Diabetic retinopathy is a specific neurovascular complication of diabetes. The early stage is microaneurysms, then haemorrhages and ischaemia; in response to ischaemia comes neovascularisation — this is proliferative diabetic retinopathy (PDR). At any stage the vessels may leak — diabetic macular oedema (DME). ADA 2026 calls diabetic retinopathy the most frequent cause of new cases of blindness among adults aged 20–74 in high-income countries.
Why the examination happens on the day T2DM is diagnosed, and not "when things get blurry". A person with T2DM may have had undiagnosed hyperglycaemia for years; significant retinopathy at onset is not rare. ADA 2026 Recommendation 12.4 is level B. The MoH RK 2022 protocol puts the fundus camera in the annual minimum; the RK endocrinology care standard requires fundus photography immediately after T2DM is diagnosed. Visual complaints are a late filter: sight-threatening retinopathy may be asymptomatic.
Intensive glycaemic and antihypertensive control reduce the risk or slow progression — Recommendations 12.1 and 12.2, level A, based on large prospective RCTs including UKPDS. This is an effect, not an association. Photocoagulation and anti-VEGF change a different endpoint: not the prevention of onset, but the treatment of threatening forms.
When to refer urgently. Recommendation 12.9, level A: any DME, moderate or worse non-proliferative retinopathy, any PDR — to an ophthalmologist who manages these conditions. Panretinal laser photocoagulation reduces the risk of severe vision loss in high-risk PDR: in the Diabetic Retinopathy Study the risk of severe vision loss fell from 15.9% in untreated eyes to 6.4% in treated eyes (DRS, cited in ADA 2026, §12). Vascular endothelial growth factor (anti-VEGF) inhibitors are a reasonable alternative to laser in some PDR and first line in centre-involving DME that reduces visual acuity (12.11, 12.12, level A). Retinopathy does not preclude aspirin for cardioprotection: it does not increase the risk of retinal haemorrhage (12.14, level A).
A caution the course names, without inflating it into a "GLP-1 ban". ADA 2026 records conflicting data on the effect of GLP-1 receptor agonists on the eye, including slight worsening of retinopathy in RCTs of liraglutide, semaglutide and dulaglutide, and an association between rapid HbA1c lowering and early worsening of retinopathy. Retinopathy status is assessed when glucose-lowering therapy is intensified. This is not a reason to withdraw a nephro- and cardioprotective class "just in case". It is a reason not to intensify blindly in a person whose fundus has not been examined.
Pregnancy with pre-gestational diabetes is a zone the course only marks: examination before conception and in the first trimester, then according to severity (12.7, 12.8). Gestational diabetes by itself does not require examinations "as in diabetes" during that pregnancy (ADA 2026, §12). The details are not part of this course.
The conclusion. Retinopathy is beaten by the one who examines the fundus before complaints and does not confuse prevention by glycaemic control with treatment by laser and anti-VEGF.