Having regular eye exams is extremely important for people with diabetes. Diabetes can cause damage to the small blood vessels in the retina at the back of the eye, a condition known as diabetic retinopathy. This damage can lead to vision problems and even blindness if left untreated. So how often should people with diabetes have their eyes checked by an eye care professional?
Summary Recommendations
The main recommendations from experts for diabetics getting their eyes checked are:
- Adults with type 1 diabetes should have an initial dilated eye exam within 5 years after diagnosis.
- Those with type 2 diabetes should have an initial dilated eye exam shortly after diagnosis.
- After the initial exam, annual dilated eye exams are recommended for all diabetics.
- Pregnant women with diabetes should have a dilated eye exam during their first trimester because retinopathy can progress quickly during pregnancy.
- More frequent exams may be needed for those with signs of diabetic retinopathy or other risk factors.
Initial Eye Exam
Since diabetes causes damage to blood vessels over time, it’s important to get a baseline eye exam soon after being diagnosed with diabetes. This gives the eye doctor a chance to evaluate the eyes for any existing issues and look for signs of diabetic retinopathy.
For adults diagnosed with type 1 diabetes, major organizations like the American Diabetes Association recommend having an initial dilated eye exam within 5 years after the onset of diabetes. Those who have had diabetes for longer than 5 years should have an exam right away.
For people with type 2 diabetes, the recommendations are to have the first eye exam shortly after diagnosis because retinopathy can begin to develop even before diabetes symptoms appear. Some experts advise getting the initial exam immediately upon diagnosis.
Annual Eye Exams
After the initial evaluation, the American Diabetes Association recommends that people with diabetes have a dilated eye exam at least once a year. This applies to those with type 1 diabetes, type 2 diabetes, and gestational diabetes.
Annual exams allow early detection of diabetic retinopathy progression and close monitoring for other diabetes-related eye problems. The eye doctor can check for signs like:
- Retinal swelling
- Pale, fatty deposits on the retina (exudates)
- Damaged blood vessels (hemorrhages)
- Fluid leakage
- Abnormal blood vessel growth
Catching retinopathy early improves the chances of preventing vision loss. Plus, controlling diabetes and associated risk factors (blood pressure, cholesterol, etc) is vital to preventing retinal damage from getting worse.
Eye Exams During Pregnancy
Pregnant women who have diabetes (type 1, type 2, or gestational diabetes) are at higher risk for developing diabetic retinopathy. The fluctuating hormones and increased insulin resistance during pregnancy can cause retinopathy to progress quickly.
The recommendation is for pregnant women with diabetes to have a dilated eye exam during their first trimester. Eye doctors then determine if follow up exams are needed during the remainder of the pregnancy. Prompt treatment can improve outcomes for both the mother and baby.
More Frequent Exams
While yearly eye exams are the standard, some diabetics require exams more often than once a year due to certain risk factors. These include:
- Uncontrolled blood sugar levels – Hemoglobin A1C over 7%
- High blood pressure
- Kidney disease
- Use of insulin
- Pregnancy
- Puberty
- Rapid retinopathy progression
- Previous retinal laser surgery
Those with signs of diabetic retinopathy also need follow-up exams more frequently than once a year. How often depends on the severity:
| Retinopathy Severity | Exam Frequency |
|---|---|
| Mild nonproliferative retinopathy | Every 6-12 months |
| Moderate-severe nonproliferative retinopathy | Every 3-6 months |
| Proliferative retinopathy | Every 1-3 months |
Pregnant women with existing retinopathy also need follow up exams each trimester until delivery.
What Happens During an Eye Exam?
A comprehensive eye exam for people with diabetes involves several important components:
- Visual acuity test – This involves reading letters on a Snellen chart to assess sharp, clear vision.
- Refraction – This test determines if glasses or contact lenses are needed to correct vision problems like nearsightedness.
- Tonometry – An instrument applies gentle pressure to the eye to measure internal eye pressure.
- Pupil dilation – Eye drops enlarge the pupils so the retina and optic nerve can be thoroughly examined.
- Retinal exam – The optometrist or ophthalmologist examines the retina and optic nerve using specialized instruments to check for signs of diabetic retinopathy.
The eye doctor will discuss the results of the exam and recommend any necessary treatment and follow up. Prompt laser surgery or injections may be needed for cases of advanced diabetic retinopathy to prevent severe vision loss.
Telemedicine Eye Exams
Some eye doctors now offer telemedicine eye exams for people with diabetes. These virtual visits allow patients to get their eyes examined without having to go into a clinic. The patient uses a smartphone or computer webcam so the eye doctor can assess their eyes in real-time.
Telemedicine exams include visual acuity testing and often imaging of the eyes. However, the technology doesn’t yet allow for a dilated retinal exam remotely. Patients with concerning findings may need to subsequently go to an eye clinic for a full dilated eye exam.
Special Considerations
Here are some other important tips related to eye exams for people with diabetes:
- Make sure to get your eyes dilated because this allows for the most comprehensive view of the retina.
- Visit an optometrist or ophthalmologist who specializes in diabetic eye disease.
- Don’t miss exams even if your vision seems fine.
- Know your target blood sugar, blood pressure, and cholesterol numbers.
- Quit smoking and manage other health conditions to lower eye disease risks.
- Call your eye doctor right away if you notice any vision changes.
The Bottom Line
Regular eye exams are extremely beneficial for identifying diabetic retinopathy in the early stages. This gives the best chance for preventing permanent vision damage. Most experts recommend annual dilated eye exams for people with all types of diabetes. Those with additional risk factors or existing retinopathy may need exams more frequently. Staying on top of exams and promptly treating abnormalities allows many people with diabetes to maintain good vision.
