Diabetic Retinopathy in Pakistan: Going Blind Without Knowing It — and How Early Eye Examination Changes Everything

Pakistan is home to an estimated 33 million people living with diabetes — the third highest number in the world. Most of them do not know they have it. And of those who do, the vast majority have never had their eyes examined. This is the foundation of a blindness crisis unfolding in slow motion across the country. Diabetic retinopathy — the damage diabetes causes to the blood vessels of the retina — is the leading cause of preventable blindness in working-age adults globally. It causes no pain. It causes no blurred vision until significant, often irreversible damage has already occurred. And it is entirely detectable through clinical eye examination.

Table of Contents

• What Is Diabetic Retinopathy and Why Does It Happen
• Why It Goes Undetected Until It’s Too Late
• Pakistan’s Specific Risk — Why the Numbers Are Alarming
• What an Eye Examination Catches That You Cannot Feel
• CARELINE’s Remote Ophthalmology Assessment
• How to Book
• Frequently Asked Questions

What Is Diabetic Retinopathy and Why Does It Happen

The retina is the light-sensitive layer at the back of the eye. It is supplied by a dense network of tiny blood vessels — some of the most delicate in the human body. Chronically elevated blood sugar, the defining feature of uncontrolled diabetes, damages these vessels over time in a specific and progressive way.

In the early stages — non-proliferative diabetic retinopathy — the vessel walls weaken and develop small bulges called microaneurysms. These can leak fluid or blood into the retina. The macula — the central part of the retina responsible for sharp, detailed vision — can swell as a result, causing diabetic macular oedema. At this stage, vision may still be entirely normal to the patient.

As the disease progresses to proliferative diabetic retinopathy, the retina responds to oxygen deprivation by growing new, fragile blood vessels across its surface and into the vitreous gel of the eye. These vessels bleed easily and extensively. Scar tissue forms. In advanced cases, the retina can detach entirely — causing sudden, severe, often permanent vision loss.

The entire journey from healthy retina to devastating vision loss can span a decade or more — during which a clinical examination would catch every stage, and intervention at any early stage would preserve vision.

Why Diabetic Retinopathy Goes Undetected Until It’s Too Late

The retina has no pain receptors. Early diabetic retinopathy causes no discomfort whatsoever. Macular oedema can reduce central visual acuity before the patient notices anything wrong — and even then, the deterioration is so gradual that it is easy to attribute to ageing, tiredness, or needing new glasses.

By the time a patient reports blurred vision, floaters, or dark patches to a doctor, they are almost always describing proliferative retinopathy or advanced macular oedema — conditions that are significantly harder to treat and carry a much higher risk of permanent vision loss than the same disease caught six months earlier.

The clinical guideline in every country with a functioning diabetes programme is clear: every person with diabetes should have a dilated fundus examination or retinal imaging at least once a year, from the point of diagnosis. This guideline exists because it works — countries that implement screening programmes reduce diabetes-related blindness by 90% or more. The examination is straightforward. The barrier, in Pakistan, is access.

Pakistan’s Specific Risk — Why the Numbers Are Alarming

The World Health Organization estimates that Pakistan has the third-highest number of people with diabetes in the world. Studies indicate that approximately 34% of people with diabetes develop some degree of diabetic retinopathy — meaning, conservatively, that over 11 million Pakistanis may currently have retinal changes from diabetes.

Of those, the overwhelming majority have never had their retinas examined. Pakistan has a severe shortage of ophthalmologists relative to its population — fewer than 2 ophthalmologists per 100,000 people, compared to a recommended minimum of 4. Those who exist are concentrated in major urban centres. For the vast majority of Pakistanis with diabetes, specialist eye care is inaccessible not because it does not exist, but because reaching it requires time, money, and proximity that most patients do not have.

The result is that diabetic retinopathy in Pakistan is consistently caught late — at the proliferative stage, when treatment is difficult, expensive, and less likely to fully restore vision — rather than early, when laser treatment, anti-VEGF injections, or simple glycaemic management can preserve sight entirely.

Vision loss is not just a medical tragedy. It is an economic one. A working-age adult who loses central vision loses their ability to read, drive, work, and care for their family. The cost of preventable blindness — in productivity, dependency, and quality of life — is enormous and entirely avoidable.

