More than seven in ten people living with diabetes in Indonesia do not know they have the disease, a diagnostic gap that is allowing a largely asymptomatic eye complication to progress unchecked toward blindness. Integrated data from the national health insurer BPJS Kesehatan, analysed by researchers at Universitas Gadjah Mada, indicate that among the 12 million diagnosed diabetes patients who regularly access care, roughly 5.2 million already show signs of diabetic retinopathy. Of those, 1.2 million require advanced interventions—laser therapy, intraocular injections, or surgery—to prevent severe vision loss.

Diabetic retinopathy develops when chronically elevated blood glucose damages the tiny vessels supplying the retina, the light-sensitive tissue at the back of the eye. Because the damage occurs inside the globe, the eye appears normal externally, and early-stage disease produces no pain or noticeable blurring. Patients often attribute gradual dimming, reduced colour saturation, or subtle loss of sharpness to ageing or cataract, delaying examination until the condition is advanced. A population study in Yogyakarta found retinopathy prevalence of 43.1 percent among diabetes patients, well above the global average of 35.4 percent, underscoring the intensity of the challenge in the archipelago.

Specialists in Jakarta and Yogyakarta stress that the same microvascular injury driving retinal damage also manifests elsewhere. Uncontrolled diabetes is a leading cause of kidney failure requiring dialysis, and it contributes to peripheral neuropathy that, combined with poor circulation, produces diabetic foot ulcers—a condition that accounted for over 45,000 recorded complications in Brazilian state capitals over a decade, with numbers tripling between 2008 and 2018. In men, chronic hyperglycaemia can damage nerves and blood vessels supplying the penis, making erectile dysfunction an early physiological marker of underlying metabolic disease, a pattern noted by clinicians in both Indonesia and Russia.

The immediate priority identified by Indonesian endocrinology and ophthalmology societies is systematic retinal screening at primary-care level, using portable fundus cameras to detect changes before symptoms appear. Because retinopathy cannot be reversed, only slowed, the clinical consensus is that every person with diabetes should undergo a retinal examination at diagnosis and at regular intervals thereafter, with frequency tailored to individual risk. The next milestone to watch is the scale-up of such screening within the national health system, where coverage remains uneven and the economic burden of preventable blindness is projected to reach Rp 84.7 trillion.