Diabetic Retinopathy Treatment Singapore
Singapore has one of the highest rates of diabetes among developed nations globally, with 13% of Singaporeans1 being affected with diabetes. Diabetic retinopathy is one of the major complications of diabetes, and a leading cause of vision loss in people with diabetes.
At LSC Eye Clinic, our ophthalmologists provide specialist-led assessment, monitoring, and treatment of diabetic eye disease, with care planned around the stage of your condition and your overall diabetes control.
If you have been living with diabetes for several years or have noticed changes in your vision, a diabetic eye assessment is a sensible first step. Book a diabetic eye assessment with our team to discuss your concerns and have your retina examined in detail.
What Is Diabetic Retinopathy?
Diabetic retinopathy is an eye condition that develops when high blood sugar levels damage the small blood vessels in the retina, the light-sensitive layer at the back of the eye. Over time, these vessels can leak fluid or blood, or close off entirely, which affects how well the retina functions.
In its early stages, diabetic retinopathy often has no symptoms. Vision usually remains normal until the condition becomes more advanced, which is why regular eye screening matters even when your eyes feel fine.
If left unmanaged, diabetic retinopathy may progress and affect central or overall vision. Early detection through a retinal examination gives you and your eye doctor the most options for managing the condition before vision is significantly affected.
How Does Diabetes Damage the Retina?
The retina is the important light-sensing structure lining the back of the eye, much like the film in a camera. In order to function well, the retina depends on oxygen supplied by blood circulating through blood vessels.
In diabetes, high blood sugar levels damage the blood vessels of the retina. The damaged blood vessels leak fluid and blood, and as a result, do not provide adequate oxygen and nutrients to the retinal photoreceptor and nerve cells. These cells malfunction and then begin to die. More recent research has shown that diabetes also directly damages the nerves of the retina.
Why See a Diabetic Eye Specialist
Diabetic retinopathy is best managed by an ophthalmologist with experience in retinal disease. A diabetic eye specialist can examine the retina in detail, identify the stage of the condition, and plan monitoring or treatment based on what is found.
A specialist assessment usually includes a dilated retinal examination and may involve imaging tests such as optical coherence tomography (OCT) or retinal photography. These investigations help map the extent of any vessel damage, swelling, or new vessel growth.
Because diabetic retinopathy can progress without obvious symptoms, specialist review is often recommended on a regular basis rather than only when vision changes. This allows treatment to be considered earlier, when more options may be available.
Who Is at Risk for Diabetic Retinopathy?
Anyone who has diabetes is at risk of developing diabetic retinopathy. The following factors can increase the risk:
- Duration of diabetes: the longer someone has diabetes, the higher the risk of developing diabetic retinopathy
- Poor control of blood sugar levels
- High blood pressure
- High cholesterol levels
- Pregnancy
Screening frequency depends on your type of diabetes, how long you have had it, and what your most recent eye examination showed.
People with type 1 diabetes are generally advised to start annual eye checks around five years after diagnosis, while people with type 2 diabetes are usually advised to have an eye examination soon after diagnosis and yearly thereafter.
Your eye doctor may recommend more frequent reviews if signs of retinopathy are already present, or if you are pregnant.
Signs and Symptoms to Watch For
The impact on vision due to diabetic retinopathy depends on the stage of the disease.
Early stage (i.e. non-proliferative) disease
At this stage, diabetic retinopathy has no symptoms. There are micro leaks and bleeding spots in the retina, clinically observable changes in the size and course of blood vessels, however these on their own do not impact vision.
Late-stage (i.e. proliferative) diabetic retinopathy
At this stage, abnormal proliferations of blood vessels form in response to the overall lack of blood and nutrients to retinal tissue. Damage to the blood vessels deprives the retina of oxygen, leading to the production of a signal protein called vascular endothelial growth factor (VEGF).
VEGF promotes the growth of blood vessels from the retina into the vitreous gel cavity. When they bleed, they cause rapid dispersion of blood into the vitreous (i.e. a vitreous hemorrhage), leading to a development of floaters, misty vision, or a partial cloud in the visual field.
Another common complaint of patients with late-stage disease is the reduction of night vision abilities. This is largely because when the retina is starved of nutrients and blood, the photoreceptor cells responsible for night vision don’t function well and die. This gives rise to significant difficulty with driving or functioning at night.
Advanced proliferative diabetic retinopathy
At this stage, the abnormal blood vessel proliferations form scar tissue that tug on the retina, causing localized areas of retinal detachment. Repeated episodes of bleeding continue and create a vicious cycle of more scarring. Retinal detachments which progress to the macula are vision-threatening and signify a very advanced stage of the disease. Such cases often require surgery in order to preserve vision. A discussion with a retinal specialist is absolutely important to understand the potential risks of surgery undertaken in this scenario, and how soon surgery should be considered.
