An 68-year-old man with type 2 diabetes has gradual vision loss and hasn't attended diabetic eye screening for 3 years. What is the most appropriate diagnosis?

• A. Glaucoma
• B. Retinopathy
• C. Cataract
• D. Macular degeneration

Answer: (B)

Diabetic retinopathy is caused by damage to the retinal blood vessels from chronic hyperglycemia in diabetes. This condition often progresses quietly and can lead to gradual vision loss, especially if regular diabetic eye screening hasn’t been done for years. Screening is crucial because it detects retinopathy early, before vision is affected, allowing timely treatment to prevent or slow vision loss. The other conditions are less tied to a lack of diabetic screening: glaucoma involves optic nerve damage with sometimes peripheral vision loss and is not specifically linked to screening history; cataracts cause lens clouding and overall blurred vision common with aging; macular degeneration is age-related and not driven by diabetes screening status. In this context, the history of diabetes with extended missed screening makes diabetic retinopathy the most likely diagnosis.