Good vision does not guarantee healthy eyes: Ophthalmologist explains conditions that develop silently

Dr Rishi Bhardwaj points out that not all eye conditions begin with vision loss and explains why regular checkups are necessary.

Good vision is often taken as proof that the eyes are healthy. However, according to ophthalmologist Dr Rishi Bhardwaj, it is not always a safe assumption.

“Several eye conditions can develop quietly, without pain, redness or a noticeable change in eyesight. By the time a person notices difficulty seeing, damage may already be established,” he shared with HT Lifestyle.

He noted that this is why a routine eye examination should be seen as more than a test for spectacles. It can help detect disease before symptoms become apparent. He went on to explain the conditions that can develop without apparent warning signs, which are presented as follows.

The development of glaucoma

Glaucoma is one of the clearest examples of a condition that can remain unnoticed for years, pointed out Dr Bhardwaj.

“It damages the optic nerve, often gradually, and early disease may not cause any obvious symptoms,” he stated. “Peripheral vision can slowly become affected while central vision remains clear, allowing a person to continue with everyday activities without realising that damage is taking place.”

Citing a 2026 systematic review of 13 population-based Indian studies, the ophthalmologist shared that the estimated glaucoma prevalence among people aged 40 years and older is at 3.23 percent, which can rise to 4.52 percent by 2050.

“These findings reinforce the importance of detecting glaucoma early, particularly with an ageing population,” he added.

Regular eye checkups help detect conditions early. (Unsplash)

How diabetic retinopathy develops

Diabetic retinopathy can also progress without noticeable symptoms in its early stages, noted Dr Bhardwaj, explaining, “Persistently high blood sugar can damage the small blood vessels supplying the retina, leading to swelling, leakage or abnormal blood vessel growth.”

“What makes the condition particularly concerning is that vision may remain normal while these changes are developing,” he added.

As diabetes becomes increasingly common, regular retinal evaluation is an important part of eye care for people living with the condition. “Maintaining blood glucose, blood pressure, and cholesterol at normal levels, along with regular eye tests, can enable the early detection of retinal changes and hence minimise the risk of visual impairment,” shared the ophthalmologist.

What a routine eye examination can reveal

Dr Bhardwaj highlighted that a comprehensive eye examination looks beyond visual acuity. Depending on age, medical history and risk factors, an ophthalmologist may assess eye pressure, examine the optic nerve and retina, test peripheral vision and use retinal imaging or pupil dilation when required.

“These assessments can identify structural or vascular changes that cannot be detected by reading a vision chart,” he noted.

“People living with diabetes should be consistent with retinal screening and should keep blood sugar, blood pressure and cholesterol under control. Those with a family history of glaucoma, increasing age or other risk factors may also need more frequent examinations,” added the ophthalmologist.

He pointed out that one of the most common mistakes is to schedule an eye examination only after vision changes. The approach does not work well for diseases that can remain silent for years. Regular examinations provide an opportunity to identify early changes, establish a baseline and begin treatment or monitoring before significant vision loss occurs.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

Dr Rishi Bhardwaj is a consultant in the Department of Ophthalmology at Paras Health, Gurugram.