What an Eye Examination Catches That You Cannot Feel

A clinical ophthalmological examination — using a fundoscope or retinal imaging device — allows a doctor to directly visualise the retina and identify changes that the patient has no awareness of:

• Microaneurysms — The earliest visible sign of diabetic retinopathy. Tiny dots of weakened vessel wall visible under magnification. The patient sees nothing. The doctor sees the beginning of a process that, if unchecked, ends in blindness.
• Retinal haemorrhages — Dot, blot, or flame-shaped bleeds within retinal layers. Each one represents a vessel that has failed. The pattern and distribution tell a doctor how advanced the disease is and where it is heading.
• Hard exudates — Yellow deposits of leaked lipid in the retina, indicating that vessel walls are no longer containing their contents. When these form near the macula, vision loss is imminent.
• Macular oedema — Swelling of the central retina from fluid accumulation. This is the most common cause of vision loss in diabetic eye disease and is highly treatable when caught before irreversible structural change occurs.
• New vessel formation (neovascularisation) — Fragile new blood vessels growing across the retinal surface. This marks the transition to proliferative retinopathy — the stage at which vitreous haemorrhage and retinal detachment become serious risks. Urgent treatment at this stage prevents catastrophic vision loss.
• Optic disc changes — Swelling or new vessels at the optic nerve head indicate advanced disease requiring immediate referral.

Every one of these findings changes what happens next. The earlier they are identified, the more options exist — and the more vision can be preserved. The window between “detectable on examination” and “causing irreversible damage” is the window that a regular retinal check keeps open.

CARELINE’s Remote Ophthalmology Assessment — Specialist Eye Examination at Your Pharmacy

CARELINE’s remote clinical examination service includes ophthalmological assessment — retinal and eye examination conducted at your nearest partner pharmacy using Finland’s eEVA™ device.

The eEVA™ device is equipped with a high-resolution ophthalmoscope that captures clear imaging of the retina and transmits it in real time to a qualified doctor. The doctor visualises the optic disc, macula, retinal vasculature, and peripheral retina — exactly as in a specialist clinic — and identifies any signs of diabetic change, hypertensive retinopathy, or other pathology.

Combined with blood pressure measurement and SpO₂ monitoring — which together paint the full cardiovascular and metabolic picture — a CARELINE examination gives a person with diabetes the annual retinal assessment their condition requires, without a hospital appointment, without waiting months, and without travelling across the city.

Ophthalmology sits alongside cardiology, pulmonology, ENT, dermatology, and general medicine in CARELINE’s scope of assessment. Learn how the examination works. CARELINE is DRAP-licensed, operating with Finland’s 73Health platform under EU GDPR data standards. Learn more about CARELINE.

Who Should Book a CARELINE Eye Examination — And When

If you have diabetes — whether recently diagnosed or long-standing — you should have your retinas examined now, and every year thereafter. This is not precautionary. It is the clinical standard of care for diabetes management worldwide.

The risk is also relevant for people with uncontrolled hypertension (which causes hypertensive retinopathy through identical vascular mechanisms), those with a family history of glaucoma, and anyone over 50 who has not had an eye examination in more than two years.

Book your CARELINE examination in two minutes. WhatsApp +92 310 2145333. Your nearest partner pharmacy, under 20 minutes, a doctor reviewing your retinal images in real time.

Frequently Asked Questions

What is diabetic retinopathy and can it be cured?

Diabetic retinopathy is damage to the blood vessels of the retina caused by chronically elevated blood sugar. Early stages can be halted or reversed with good glycaemic control and targeted treatment (laser therapy or anti-VEGF injections for macular oedema). Advanced proliferative retinopathy and retinal detachment are much harder to treat. Early detection — before irreversible change — is when treatment is most effective.

How often should a diabetic patient have their eyes examined?

Every person with type 1 or type 2 diabetes should have a dilated fundus examination or retinal imaging at least once per year — from the time of diagnosis. Those with existing retinopathy may need examination every three to six months. In Pakistan, most diabetic patients have never had this examination at all.

Can I have diabetic retinopathy with normal vision?

Yes — this is what makes it so dangerous. Early and moderate non-proliferative retinopathy, and even early macular oedema, can be present with completely normal visual acuity. Patients report no symptoms until the disease is advanced. Only a direct clinical examination of the retina reveals the true picture.

Does CARELINE’s examination replace a full ophthalmology clinic?

CARELINE’s assessment provides a qualified clinical review of the retina that covers the key findings of diabetic eye screening — including microaneurysms, haemorrhages, exudates, macular oedema, and neovascularisation. Where advanced intervention is required (laser treatment, intravitreal injections, surgical management), CARELINE will refer appropriately. The examination is designed to catch disease early — which is precisely when referral and treatment are most effective.

Is the examination painful?

No. Retinal examination using the eEVA™ ophthalmoscope is entirely non-invasive. There is no contact with the eye and no discomfort involved.

Is CARELINE available in my city?

CARELINE currently operates across Karachi with expansion underway to Lahore and Islamabad. WhatsApp +92 310 2145333 to confirm your nearest partner pharmacy.

Book your CARELINE eye examination today.
Pakistan’s diabetes crisis is producing a blindness crisis. You do not have to be part of it.

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📧 contact@thecareline.org
Specialist-grade remote eye examination. At your nearest pharmacy.