Diabetes is one of Australia's fastest-growing chronic diseases, and eye complications are among its most serious consequences. Diabetic retinopathy — damage to the blood vessels of the retina caused by persistently elevated blood glucose — is the leading cause of preventable vision loss in working-age Australians. The critical fact that every diabetic patient should know is this: the condition is often completely asymptomatic until it reaches an advanced stage. Annual eye checks are recommended for all people with diabetes, regardless of how good their vision feels.
At Northern Eye Consultants, medical retina assessments are performed by Dr Xavier Fagan, a subspecialist ophthalmologist with fellowship training in medical retina and ocular inflammatory disorders at the Royal Victorian Eye and Ear Hospital. Our rooms are at Northpark Private Hospital, Bundoora, serving patients from Epping, Mill Park, Thomastown, Preston, Reservoir, Whittlesea, and across Melbourne's northern suburbs.
How diabetes affects the eyes
High blood glucose levels cause progressive damage to the small blood vessels that supply the retina — the light-sensitive layer at the back of the eye. This damage evolves through several stages.
In background (non-proliferative) retinopathy, the blood vessel walls weaken and develop small outpouchings (microaneurysms) that can leak fluid and blood. Small haemorrhages and hard exudates (lipid deposits) appear in the retina. Vision is often unaffected at this stage, but the changes are visible on examination.
Diabetic macular oedema (DMO) occurs when fluid leaks into the central retina (the macula), causing swelling that directly disrupts central vision. DMO is the most common cause of vision loss in people with diabetes and can occur at any stage of retinopathy.
Proliferative diabetic retinopathy (PDR) is a more advanced stage in which the retina becomes so oxygen-deprived that it responds by growing fragile new blood vessels (neovascularisation). These new vessels are abnormal and prone to bleeding into the vitreous or causing tractional retinal detachment — both sight-threatening complications.
Symptoms — and why they matter less than you might think
Early and moderate diabetic retinopathy, including mild to moderate macular oedema, often causes no noticeable change in vision. By the time a patient notices blurred central vision, floaters, or visual distortion, the retinopathy may already be at an advanced stage. Warning signs that should prompt urgent review include sudden blurred vision, new floaters, flashes of light, or a shadow across part of the visual field — but waiting for these symptoms is not a screening strategy.
Screening recommendations
The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) recommends annual dilated retinal examination for all people with diabetes. For type 1 diabetes, this should begin within five years of diagnosis. For type 2 diabetes, screening should begin at the time of diagnosis, as many patients already have early retinopathy when diabetes is first detected.
More frequent review — every three to six months — is required once retinopathy is present, when macular oedema has been detected, when HbA1c is poorly controlled, when blood pressure is elevated, and during pregnancy (when diabetic retinopathy can progress rapidly).
What a diabetic eye assessment involves at NEC
A comprehensive diabetic eye assessment includes dilated fundus examination, optical coherence tomography (OCT) of the macula to detect and quantify any macular oedema, ultra-widefield retinal photography to document the extent of retinopathy across the peripheral retina, and fluorescein angiography when indicated to map areas of leakage or non-perfusion.
A written report is sent back to your referring GP and endocrinologist after each visit, supporting the coordinated management approach that is essential in diabetic eye care.
Treatment options
Intravitreal injections of anti-VEGF agents (such as Eylea/aflibercept, Lucentis/ranibizumab, or Vabysmo/faricimab) are now the standard of care for diabetic macular oedema. These injections block the growth factor responsible for abnormal vessel leakage and new vessel formation. Most patients with DMO require an initial loading phase of monthly injections, followed by a maintenance phase adjusted based on their response. PBS-listed anti-VEGF medications are available for eligible patients with diabetic macular oedema, significantly reducing medication costs.
Retinal laser treatment (panretinal photocoagulation) is used for proliferative diabetic retinopathy to reduce the stimulus for new blood vessel growth. Focal laser is occasionally used for specific leaking microaneurysms outside the central macula.
Vitreoretinal surgery is required for advanced complications including vitreous haemorrhage that fails to clear and tractional retinal detachment involving the macula. A detailed overview of vitreoretinal surgical options is available on our vitreoretinal surgery service page.
Working with your GP and endocrinologist
Diabetic eye disease is best managed as part of a coordinated care team. Optimal outcomes depend on good systemic control — maintaining HbA1c as close to target as safely possible, controlling blood pressure, managing lipids, and stopping smoking. These systemic factors are at least as important as any ocular treatment in slowing the progression of retinopathy. Our team communicates directly with your GP and endocrinologist after each specialist review.
To arrange a diabetic eye assessment, contact Northern Eye Consultants on (03) 9466 8822 or ask your GP or endocrinologist to refer via HealthLink EDI nthneyec.