03/03/2026
Many of my diabetic patients come to my clinic believing that if their blood sugar readings are normal, or their HbA1c is within target, their eyes are automatically safe. While it's a reasonable assumption, the truth is more complex.
In this article, I will address the most common concerns I hear from patients about how diabetes can affect the retina.
Is Checking Blood Sugar Once or Twice Daily Sufficient?
When you check your glucose at home, you are having one reading at one moment in time. Though that number may be reassuring, it does not tell us what happened after your meals, during the night, or on days of stress. Blood sugar can fluctuate significantly without causing noticeable symptoms and those fluctuations may still affect the small, delicate blood vessels in the retina.
For your eyes, consistency matters more than isolated normal readings. I am not only interested in what your sugar level is at 8 a.m, I care more about how stable it is throughout the day and over months and years.
Does HbA1c Alone Guarantee Retinal Protection?
HbA1c is extremely important. It reflects your average blood sugar over approximately three months, and we know from major studies such as the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study that better long-term control significantly reduces the risk of diabetic retinopathy progression.
However, HbA1c is an average. Two patients may have the same HbA1c, but one has stable glucose levels while the other experiences frequent highs and lows. Emerging evidence suggests that these fluctuations (what we call glycemic variability) may place additional stress on blood vessels, including those in the retina.
So yes, HbA1c is essential. But stability is just as important as the number itself.
Should Glucose Monitoring Be More Comprehensive During the Day?
In some cases, yes. Scheduled testing at different times, including after meals, can reveal spikes that fasting measurements might miss. Continuous glucose monitoring devices provide even more detailed information, showing not just average levels but trends, variability, and time spent within target range.
For certain patients, especially those with established, progressive retinopathy or fluctuating control, this additional information can help achieve steadier metabolic control, which ultimately benefits the eyes.
Can Retinopathy Progress Even When Diabetes Improves?
This can be confusing to people living with diabetes. The answer is yes, temporarily.
When someone has had poorly controlled diabetes for years and blood sugar is lowered rapidly, the retina may sometimes react with short-term worsening. This is known as early worsening of diabetic retinopathy. It is thought to result from sudden changes in retinal blood flow, oxygenation and growth factor activity.
Importantly, this does not mean improving diabetes is harmful. On the contrary, good long-term control is protective. This emphasizes the need for slow adjustment of glucose levels and closer retinal follow-ups during those periods.
Are Elevated Glucose Levels the Only Risk Factor for Retinal Damage?
No, and this is something I emphasize strongly.
Diabetes rarely exists alone. More than 70 percent of patients with type 2 diabetes have at least one additional chronic condition. High blood pressure affects the majority of these patients and significantly increases the risk of retinal bleeding and macular edema. Abnormal cholesterol levels are also common and contribute to lipid deposits in the retina. Kidney disease, which develops in approximately 20 to 40 percent of patients with diabetes, often parallels retinal disease because both organs share similar microvascular structures. It is always recommended to actively control these factors, because managing blood pressure, cholesterol, and kidney health can significantly reduce the risk of retinal complications.
If Vision Remains Normal, Are Eye Examinations Still Necessary?
Absolutely.
Early diabetic retinopathy often causes no symptoms. I frequently examine patients who look perfectly well yet already show retinal changes. By the time vision becomes blurred, the disease may be more advanced and treatment more complex.
Regular examinations allow us to detect changes early, when prevention is possible, intervention is simpler and outcomes are better.
Our Experts
Dr. Wissam Charafeddin Aboul-Hosn - Consultant Ophthalmologist, Retina Expert
Dr. Wissam Charafeddin is a Consultant Ophthalmologist at Barraquer Eye Hospital UAE, with over 15 years of experience in retinal and comprehensive ophthalmic care. He is European Board Certified and specializes in retinal diseases, including diabetic retinopathy, age-related macular degeneration, vascular retinal disorders, and congenital retinal conditions.
Dr. Charafeddin has trained and practiced internationally, contributing to research published in leading ophthalmology journals. He is also actively involved in humanitarian initiatives, participating in multiple medical missions to Africa through the Barraquer Foundation. Fluent in English, Arabic, Spanish, and French, he combines advanced clinical expertise with compassionate, patient-centered care.
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