Diabetic Eye Exams

Diabetic eye examinations are necessary for anyone who has diabetes because of the strong connection between the disease and vision problems. Someone with diabetes should have at least one eye exam per year.

Examples of eye diseases related to diabetes include:

• Cataracts
• Glaucoma
• Diabetic retinopathy
• Diabetic macular edema

Routine eye exams and diabetic eye exams are similar to each other, but in a diabetic eye exam the ophthalmologist looks particularly close at the optic nerve (macular), the retina, and blood vessels in the eyes.

Intro

Diabetes is a lifelong health condition that occurs when your pancreas no longer produces enough insulin, an essential hormone that controls glucose levels in your body.

When insulin production decreases, the level of glucose in your body increases, causing high blood-sugar levels that can cause damaged blood vessels.

Studies show that people with diabetes are at a high risk of developing a range of eye conditions. 

What happens is the eye’s damaged blood vessels can cause fluid leakage and eye swells leading to different diabetic-related eye diseases. Examples of diabetic eye diseases include:

• Diabetic retinopathy (DR). This happens when blood vessels weaken in the retina, possibly resulting in blood leaks.
• Diabetic macular edema. This is the advanced stage of diabetic retinopathy as it destroys sharp vision in the macular, the middle part of the retina used for reading and seeing objects. 
• Cataracts. A common occurrence which causes blurry vision by clouding the lens of your eye.
• Glaucoma. A condition caused by pressure in the eye, it can lead to vision loss or blindness if untreated.

If diabetes goes undetected for too long, you will likely have poor vision or possibly lose your eyesight. It makes regular eye examinations essential.

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Why You Need Diabetic Eye Exams

The need for eye exams if you have diabetes is imperative because you can correct some diabetic eye diseases such as cataracts if detected early. For instance, diabetic retinopathy has no symptoms when it starts, but it can cause blindness.

Additionally, routine diabetic eye exams can give you clues to a decline in cognitive ability. Studies show:

• Diabetes doubles your risk of developing open-angle glaucoma and makes you two to five times more likely to develop cataracts.
• 1 of 5 people with diabetes develops diabetic macular edema.
• The longer you have diabetes, the higher the chances of developing diabetic retinopathy.
• Signs of diabetic retinopathy are common in a third of people with diabetes age 40 and above.
• You can reduce the risk of blindness by 95 percent by finding and treating diabetic retinopathy early.

What Goes into a Diabetic Eye Exam?

A diabetic eye exam involves screening the eyes to detect eye problems caused by diabetes. An ophthalmologist usually administers the exam. It goes like this:

Before the Diabetic Exam

Request someone to either come with you or pick you up the day of the exam. It is because your eyesight may remain blurry for a few hours after the checkup.

Bring your glasses, sunglasses, or contact lenses and contact lens solution because after the exam, everything can look very bright for a few hours because your eyes have been dilated.

During the Diabetic Exam

Once you settle down for the test, your doctor will ask about your medical history then do a visual acuity test. This test involves reading some letters on a chart at a distance.

Your doctor’s primary focus will be your retina and blood vessels in the eye. The next step is measuring your eye pupil. Your doctor or a technician will place some stingy drops in your eyes which will blur your vision after about 30 minutes. The eye drops will dilate your pupils to enable the doctor to see the inner structures of your eye.

Your eye doctor may recommend further tests such as fluorescein angiography and optical coherence tomography. In fluorescein angiography, the ophthalmologist will inject a special dye into your left arm to highlight any damage in your eye’s blood vessels.

After that, they may conduct an optical coherence tomography, where you will look into a bright, flashing camera as the ophthalmologist takes a picture of the back of your eye. They will use the images and the visual acuity test to identify the underlying eye problem.

After the Test

Remember not to drive or walk alone because of blurred vision that could last up to six hours. Do not forget to put on your glasses to protect your eyes from bright light. You may have to wait several weeks to learn the exact results of your test.

Return to the eye clinic if:

• The painful eye worsens
• Your eye turns red
• You still have blurred vision six hours later

How Often Should You Get a Diabetic Eye Exam?

If you have type 2 diabetes, you should schedule a regular annual checkup for diabetic retinopathy.

For type 1 diabetics, go for a checkup within the first five years of your final diagnosis. Once the five years have elapsed, visit the nearest ophthalmologist at least once or twice a year.

Pregnant women with type 1 and type 2 diabetes should undergo a diabetic eye exam within:

• The first three months
• Later during pregnancy if required by your doctor
• Once your baby turns 1 year old

Generally, any diabetic patient 12 years or older should have an annual eye checkup to take charge of their eyes’ health.

Diabetic vs. Regular Eye Exam

Diabetic eye exams and regular eye checkups are similar. The significant differences revolve around the area of focus and methods to achieve the result.

In a diabetic eye exam, the ophthalmologist focuses on the optic nerve (macular), the retina, and the blood vessels of your eyes. On the other hand, during regular eye tests your eye doctor takes note of the eye’s current status.

In addition, optimal retinal imaging is a procedure mainly used to examine diabetic retinopathy by dilating the pupils. This step is not necessary for a regular eye checkup.

Lastly, you will get feedback the same day after a regular eye exam. However, it can take up to six weeks to receive your test results after the more extensive diabetic eye screening. 

FAQs

What do they do during a diabetic eye exam? 

During a diabetic eye exam, the ophthalmologist:

• Carries out a visual acuity test
• Dilates your pupil using a special eyedrop to see the inner structures of your eye
• Injects a blood vessel amplifying dye in your arm for fluorescent angiography
• Takes photos of the back of your eye to identify damaged blood vessels.

What is the difference between a diabetic eye exam and a regular eye exam? 

The main difference is:

• A diabetic eye exam focuses on the retina, macular, and blood vessel, while a regular eye checkup focuses on the overall structure of the eye.
• Diabetic eye exams involve fluorescein angiography and optical coherence tomography, whereas a regular eye exam rarely does.

How often should you have a diabetic eye exam?

You should have a diabetic eye exam:

• Once a year if you have type 2 diabetes
• If you have type 1 diabetes once a year after five years of the first test
• Regular annual checkup if you are 12 years or older
• Within three months if you are pregnant and once a year after giving birth

References

1. Diabetes. (November 2021). World Health Organization.

2. Diabetic Eye Diseases. (May 2017). National Institute of Diabetes and Digestive and Kidney Diseases.

3. Diabetes and You: Healthy Eyes Matter. (January 2014). Centers for Disease Control and Prevention.

4. Diabetic Retinopathy. (July 2021). National Eye Institute.

5. What happens -Diabetic eye screening. (May 2019). National Health Service.

6. Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes. (2017). National Library of Medicine.

7. Diabetes Eye Exams. (November 2010). MedlinePlus.