Ophthalmic Opticians or Optometrists - are different titles for the same qualifications. This group is qualified to fully examine the eyes. If there are any abnormalities or suspected abnormalities then they refer the person to their GP or directly to the hospital if it is an emergency situation. They also test for glasses and to fit and supply them. They may be 'high street' opticians or hospital based.

NB If you have diabetes and you are having an eye check with an optician/optometrist, it is important that he/she carries out an eye examination with drops to enlarge the pupil so that he/she can observe more of the retina. If necessary, you should ask for this to be done, especially if you are not having this done at the hospital as part of your diabetes care.

Consultant Ophthalmologist - this is the hospital consultant to whom the GP refers people with suspected abnormalities and he/she carries out the necessary treatment or surgery.

REMEMBER

Visual difficulties can affect people with or without diabetes but the one thing that insulin-treated people have to do is be able to inject the accurate amount of insulin. While visual difficulties may not prevent many activities, not being able to do your own injections [and blood glucose tests] results in a loss of independence, especially for people who live alone. There are also many everyday things that fully sighted people take for granted but these become difficult or impossible for people with visual impairment.

Alsion Blackburn has had diabetes for many years and is visually impaired as a result of diabetic retinopathy. She shares with us some of the tips she has picked up over the years that her sight was deteriorating that have enabled her to maintain her independence and ability to do many of the everyday things in life.

- There are a variety of pens available and they have clicking devices so that you can count the clicks to know how many units you are injecting.

- There are pre-filled disposable pens available for some brands of insulin and this means that you do not have to re-load the pen when a cartridge runs out. This can be easier for people with visual impairment [and for people with hand movement problems].

- Magnifiers are available that fit on to the pen.

While a pen injector may seem ideal, not everyone likes to use them and many people still prefer to use syringes for their injections. Here are a few of Alison's tips:

- Syringe magnifiers that slot over a disposable syringe are available.

- If you take the same dose of insulin regularly, score the outside of the syringe at your dose and then draw up to this mark. If you take two different doses, morning and evening, score two syringes but make sure you keep them in different places.

- If seeing the clear insulin is difficult then hold a coloured card behind the syringe for a better contrast making sure that the colour is one that you can see well. If you 'haven't enough hands' pin the card to the wall or a door.

- Syringes are available in different sizes, 100ml, 50ml and 30ml. If your dose is small enough choose the smallest size syringe because the markings are further apart and easier to see - 30ml are easier to see than 50ml and 50ml easier than 100ml.

- A nurse or relative can draw up a week's supply of insulin in syringes and leave them in the fridge. Again if the dose or type of insulin is different at different times of the day, make sure that the morning syringes are stored on the top shelf and the evening ones on the bottom shelf. If using longer-acting cloudy insulin, then make sure that you roll the syringe about 20 times to ensure that the insulin is mixed properly before injecting.

- If you make tea or coffee from leaves or powder then use the old-style sugar dispensers that were used in transport cafes. This way you get a limited amount of powder each time you tip up the dispenser. This is also a useful way of measuring custard powder, gravy etc.

- For people with poor eyesight, powders can be stored in large clear coffee jars. If these are held up to the light, it is possible to see the colour of the powder.

- If this doesn't work then powders and foodstuffs can be stored in jars or canisters that are labeled with tactile buttons that you can feel. Self-adhesive buttons jelly like buttons can be purchased and you can stick different numbers of jars with different contents or place the buttons on a different part of the jar. Rubber bands work just as well and are cheaper! It is important that other members of the family don't move the buttons or bands otherwise you may be making coffee with gravy powder!

- When storing foods stack in a regular, particular way so that you know the order.

- Always store cleaning materials well away from food stuffs.