Some advanced cases may also develop proliferation of blood vessels on the iris tissue in the front of the eye as well, causing a specific type of glaucoma, i.e. neovascular glaucoma. The pressures in these eyes are high and vision often poor. Neovascular glaucoma represents a severe end-point of the disease, often requiring both glaucoma and retinal surgery in order to stabilize the eye pressure and prevent further vision loss.
Diabetic macular edema
Diabetic macular edema can occur alongside non-proliferative or proliferative diabetic retinopathy, and occurs when blood vessels in the macula leak. The macula is the central-most part of the retina, responsible for high-definition and crisp visual quality. Thus, this condition affects central vision, giving rise to a central blur and distorted images.
How Do I Know if I Have Diabetic Retinopathy?
A comprehensive eye examination by an ophthalmologist or diabetic eye specialist is important to make a diagnosis, and consequently treatment, before sight is affected.
Those with type 1 diabetes should see an ophthalmologist once a year, starting five years after the onset of their disease, while those with type 2 diabetes should see an ophthalmologist for a retinal examination soon after their diagnosis, and then schedule annual exams after that.
You may need to see an ophthalmologist more frequently if you are pregnant, or have more advanced diabetic retinopathy.
How Diabetic Retinopathy Is Diagnosed
A dilated fundus examination is essential for your doctor to examine your retina in detail for changes of diabetic retinopathy. This would require the use of dilating eye drops to dilate your pupil.
Further imaging tests are usually conducted as well. The main ones are:
This test sensitively assesses for macular edema. It also gives information about the status of the various nerve cell layers in the retina, and the location of areas in the macula which could be treated before fluid leakage or bleeding.
Additionally, OCT is useful in identifying membranes and scar tissue which often develop in the retina in diabetic retinopathy, and is thus helpful in planning for surgery for these conditions.
A record of your retina is made at each check, which can be helpful in making comparisons at the following visit, especially when there are specific retinopathy changes that need to be closely monitored. With ultra-wide field imaging, a panoramic view of the retina can be captured in a single image.
This is useful to determine if the disease is in the non-proliferative or proliferative phase, and can map out areas of unhealthy retina which should be especially targeted in pan-retinal photocoagulation laser treatment.
Where a good view of your retina is challenging because of significant blood dispersion in the vitreous gel, an ultrasound scan is required to make an assessment of your retinal structural status, and is helpful in planning surgery.
OCT-A is potentially useful in defining the macular blood vessel status, providing information on visual prognosis before commencing any injection or laser treatment.
Can Diabetic Retinopathy Be Prevented?
- Good diabetic control (most important factor)
The American Diabetes Association recommends that most people with diabetes keep their A1c level (a measure of average blood sugar levels over the previous two to three months) below 7% to help reduce the risk of complications. Better blood glucose control reduces the likelihood of developing diabetic retinopathy, and in patients who have diabetic retinopathy, the severity is often lower if the A1c level is better. - Good blood pressure control
Maintaining optimal blood pressure levels are also important in preventing developing diabetic retinopathy. However, once an individual has diabetic retinopathy, it is unclear if controlling blood pressure alters the course of established diabetic retinopathy. - Maintain a good cholesterol level
Managing cholesterol is recommended for overall diabetes management. Although the medical evidence is less clear whether strict cholesterol control also reduces the risk for developing diabetic retinopathy, it makes good sense to also maintain a healthy blood cholesterol level.
Diabetic Retinopathy Treatment Options
Diabetic retinopathy treatment in Singapore is tailored to the stage of the disease, the presence of macular swelling, and your overall health. At LSC Eye Clinic, treatment is planned after a detailed retinal assessment.
Close monitoring
In early, non-proliferative diabetic retinopathy, the main approach is often regular monitoring along with optimising your diabetes control. Many early changes can settle without active eye treatment.
Anti-VEGF injections
These medications are injected into the eye to reduce fluid leakage and slow abnormal blood vessel growth. They are commonly used for diabetic macular oedema and may also be used in proliferative disease. Treatment usually involves a course of injections rather than a single dose.
Steroid injections
In some cases of macular oedema that do not respond well to anti-VEGF treatment, intraocular steroid injections may be considered. Eye pressure is monitored during treatment, as it can rise in some patients.
Laser treatment
Laser treatment for diabetic retinopathy in Singapore can take different forms. Focal or grid laser targets leaking areas in the macula, while pan-retinal photocoagulation is used in proliferative disease to reduce the drive for abnormal vessel growth.
Vitrectomy surgery
For more advanced cases, such as persistent vitreous haemorrhage or retinal detachment from scar tissue, vitrectomy may be considered to remove blood and scar tissue and reattach the retina where needed.
Each option has its own role, and the most suitable approach depends on your specific findings. Your ophthalmologist will go through the options that apply to your situation so you can make an informed decision.
What to Expect During Laser or Injection Treatment
Laser treatment and intraocular injections for diabetic retinopathy are usually carried out in the clinic rather than in an operating theatre. The eye is numbed with drops, and the procedure itself often takes only a few minutes.
