens

Pupil

Cornea

Iris
NOTES FOR HEALTH PROMOTERS 4A

THE DILATED EYE EXAM

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A comprehensive eye exam measures vision, checks for 

refractive errors (such as nearsightedness, farsightedness, 

or astigmatism), and includes dilating the pupils to detect eye 

disease.

A dilated eye exam allows an eye care professional 

(ophthalmologist or optometrist) to see more of the inside of 

your eyes to check for signs of disease. Early detection and 

timely treatment can reduce the risk of blindness. 

A person with diabetes should remember the following:

Some eye diseases do not have symptoms. Do not wait to 

visit an eye care professional.

At least once a year you should see an eye care professional. 

The dilated eye exam is short, simple, and painless.

An eye care professional who has experience examining the 

eye and the retina should perform this exam. 

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The eye care professional will put two eye drops in each 

eye to open, or dilate, the pupil. 

Then the eye care professional will examine the different 

parts of the eye, especially the retina. 

Only an eye care professional can tell what is happening inside 

the eye.

During the dilated eye exam, the eye care professional can 

find damage to the lens, cornea, retina, and/or other parts of 

the eye. 
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THE DILATED EYE EXAM

A dilated eye exam allows an eye 

care professional to see more of the 

inside of your eyes to check for signs 

of disease. 

Don’t wait for symptoms to see an 

eye care professional. 

Have a dilated eye exam at least once 

a year. 
NOTES FOR HEALTH PROMOTERS 5A

DIABETIC RETINOPATHY

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It is an eye complication of diabetes. 

It damages the small blood vessels in the retina.

The longer someone has diabetes, the more likely he or 

she will get diabetic retinopathy.

The eyesight of a person with diabetic retinopathy can be 

damaged due to various causes:

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Bleeding.

Detachment of the retina.

Presence of abnormal blood vessels in the retina 

(proliferative retinopathy).

There are often no symptoms in the early stages of 

diabetic retinopathy. There is no pain, and vision may not 

change until the disease becomes severe.

Vision loss may be prevented by finding and treating the 

disease in its early stages.

Treatment involves laser surgery, in which a strong light 

beam is aimed onto the retina. 

Laser surgery and appropriate follow-up care can reduce 

the risk of blindness by 90 percent. 
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DIABETIC RETINOPATHY

Diabetic retinopathy is the most frequent 

cause of blindness in the United States.

It affects the tiny blood 

vessels in the retina. This 

picture shows an eye with 

swollen blood vessels from 

diabetic retinopathy. 

Normal vision.

Same scene 

viewed by 

a person 

with diabetic 

retinopathy.
NOTES FOR HEALTH PROMOTERS 6A

DIABETES AND CATARACT

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Cataract is a clouding of the lens in the eye that 

affects vision.

Symptoms that can appear to indicate cataract include 

the following:

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Cloudy and blurry vision

Faded colors

Poor night vision

Double vision

Problems with bright lights, especially at night

Diabetes increases the risk of cataract.

Cataract can occur in one or both eyes. It cannot spread 

from one eye to the other.

In earlier stages, the cataract is not yet visible; an eye 

exam is necessary for detection.

Symptoms of early cataract may be improved with new 

eyeglasses, brighter lighting, anti-glare sunglasses, or 

magnifying lenses. If these measures do not help, surgery 

is the only effective treatment.

Cataract surgery is usually safe and successful; the 

cloudy lens is replaced with a plastic lens.
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 DIABETES AND CATARACT

Cataract is common all over the world 

and affects people with diabetes.

A cataract is a clouding of 

the lens.

People with cataract see 

through a haze.

Normal vision.

Same scene viewed 

by a person with 

cataract.
NOTES FOR HEALTH PROMOTERS 7A

DIABETES AND GLAUCOMA

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Glaucoma is a group of diseases that can damage the 

optic nerve and result in vision loss and blindness. 

Glaucoma may be caused by an increase in eye 

pressure. However, in some forms of glaucoma, eye 

pressure is normal. 

A form of the disease called open-angle glaucoma is 

diagnosed most often in the following groups of people:

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African Americans aged 40 and older

Everyone over age 60, especially Mexican Americans

People with a family history of glaucoma

People with diabetes are at an increased risk for 

an aggressive type of glaucoma called neovascular 

glaucoma. In this form, abnormal blood vessels grow in 

the front part of the eye. 

People may not realize they have glaucoma until the 

disease is advanced. In the early stages, it often has no 

symptoms because one eye compensates for the other.

Vision lost to glaucoma cannot be restored. However, 

with early detection and treatment, vision loss may be 

prevented or slowed down.

Treatment options for glaucoma include medications such 

as prescription eye drops or pills, or surgery.
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DIABETES AND GLAUCOMA

At first, glaucoma has no symptoms 

and, if left untreated, vision loss or 

blindness can occur.

Glaucoma is a group of 

diseases that can damage 

the optic nerve and result in 

vision loss and blindness. 

Normal vision.

Same scene viewed 

by a person with 

glaucoma.
NOTES FOR HEALTH PROMOTERS 8A

 THE EYE HEALTH TEAM

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Health professionals who are part of an eye health 

team may include— 

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Certified diabetes educator

Health promoter

Nurse 

Ophthalmologist 

Optometrist 

Pharmacist

Primary care provider

Social worker

This team can be smaller or larger, depending on a 

person’s need.

All of these people can help a person with diabetes obtain 

optimal health, but the person with diabetes has the main 

responsibility by controlling his/her glucose levels and getting 

a dilated eye exam at least once a year.

People with diabetes should know the following:

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They can take action to protect their vision. 

Everyone with diabetes should visit an eye care 

professional at least once a year.

An annual visit to an eye care professional can help to 

prevent blindness.

When they talk with their primary care provider, they can 

ask for ways to control their glucose levels, blood pressure, 

and cholesterol. 
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THE EYE HEALTH TEAM

People with diabetes can protect their vision.

Health professionals who are part of an eye health 

team include—

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Certified diabetes 

educator

Health promoter

Nurse 

Ophthalmologist 

Optometrist 

Pharmacist

Primary care provider 

Social worker

Remember—

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Visit an eye care professional and 

take care of your eyes.

Ask for a dilated eye exam.

Have a dilated eye exam at least once 

a year. 
 Acknowledgements

The National Eye Health Education Program (NEHEP) of the 

National Eye Institute (NEI) would like to acknowledge the 

following organizations for contributing to the development 

of the module and flipchart that are part of the Diabetes and 

Healthy Eyes Toolkit: 

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The staff at the Midwest Latino Health Research, Training, 

and Policy Center at the University of Illinois at Chicago 

(UIC Latino Research Center) for laying the groundwork 

for the module and flipchart.

The National Alliance for Hispanic Health for conducting 

discussion groups with their network of community lay 

health workers.

The members of the NEHEP Diabetic Eye 

Disease Subcommittee for reviewing materials for 

scientific accuracy.

The health promoters who tested the Diabetes and Healthy 

Eyes Toolkit in the field and provided invaluable feedback.

NEHEP works to ensure that vision is a health priority by translating eye and vision research into 

public and professional education programs. For more information about resources and materials 

available to educate your community, contact— 

National Eye Institute

National Institutes of Health

Building 31, Room 6A32

31 Center Drive MSC 2510

Bethesda, MD 20892–2510

Telephone: 301–496–5248

E-mail: 2020@nei.nih.gov

Website: www.nei.nih.gov/nehep

www.nei.nih.gov/nehep

Pub. No. 10-7364

Printed 8/10