When to Get Eye Examinations for Diabetic Retinopathy

When to Get Eye Examinations for Diabetic Retinopathy

Regular eye examinations prevent vision loss in diabetic retinopathy.  Randall V. Wong, M.D., Retina Specialist, Fairfax, Virginia.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.

Diabetic Retinopathy Occurs in Everyone

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.

Perfect Vision Does Not Ensure No Disease

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.

Routine Eye Examinations Can Prevent Loss of Vision

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 Exam is Easy

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.

Testing for Diabetic Retinopathy

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!


  • Natalie Sera
    Posted at 15:31h, 15 March Reply

    OK, I have had diabetes for 20 years and on insulin for 18, and so far have no signs of retinopathy. And I’m going to do my best to prove you wrong when you say everyone gets retinopathy, by going another 20 years (until I’m 84) without it, and then I’m going to die peacefully, satisfied with my conquest! Love your blog, Randy! 🙂

  • angela kim
    Posted at 21:26h, 18 March Reply

    hello quick questiions ,,,,,,why does the silicone oil change, on the top part of my sons eye i can see the oil.

  • JulieW
    Posted at 14:05h, 25 March Reply

    I was Diagnosed with Type 1 DM 29 yrs ago. Had yearly eye exams with no change over the years. Aug 2010 diagnosed with PDR and had laser tx. Oct 2011 had vitrectomy for retinal detachment with macular involvement. Vision improved to 20/30 (Jan 2012). Just went to my regular ophthalmologist because of vision issues. Vision is now (2 months later) 20/60 in that eye. No cataract, pressure 18, slight stigmatism. Can correct to 20/30 with glasses,but stated my vision is likely to get worse over the next several months, but didn’t say why and his office notes don’t indicate a reason either. (About a month ago, I did develop some wavy black lines in my peripheral vision —opposite of where the retina previously detached. That comes and goes, but is always in the same place).

    Should I see my retina surgeon for a 2nd opinion? I don’t see him again until May otherwise.

    • Randall V. Wong, M.D.
      Posted at 08:30h, 30 March Reply

      Dear Julie,

      Without a doubt go see someone who can explain what’s going on. Making a random statement like that? Crazy.

      Let me know the outcome.

      Good thing is that you refract to 20/30!!!!


  • JulieW
    Posted at 22:25h, 15 August Reply

    My original posting is above this one having had laser surgery and vitrectomy (Oct 2011) for traction retinal detachment. Have Type 1 diabetes. I went to my “regular optho” and have been diagnosed with a cataract (nuclear sclerosis) in the affected eye. My vision in Jan was 20/30 and 7 months later is now 20/150. Dr left it up to me when or if I want surgery.

    My questions are:
    -Is there any harm in waiting to have cataract surgery? (I don’t see my retina surgeon for 3 more months and wanted to talk to him about the change in my vision/cataract).
    -Will waiting affect the likelihood of restoring my vision to 20/30?
    -I have read there is an increased risk of a detached retina with surgery. Can that still happen even after having had a vitrectomy?

    Enjoy the information you provide. THanks

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