Several visual symptoms in a person with diabetes should prompt same-day or next-day retinal specialist review rather than a routine appointment. Sudden onset of floaters, which are new spots, threads, or a shower of dark dots appearing in the vision, may represent a vitreous haemorrhage from a bleeding new vessel and need prompt assessment. A dark shadow, curtain, or veil that covers part of the visual field may indicate a retinal haemorrhage or, more urgently, a retinal detachment. Sudden blurring of central vision that was not present the day before may indicate acute macular oedema. Distortion of straight lines, where lines appear wavy or bent, suggests macular involvement that requires prompt treatment. Any of these symptoms in a person with known diabetic retinopathy, or in a person with longstanding or poorly controlled diabetes who has not had a recent retinal examination, should be assessed as urgent. In contrast, a person with diabetes who has no visual symptoms but has not had a retinal examination in the past twelve months should be seen for a routine annual review, not an emergency. At Kasturi Nagar, Bengaluru, I prioritise urgent review for any sudden visual change in a diabetic patient because the window for effective intervention in vitreous haemorrhage and traction retinal detachment narrows quickly once the process has begun.
Written by Dr. Usha Shree, MBBS (Rajiv Gandhi University of Health Sciences, 2007), DNB Ophthalmology (National Board of Examinations, 2012), FICO (International Council of Ophthalmology, 2015), FVRS (Rajiv Gandhi University of Health Sciences, 2016), Vitreo-Retina Specialist, Kasturi Nagar, Bengaluru. 12 years. 10,000+ patients. Phone: +91 96633 58193.
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