Eye Exams for Diabetic Patients
Both Type 1 and 2 diabetics are at risk of developing diabetic retinopathy (damage to the retina). It is one of the leading causes of preventable blindness in adults. Retinopathy is directly correlated with nephropathy (kidney damage) in diabetics, so regular monitoring is of paramount importance
Q: How often should diabetics get an eye exam?
A: Routine exams are important in order to catch early signs of retinal damage before it leads to vision loss. Guidelines state that Type 1 patients should be seen within 5 years of diagnosis, and annually thereafter. Type 2 diabetics should be seen at the time of diagnosis and annually thereafter. If signs of damage are noted, the frequency of examination will increase accordingly. Examinations and retinal imaging required explicitly for the management of diabetic eye disease are fully covered by Alberta Health. Routine comprehensive examinations including prescriptions for eyewear are NOT publicly funded by the government, regardless of diabetic status,
Q: What causes diabetic retinopathy and what can I do to prevent it?
A: Diabetes is a disorder of metabolism that affects the cells that surround the small blood vessels. This causes leakage of fluid and/or blood into the surrounding tissue space leading to inefficient supply of oxygen (hypoxia). The body will try to grow new vessels to supply the tissue, but these are also weak and leaky, leading to further oxygen deprivation and an ensuing cycle of bleeding. The best defense is to tightly regulate your blood sugar and ensure A1c levels stay well below 7. Good cardiovascular health and blood pressure control will also help reduce the severity of retinopathy. Regardless of control, statistically 60% of diabetics will have some degree of retinopathy 10 years after initial diagnosis.
Q: What is the treatment for diabetic eye disease?
A: Mild retinopathy simply requires monitoring and retinal imaging. If there is leakage close to the macula (central retina), then referral is made to a retinal specialist who will likely inject a drug to control and limit the leakage. If retinopathy is severe (proliferative) then the specialist will likely use a laser to selectively kill the peripheral retina in order to reduce oxygen demand and thus save the central vision. In all cases of retinopathy, care is coordinated with your family physician and internist to ensure your diabetes is well managed systemically in order to prevent further retinal or kidney damage.