If you have diabetes, you should already be aware of the danger of diabetic retinopathy. This unfortunately common complication can lead to eyesight issues and, in extreme cases, even blindness.
It doesn’t have to happen that way. Diabetic retinopathy is preventable, treatable, and in certain stages can even be reversible.
That’s exactly why annual diabetes eye exams are so important. Identifying eye issues before they affect your vision gives you the best possible chance to fix the damage and prevent your eyesight from getting worse.
Early Diabetic Retinopathy Has No Symptoms
The retina, the part of the eye that actually senses light, has many small blood vessels that are very sensitive to high blood sugar levels and other metabolic dysfunction, particularly high blood pressure. These tiny blood vessels are among the most vulnerable parts of the body in people with diabetes.
In diabetic retinopathy, these small blood vessels begin to swell and burst, leaking blood into the eyeball. As the condition progresses, the hemorrhaging gets worse, and the retina begins to grow both scar tissue and new abnormal blood vessels, which can have a profound impact on eyesight.
The earliest stages of diabetic retinopathy typically have no effect on eyesight. That means that some people with diabetes are experiencing early retinopathy, and they don’t even know it.
If you’re waiting until your vision actually suffers to visit the ophthalmologist (eye doctor), you could be making a huge mistake. Those who put off their regular exams run the risk of sustaining permanent damage to the eye.
“The best thing is prevention,” says Ben Szirth, PhD, the director of applied vision research and ophthalmic telemedicine at Rutgers New Jersey Medical School. “The key is yearly screening.”
Early Diabetic Retinopathy Can Be Treated and Reversed
Dr. Szirth says it’s often possible to “reverse” the early stages of diabetic retinopathy.
Early diabetic retinopathy generally does not call for any special eye treatments. Instead, you’ll be advised to use diet, exercise, or medication to improve your metabolic risk factors — namely, your blood sugar, blood pressure, and possibly your cholesterol levels. Put simply, the first treatment for diabetic retinopathy is good diabetes management.
“You have two things to do: You have to get your blood sugar under control, and you have to get your blood pressure under control. And if you will actually follow the regimen carefully, we can bring you back,” says Szirth.
Without screening, not all patients will be so lucky, and more severe damage may be permanent. “When some parts of the eye die, we can’t turn that around,” says Szirth. That’s why regular screening and early intervention can be so important. If eye damage is detected early, it may be treatable before it gets worse.
Targeted treatment for the eyes is not usually recommended until later stages. At that point, you will likely be asked to have comprehensive eye examinations as often as every few months to assess the condition’s progression. Ophthalmologists have several treatment options, including laser photocoagulation and antivascular endothelial growth factor (anti-VEGF) drugs.
The Comprehensive Diabetes Eye Exam
Szirth says that the most important thing to do for your eye health is to schedule regular comprehensive eye examinations. This is the best way to detect and treat issues before they cause irreversible damage.
This isn’t a usual visit to the doctor to check your eyesight or get a new prescription for corrective lenses. This is a special examination that is designed for patients with diabetes, in which an ophthalmologist or optometrist will dilate your pupils to get a clearer view of the retina.
Here’s what you can expect during a routine diabetes eye exam:
Visual Acuity Testing The doctor uses an eye chart to determine your overall vision and whether you need glasses or contacts or an update to your current prescription.
Tonometry This test measures the pressure in your eye. High pressure could mean you’re at risk for glaucoma.
Retinal Imaging An imaging device allows the eye doctor to detect very subtle changes to the health of your eyes.
Dilated Eye Exam After applying eye drops that enlarge your pupils, your eye doctor will be able to look into the back of your eye to detect any swelling of the retina, leaking blood vessels, nerve damage, cataracts, and other eye diseases that are more common in people with diabetes. This is the most important test for people with diabetes.
None of these tests is painful.
When you’re scheduling a comprehensive eye exam, make sure to make it clear that you have diabetes and require a dilated and comprehensive eye examination for patients with diabetes. If your optometrist is unaware of your diabetes, they will not conduct the tests necessary to diagnose diabetic retinopathy.
How Often Do You Need Eye Exams?
Diabetes and eye health authorities recommend that most people with diabetes get a comprehensive eye exam annually, that is, once per year. Your own healthcare provider and insurer will likely assume that you require annual exams.
If you have any history of retinopathy, it is likely that your optometrist or ophthalmologist will ask you to have exams more frequently than once per year.
If You’re New to Diabetes: Scheduling Your First Eye Exam
If you’ve only recently been diagnosed with diabetes, the American Diabetes Association recommends these guidelines for scheduling your first eye exam.
For adults with newly diagnosed diabetes:
Adults with newer cases of type 1 diabetes are unlikely to develop diabetic retinopathy quickly after their diagnosis. They should have their first comprehensive eye exam five years after the onset of diabetes.
Adults with newly diagnosed type 2 diabetes should schedule an eye exam immediately.
For children with newly diagnosed diabetes:
Children with newly diagnosed type 1 diabetes are unlikely to develop diabetic retinopathy quickly after diagnosis. They should have their first comprehensive eye exam five years after the onset of diabetes. There is one exception to this rule: children experiencing puberty.
Puberty accelerates the development of diabetic retinopathy.Children with type 1 diabetes who have never had a diabetic eye exam should get their first exam at the onset of puberty or at age 11, whichever comes first.
Children with newly diagnosed type 2 diabetes should schedule an eye exam immediately.
Pregnant or Planning on It? Get an Eye Exam!
If you are pregnant or trying to conceive, it’s important to know that pregnancy represents a special case that may require special treatment. Pregnancy can greatly accelerate the progression of diabetic retinopathy, and the most important pharmaceutical treatment, anti-VEGF drugs, should not be used during pregnancy.
All women with type 1 or type 2 diabetes who are pregnant or planning on becoming pregnant should have their eyes evaluated.
If you exhibit any evidence of retinopathy, your ophthalmologist may want to examine your eyes multiple times during the pregnancy. You may be asked to set even stricter glycemic targets to reduce the chance of damage.
The Takeaway
Regular comprehensive eye exams are crucial for people with diabetes.
Early detection and treatment of diabetic retinopathy, which has no symptoms, can help prevent vision loss and preserve quality of life.
Annual eye examinations are the best way to detect issues before they cause irreversible damage. If you want to prevent, slow, stop, or reverse diabetic retinopathy, the time to act is now.
