Diabetic Eye Exam: What to Expect, Costs, and How Often

Diabetes and Eye Health

Diabetes is a chronic disease. It changes the way the body turns food into energy.

The body breaks down food into sugar (or glucose) and releases it into the bloodstream. This boosts blood sugar, which tells the pancreas to release insulin. Insulin allows blood sugar into the cells to use as energy.

With diabetes, this process looks different. The body doesn’t make enough insulin, or the cells don’t respond to the insulin the way they should. Too much blood sugar stays in the bloodstream, which can lead to health issues. This includes eye problems.

More than 37 million people in the U.S. have diabetes. This makes up 11.3 percent of the population. Of those, 8.5 million are undiagnosed. Meanwhile, 96 million people aged 18 years and older are prediabetic.⁸ 

This article covers what you need to know about diabetes and how it can affect your eye health.

What is Diabetic Retinopathy?

Diabetic retinopathy is the single-most common eye disease in people who have diabetes. It’s also a leading culprit of blindness in the United States.²

Diabetic retinopathy refers to a health condition that develops when the blood vessels in the retina change.² The retina refers to the layer of tissue in the back of the eye that is sensitive to light. 

When you look around, the images you see come through your eye’s lens. They are then focused on the retina, which sends them as signals along the optic nerve to your brain. The retina plays an important role in your vision, but diabetic retinopathy can take a toll on it.

There are two stages of diabetic retinopathy:

1. Nonproliferative diabetic retinopathy is the first stage. During this early stage, the blood vessels in your retina become swollen and leak. You may experience some vision issues during this stage if fluid or blood leaks into the central part of the retina (macular edema).²
2. Proliferative diabetic retinopathy is the second stage. During this advanced stage, new blood vessels grow on your retina. They can break and bleed into the vitreous (the natural gel in your eyes). You can experience severe vision loss during this stage.²

Causes

Diabetic retinopathy happens when there are changes in the blood vessels in your retina. This can happen if you develop diabetes.²

Living an inactive lifestyle and obesity are two of the most common causes of type 2 diabetes.

Symptoms 

You may not notice any symptoms at first. However, as diabetic retinopathy progresses, you may experience:²

• Blurry vision
• Double vision
• Dark spots in your vision
• Floating spots in your vision
• Blank spots in your vision
• Eye pain
• Eye pressure
• Halos
• Flashing lights in the eyes

Diabetic retinopathy can also cause neovascular glaucoma. This refers to when blood vessels grow in the drainage structure of the eye. They can block fluid from exiting the eyes.⁴

It can also result in retinal detachment. This happens when scars form in the back of your eye and pull your retina away.⁴

Risk Factors

Anyone who has a family history of diabetes is at an increased risk of developing the disease. Living a sedentary lifestyle also increases your risk. 

If you develop diabetes, you are at further risk of developing diabetic retinopathy. The longer you have diabetes, the more likely you are to develop symptoms like this one.²

Other risk factors of developing diabetic retinopathy include if you have diabetes and:

• Are pregnant
• Smoke
• Have high blood pressure

What is a Diabetic Eye Exam?

A diabetic eye exam tests you for diabetic retinopathy. It involves several key steps:

• Health history check
• Family health history check
• Visual acuity test with a common eye chart to measure vision at various distances
• Tonometry to check the pressure inside your eye
• Pupil dilation
• Ophthalmoscopy to examine the retina with a specific magnifying glass
• Fluorescein angiography, which injects organic dye into the bloodstream to show the blood vessels
• Optical coherence tomography to cross-sectional images of the retina

An eye exam usually only takes about 30 minutes. But if your doctor uses drops to dilate your eyes, you may experience blurry vision for about 6 hours after.

Plan to have someone drive you home. You should also bring sunglasses or a hat to shade your eyes, as they may feel extra sensitive.³

Diabetic vs. Regular Eye Exam

A diabetic eye exam looks for signs of diabetic retinopathy.

A regular eye exam may skip some of the above tests. A regular eye exam will also look for other issues with your eye health.

Who Needs a Diabetic Eye Exam?

If you have diabetes or prediabetes, you should get a diabetic eye exam every year.^{1, 2}

Women who are pregnant should also have one before pregnancy or within the first trimester of their pregnancy. From there, they should be monitored throughout the pregnancy and for a year following birth, depending on the severity.²

How Much Does a Diabetic Eye Exam Cost?

The cost of a diabetic eye exam depends on various factors, including your vision insurance coverage. Check with your vision insurance to see whether or not your exams are covered. 

Medicare Part B covers diabetic eye exams once per year for people with diabetes.⁶

How to Diagnose Diabetic Retinopathy

Your eye doctor will diagnose diabetic retinopathy with a diabetic eye exam.

Only an ophthalmologist (eye specialist) or optometrist (a doctor of optometry) can diagnose you with diabetic retinopathy.

Treatment for Diabetic Retinopathy 

There is no cure for diabetic retinopathy, but there are ways to treat it.⁹ 

Your treatment will depend on factors like your age, overall health, and the severity of your condition. Here are three common options.

1. Laser surgery

Laser surgery can treat proliferative retinopathy. It shrinks the abnormal blood vessels and closes up any leaky ones.^{2, 5}

2. Vitrectomy

A vitrectomy is a medical procedure that entails removing the vitreous from the center of the eye and replacing it with a saline solution.²

3. Medical injections

Your doctor may inject medication into your eye to stunt the growth of any abnormal blood vessels. They may also use this medication to treat macular edema.^{2, 5}

Anti-VEGF is one type of medication. It can reduce swelling and improve vision. Corticosteroid medicine is another injection option.^{4, 7}

Can You Prevent Diabetic Retinopathy? 

You cannot completely prevent diabetic retinopathy. However, controlling your blood sugar can reduce your risk of developing it or slow its progression if you already have it.²

Diabetes is accompanied with many unpleasant symptoms. You can better avoid or reduce them by being mindful of your blood sugar.²

Summary

Diabetes is a common disease, and diabetic retinopathy is a common result of it. Diabetic retinopathy will ultimately damage your vision and cause partial or total vision loss. 

While you cannot totally prevent it, you can reduce your risk.

Do your best to keep active. Monitor your blood sugar and get annual eye exams.