How Diabetes Affects the Eye Proposed mechanisms contributing to the microvascular damage in diabetes include the direct toxic effects of hyperglycemia, sustained alterations in cell signaling pathways, and chronic microvascular inflammation with leukocyte-mediated injury. Whatever the mechanism or combination of mechanisms, the end result is retinal blood vessel leakage, hemorrhaging, and ischemia. ther common nonretinal findings and symptoms of diabetic eye disease include fluctuations of refractive errors when glucose from the aqueous and vitreous diffuse into the natural lens. Classifications Nonproliferative diabetic retinopathy Proliferative diabetic retinopathy Diabetic macular edema Ocular Signs of Diabetic Retinopathy Microaneurysms, Fluorescein angiography Management All patients with a diagnosis of diabetes should have a comprehensive annual eye examination with dilation. Conclusion The ability to recognize these signs of diabetic retinopathy will allow for a more streamlined referral process when an ophthalmologist is required for appropriate care. If there is uncertainty, it is usually in the best interest of the patient to refer to a specialist. Patients with diabetes should have a dilated eye examination at least once a year. Those with poor glucose control or other complicating factors may be advised to have their eyes examined more often.