Diabetic Eye Exams

What diabetes does to the eye

High blood sugar over years weakens the walls of the retina's capillaries. They leak fluid and blood, close off and starve areas of retina, and, in the advanced stage, prompt the growth of fragile new vessels that bleed and scar. Fluid leaking into the macula, the center of the retina, causes macular edema, the most common cause of vision loss in diabetes. None of this is felt, and vision is often normal until the process is advanced. Diabetes also brings cataracts earlier and raises glaucoma risk.

The exam

• Vision and refraction, since blood sugar swings change the prescription
• Eye pressure and a check of the drainage angle
• Dilation, so the whole retina can be examined
• A detailed examination of the retina and its vessels for hemorrhages, leakage, closed vessels and new vessel growth
• Optical coherence tomography of the macula, which detects edema earlier and more precisely than examination alone
• Retinal photography to document the findings and compare year to year
• Assessment of the lens for cataract

What the findings mean

No retinopathy: return in a year. Mild non-proliferative retinopathy, with a few small hemorrhages: return in six to twelve months, and tighter control of blood sugar, blood pressure and cholesterol slows progression. Moderate to severe non-proliferative retinopathy: closer monitoring, every three to six months, and a retina specialist's opinion. Macular edema affecting vision, or proliferative retinopathy with new vessels: treatment with injections or laser, arranged promptly with a retina specialist, with whom we co-manage.

Your diabetes team

We keep your primary care physician or endocrinologist informed of your results, because the findings inform your diabetes management and because the yearly eye exam is a measured quality standard in diabetes care. If you were referred by your doctor, the referral is closed with that report.