When you have diabetes, your daily to-do list is long: Carefully monitor your blood sugar levels, closely manage blood pressure, watch what you eat, juggle different medications, pay attention to changes in your circulation … and so on. 

No wonder keeping an eye on diabetic eye problems rarely ranks near the top. 

Diabetes-related eye conditions are the leading cause of vision impairment and blindness among working adults. Yet, when researchers surveyed adults with diabetes in six different countries, although 50 percent said they were concerned with vision loss at the time of diagnosis, 75 percent said the problem was a remote risk or was not really concerning. 

If you have diabetes and find yourself nodding in agreement, you might want to reconsider. According to the American Diabetes Association, people with diabetes are more likely to get cataracts (which cause cloudy vision), compared to people who don’t have diabetes. 

What’s more, almost everyone with type 1 diabetes and most people with type 2 diabetes will develop a form of diabetic retinopathy, a condition that can lead to low vision. (Think, needing a magnifying lens to read your emails or use your smartphone.)

Diabetic retinopathy happens when high blood sugar levels cause tiny blood vessels in the eye to weaken and leak. The leaking fluid sparks a host of vision problems that you won’t be able to brush aside. You have a higher chance of developing diabetic retinopathy if you've had diabetes for more than 10 years. You're also at a higher risk if you have poor blood sugar and blood pressure control; are dependent on insulin; and if your A1C is above 7 percent.

Stay alert for these three warning signs that diabetes is stirring up trouble. If you experience any of them, book an appointment with your eye doctor right away.

Diabetic Eye Problem Warning Sign #1: A Burst of Floaters

Diabetic retinopathy in its early stages is often free of symptoms, says Rahul N. Khurana, M.D., a vitreoretinal surgeon with Northern California Retina Vitreous Associates Medical Group and clinical spokesperson for the American Academy of Ophthalmology.

“But when the abnormal blood vessels burst, people see a lot of floaters because the fluid in the eye starts to fill up with blood,” says Dr. Khurana. Even just a few floaters—which are small moving shapes that drift in and out of your line of sight—may signal that a new blood vessel burst, so tell your eye doctor about that too.

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Diabetic Eye Problem Warning Sign #2: A Blind Spot in the Center of Your Vision

Weak blood vessels can also cause leaking into the macula, part of the retina at the center of the eye. The macula’s main job is to make sure that what’s right in front of you is crystal clear, so if it fills up with blood or a fluid called exudate, which is made of proteins, cells, and solid materials, you may notice a blind spot at the center of your vision. 

This can happen slowly or suddenly, but as soon as you notice it, you should get it checked out. Blood vessel changes like these go hand in hand with nerve damage that is “the final common pathway for vision loss,” according to a team of eye health experts who put together the American Diabetes Association’s 2018 position statement on diabetic retinopathy. 

Diabetic Eye Problem Warning Sign #3: Flashes and Blurry Vision

As retinopathy progresses, you are at risk for a retinal detachment. According to the American Academy of Ophthalmology, the retina can pull away from the back of the eye if there are too many abnormal blood vessels or a buildup of scar tissue behind the retina. If it tears away completely—retinal detachment—it can cause a sudden and total loss of vision in the affected eye. 

The Best Preventive Medicine for Diabetic Eye Problems

Along with following your diabetes treatment plan to keep your blood sugar under control, don't skip your annual eye exam. Your eye doctor can help you monitor any vision changes and recommend treatments that can stop or reverse damage from many types of diabetes-related eye conditions. 

Even more exciting—improvements to treatments are being made all the time. For example, the Journal of Ophthalmology reported in 2018 that therapy using anti–vascular endothelial growth factor medicines, which are injected into the eye, has replaced laser surgery as the gold standard for treating blood vessel problems in the retina.

Laser treatments are also being tweaked to make surgery quicker and recovery easier. In addition, early diagnosis often leads to a better outcome, says Dr. Khurana. Eye doctors have more options at their disposal when symptoms begin—or before. This includes low-vision therapy, low-vision aids, and various medications.  

In best-case scenarios, he says, eye doctors are able to stop or even reverse any vision loss that has already occurred.