World Diabetes Day is held every year on 14 November. While diabetes is commonly associated with blood glucose management, its impact extends far beyond blood sugar. One of the most significant complications is damage to eye health, which can directly increase the risk of falls and fall-related injuries. For health professionals and those working with older adults, understanding this relationship is important to support healthy ageing and reduce the risk of falls.
Why eye health matters in falls prevention
Vision plays a vital role in balance, mobility, and navigating everyday environments. It helps people judge distances, avoid hazards, identify changes in surface levels, and move safely through their surroundings. When vision is impaired, falls become more likely. For people living with diabetes, this risk is particularly important. Diabetes can affect eye health in several ways, including:
- Diabetic retinopathy (damage to the blood vessels in the retina)
- Diabetic macular oedema (swelling in the central part of the retina)
- Cataracts (a clouding of the natural lens inside the eye)
- Glaucoma (a buildup of fluid pressure inside the eye which damages the optic nerve)
These conditions can cause blurred or patchy vision, reduced contrast sensitivity, glare sensitivity, impaired depth perception, difficulty seeing in low light, and loss of peripheral vision.
Impact of diabetes- related eye disease
Diabetic eye disease often develops gradually and may not cause noticeable symptoms in its early stages. As a result, older adults may be unaware that their vision has changed until it begins to affect everyday activities.
Research continues to show a strong relationship between diabetic retinopathy, vision impairment, and falls. Individuals experiencing both diabetic retinopathy and vision impairment have been found to experience higher rates of falls and fall-related injuries than those without these conditions.
Beyond increasing falls risk, vision loss can contribute to reduced confidence, decreased physical activity, social isolation, and loss of independence, factors that can further affect health and wellbeing.
What can you do to support older adults with diabetes
Diabetes management, eye health, and falls prevention should not be viewed as separate issues. A holistic approach can help identify risk factors early and support older adults to remain active and independent.
Health professionals and those working with older adults can:
Encourage Regular Eye Examinations
Regular comprehensive eye examinations are one of the most effective ways to detect diabetes-related eye disease before symptoms occur. Diabetes Australia recommends regular diabetes eye checks from the time diabetes is diagnosed, with ongoing monitoring to identify and treat changes early.
Include Vision in Falls Risk Assessments
When discussing falls risk, ask questions about:
- Recent changes in vision
- Issues with balance
- Difficulty seeing steps, kerbs, or uneven surfaces
- Night-time vision challenges
- Glare sensitivity
- Recent eye examinations
Vision should be considered alongside other falls risk factors such as balance and mobility, strength, medication use, foot health and nutrition.
Promote Physical Activity
Regular physical activity supports diabetes management while improving balance, mobility and strength. Activities such as strength training, tai chi, and balance exercises can help reduce falls risk and support overall health.
Support Home Safety
For people experiencing vision changes, small environmental modifications can make a significant difference. Encourage:
- Good lighting throughout the home
- Removal of trip hazards
- Securing loose rugs
- Installation of handrails and grab rails where needed
- Clear contrast between steps and flooring surfaces
Reinforce diabetes self-management
Maintaining healthy blood glucose, blood pressure, and cholesterol levels can help reduce the risk of diabetes-related eye disease and its progression.
By encouraging regular eye checks and considering vision during falls risk assessments, health professionals and those working with older adults can help prevent falls and support healthy ageing.