For injections, the eye is cleaned, anaesthetic drops are applied, and the medication is delivered through a fine needle into the side of the eye. Most patients describe a brief pressure sensation rather than sharp discomfort.
For laser treatment, you will sit at a slit-lamp microscope while the laser is applied to specific areas of the retina. You may see bright flashes during the procedure.
In many cases, patients go home the same day. Treatment is often repeated over a course of visits rather than completed in a single appointment, and the schedule will be discussed with you in advance.
Recovery and Follow-Up
After laser or injection treatment, mild irritation, watering, or temporary blurring is common and usually settles within a day or two. Your eye doctor will explain what to look out for and when to call the clinic.
Follow-up appointments form an important part of diabetic eye care. These visits allow your ophthalmologist to check how the retina is responding, decide whether further treatment is needed, and monitor for new changes.
Because diabetic retinopathy is closely linked to overall diabetes control, ongoing review with your diabetes doctor matters too. Keeping blood sugar, blood pressure, and cholesterol within recommended ranges supports the work being done on the eye.
Payment Options
We accept cash, NETS, and major credit cards.
Interest-Free Instalment Plans
Available with UOB, OCBC, DBS, and POSB bank credit cards.
Why Choose LSC Eye Clinic for Diabetic Eye Care
EXPERTISE
Experience in managing diabetic retinopathy, diabetic macular oedema, and other diabetes-related eye conditions
TAILORED CARE
Specialist assessment, treatment planning, and ongoing monitoring through the course of your condition
PATIENT EDUCATION
Clear explanations of your findings and the options available, so you can make informed decisions about your care
To book a diabetic eye assessment, get in touch with our team.
Source:1The International Diabetes Federation (IDF) Diabetes Atlas 7th Edition 2015
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Glaucoma is a group of conditions that can damage the optic nerve, often linked to raised eye pressure. Our team provides glaucoma screening, monitoring, and management, including medical, laser, and surgical options depending on the type and stage of glaucoma.
Meet Our Doctor
Dr Wong Chee Wai
Senior Consultant (Visiting)
MBBS (Singapore), M.Med (OPHTH), FAMS (Ophth), MCI (SINGAPORE), PHD (UTRECHT)
Specialty: Ophthalmology
Dr Wong Chee Wai is a senior consultant ophthalmologist with over 16 years of clinical experience and a particular focus on retinal conditions. He completed his MBBS and MMed (Ophthalmology) at the National University of Singapore, a vitreoretinal fellowship at the Singapore National Eye Centre (SNEC), a Master’s in Clinical Investigation at NUS, and a PhD in Ocular Drug Delivery at Utrecht University.
Previously with the SingHealth Group, Dr Wong established the High Myopia Clinic at SNEC and set up the vitreoretinal service at Sengkang General Hospital. He has published over 70 scientific articles in the field of ophthalmology and serves as a peer reviewer for leading journals including Ophthalmology and Investigative Ophthalmology & Visual Science.
At LSC Eye Clinic, Dr Wong sees patients for diabetic eye assessments and the management of diabetic retinopathy, diabetic macular oedema, and other retinal conditions, with a focus on clear communication and tailored treatment planning.
Frequently Asked Questions About Diabetic Retinopathy
For most people with diabetes, an annual eye examination with an ophthalmologist is a sensible starting point. People with type 1 diabetes are usually advised to begin yearly checks about five years after diagnosis, while people with type 2 diabetes are typically advised to be reviewed soon after diagnosis and yearly thereafter. More frequent visits may be recommended if you are pregnant or if retinopathy has already been detected.
Yes. Diabetic retinopathy can progress without noticeable symptoms, especially in its earlier stages. Regular eye examinations help pick up changes before vision is affected.
Mild, non-proliferative diabetic retinopathy is often managed with close monitoring and optimising diabetes control rather than active eye treatment. Your ophthalmologist will advise whether your current findings call for treatment or for regular follow-up.
Most patients find laser treatment and intraocular injections manageable. The eye is numbed with drops before the procedure, and discomfort is usually described as brief pressure or mild stinging rather than sharp pain.
The number of sessions varies. Anti-VEGF injections are often given as a course, sometimes monthly at the start and then less frequently. Laser treatment may be completed in one or several sittings depending on the area being treated. Your eye doctor will outline a schedule based on your findings.
Vision is often blurred after laser, injections, or a dilated eye examination, so it is generally advised to arrange transport home rather than drive yourself. Your clinic team will let you know what to expect for your specific procedure.
If untreated, advanced diabetic retinopathy can lead to significant vision loss through bleeding inside the eye, retinal detachment, or swelling of the macula. Treatment options become more limited at later stages, which is why regular review is encouraged.
Some early changes can settle with better diabetes control alone. More advanced changes, particularly scarring or established vessel damage, may not fully reverse, although treatment can help stabilise the condition and protect remaining vision.
