All patients with diabetes should get checked for diabetic retinopathy at least annually. This recommendation is supported by the American Academy of Ophthalmology and the American Optometric Association.
It is likely almost every patient with diabetes will develop some diabetic retinopathy….even if the sugar is well controlled and the A1C is low! For reasons we do not understand, the duration of having the disease is the largest risk factor to your developing the disease, with dietary factors a close second.
You can have perfect (20/20) vision and still have diabetic retinopathy. The eye disease can be present without any signs or symptoms! The most common symptoms of diabetic retinopathy include blurry vision. It’s impossible for you to tell if this is due to diabetic retinopathy, change in sugar level or other eye disease.
Severe vision loss is unlikely to occur in your lifetime if the disease is identified early by dilated eye examination. The goal of treatment is to prevent vision loss and/or preserve your excellent vision.
As you can not tell if you have the disease, you can not tell if you need treatment.
The best test is a dilated eye exam. Again, this needs to be done by your eye professional at least yearly.
We are only looking for two signs of diabetic eye disease; presence of macular edema and evidence of proliferative diabetic retinopathy. Macular edema is usually easily seen with my naked eye (and a special lens). PDR is defined as neovascularization (abnormal blood vessel growth) on the iris, optic nerve or retina.
The single best test is probably a fluorescein angiogram. This test can show macular edema, active PDR and abnormalities in blood flow. This test can show subtle changes in the retina as pictures of the eye are taken as the fluorescein dye is injected into your arm.
Optical coherence tomography is also helpful in characterizing any possible macular edema. It can NOT diagnose the disease. This is a non-invasive test.
Your retina specialist might choose to either of these tests, but neither is a routine component of a diabetic eye exam.
What Does This Mean? Regular examinations are worthwhile and integral to maintaining excellent vision for your lifetime. Unlke other eye diseases where routine screening is less fruitful, the goal of routine examination is to treat you before you even think you need treatment!