Diabetic Eye Care

The timing of your eye exams depends on your type of diabetes and current eye health:

• Type 1 diabetes: First exam within 5 years of diagnosis if diagnosed after puberty, then yearly
• Type 2 diabetes: Eye exam at diagnosis, then yearly
• If eye disease is found: More frequent exams every 3 to 6 months
• Well-controlled diabetes with healthy eyes: May extend to every 2 years with doctor approval

People with existing type 1 or type 2 diabetes should have an exam before getting pregnant and in the first trimester. You will then be checked each trimester and for one year after delivery based on any eye problems found. Women with gestational diabetes alone do not need special eye exams during pregnancy unless other risk factors are present.

Diabetes-related eye disease is often silent until advanced stages. Yearly dilated exams are important even when your vision seems normal. Finding retinopathy early lets us take steps to protect your sight before damage occurs that cannot be reversed. By the time you notice vision changes, significant damage may have already happened.

During your comprehensive diabetic eye exam, our eye doctors will check your eyes thoroughly for any signs of damage. We use special drops to widen your pupils so we can see the back of your eye clearly. The exam includes checking your retina, optic nerve, and blood vessels for any problems. Your vision will be blurry and light-sensitive for a few hours after the drops.

Sometimes we need special tests to get a better look at your eyes:

• Optical coherence tomography to see layers of your retina in detail
• Fluorescein angiography to check blood flow in your retina using a dye
• Fundus photography to take detailed pictures of your eye
• Visual field testing to check your side vision and blind spots
• Ultrasound to see through blood in the eye if needed

Most people with diabetes do not go blind. With good blood sugar control and regular eye exams, you can prevent serious vision problems. Early detection and treatment are very effective at protecting your sight. Modern treatments can often restore some lost vision and prevent further damage. Our eye doctors are here to help you maintain healthy vision throughout your life.

Yes, regular eye exams are essential even if your vision feels normal. Diabetic eye disease usually starts without symptoms you can notice. By the time you feel changes in your vision, the disease may be advanced and harder to treat. Regular check-ups help us catch and treat problems before they affect your sight. Think of it like checking your blood pressure, which also has no symptoms.

Diabetic eye exams are not painful, though you may feel some discomfort from the bright lights. The eye drops that widen your pupils may sting briefly when we put them in, similar to getting soap in your eyes. Your eyes will be sensitive to light and your vision will be blurry for 3 to 6 hours after the exam. Bring sunglasses and arrange for someone to drive you home if possible.

A complete diabetic eye exam usually takes 45 to 90 minutes from start to finish. This includes time for your pupils to widen after we put in the eye drops, which takes 15 to 30 minutes. The actual exam takes about 15 to 20 minutes once your eyes are ready. We take our time to thoroughly check your eye health and may need extra tests if we find any problems.

You should not drive for 4 to 6 hours after your dilated eye exam. Your vision will be blurry and you will be very sensitive to bright light. This makes driving unsafe for you and others on the road. Plan to have someone drive you to and from your appointment, or use public transportation or rideshare services. The effects will wear off completely by the next day.

Treatment options depend on what type and stage of eye problem is found:

• Anti-VEGF injections are first-line treatment for diabetic macular edema with vision loss
• Laser treatment prevents severe vision loss in advanced retinopathy
• Steroid injections or implants for certain types of swelling
• Vitrectomy surgery for bleeding or scar tissue that threatens vision
• Better blood sugar, blood pressure, and cholesterol control for all patients

Good diabetes control greatly reduces your risk of developing eye problems and slows progression if you already have some damage. However, even people with excellent control can develop some retinopathy after many years of diabetes. The longer you have diabetes, the higher your risk, regardless of control. This is why regular eye exams remain important even with good diabetes management.

Most patients say eye injections are much less painful than they expected. We use numbing drops and sometimes a numbing gel before the injection. You may feel pressure or a slight pinch, but the actual injection takes only a few seconds. Your eye may feel scratchy or irritated for a day or two afterward. Many patients are surprised how comfortable the procedure is.

Like all medical treatments, diabetes eye treatments can have side effects, but serious ones are rare. Eye injections may cause temporary eye pressure increases, infections, or retinal tears in less than 1 in 1000 patients. Laser treatment can cause some loss of side vision or night vision. Steroid treatments may increase eye pressure or speed up cataract formation. We monitor you closely for any problems.

Retinal photography and newer AI screening tools are helpful for detecting some diabetic eye problems, especially in areas where eye doctors are not available. However, they cannot replace comprehensive dilated eye exams when clinical guidelines recommend them or when problems are found. These screening tools are best used as a bridge to help more people get checked, with referral to eye specialists when needed.

Most insurance plans, including Medicare, cover annual dilated eye exams for people with diabetes because they are considered medically necessary. Treatment for diabetic eye disease is also typically covered when medically indicated. Coverage for specific treatments may vary by plan. Our office staff can help verify your benefits and work with your insurance company to get needed treatments approved.

Check your blood sugar as often as your diabetes doctor recommends, typically before meals and at bedtime for people taking insulin. Keeping your blood sugar in target range as much as possible protects your eyes from damage. Your A1C test every 3 to 6 months shows your average blood sugar control over time. An A1C below 7 percent is the goal for most adults to prevent eye complications.

Pregnancy can make existing diabetic retinopathy worse, especially if blood sugar control is poor early in pregnancy. This is why women with diabetes should have an eye exam before getting pregnant and early in the first trimester. Rapid improvements in blood sugar control during early pregnancy can sometimes temporarily worsen retinopathy. Close monitoring throughout pregnancy helps catch any changes early.

While your regular doctor may look at your eyes during routine visits, this does not replace the need for comprehensive dilated eye exams by an eye care specialist. Eye doctors have specialized equipment and training to detect early diabetic eye disease that may not be visible during a basic eye check. Your primary care doctor and eye doctor should work together as a team to protect your vision.