Diabetes is on the rise in the United States and across the globe, resulting in more cases of blindness, even in working-age adults. The National Eye Institute reports that 40 percent to 45 percent of Americans with diabetes have diabetic retinopathy — damage to the back of the eye or retina, which is the form of diabetes damage in the eyes that can cause the most trouble.
It is important to realize, however, that not everyone who already has retinopathy has or will have severe vision impairment; with care, the severity of vision loss can be minimized. The number of Americans with retinopathy has increased almost 90 percent since 2000 and projections show that number may increase another 75 percent by 2020.
To prevent severe vision loss, all people who have diabetes should have a yearly eye examination. This test is different from an examination for glasses. The diabetes eye examination typically is covered by insurance as part of diabetes care, and is not limited by vision insurance. The longer a person has had diabetes, the greater the chance for diabetic changes in the eyes, and therefore the more important this retinal examination is. High-risk patients may need to be seen more than once a year for their diabetes eye-health examination.
Doctors of optometry are trained to diagnose and treat eye diseases and can provide this annual diabetic eye examination. An optometrist works with a patient’s primary care provider and/or endocrinologist managing diabetes. A key part of the diabetic eye examination is that pupils should be dilated. Sometimes diabetic patients dilate poorly and at slower rates than people without diabetes, so the doctor needs to make sure that the eyes are fully dilated before examining the retinas. Small pupils are problematic in properly evaluating the retinal tissue during this part of the examination.
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Prior to the examination, the doctor should take a complete history from a patient, including a family history of diabetes, current medications, as well as how often the patient sees the doctor who manages his or her diabetes. The optometrist also should know of any other health conditions, such as high blood pressure. In addition you should tell your optometrist what your A1C level is, as this is a key indicator of the status of your diabetes. In addition, high cholesterol and smoking increase the risk of retinopathy, and the presence of cardiovascular disease suggests a greater risk for diabetic changes; it is important to share all this information with your optometrist.
In addition to the special diabetes eye exam, it is important for the diabetic patient to have his/her refractive examination done, used to determine a patient’s spectacle or contact lens prescription. Certain types of changes in this prescription also may be an indication of a diabetic problem.
Every patient needs to understand how important a yearly eye examination is. They have the final responsibility for their health.