Diabetic eye test

Dealing with diabetes can hurt your eyes. It may affect the tiny blood vessels in the retina, which is the back surface of your eye. Diabetic retinopathy is the name for this disease.

You are also more likely to get cataracts and glaucoma if you have diabetes.

You might not know your eyes have been damaged until the problem is really bad. If you go to the eye doctor regularly, they can find problems early on. This is important. As the disease starts to spread, it won’t change your eyes or give you any other signs. An eye test is the only way to find out what’s wrong and take steps to stop the damage from getting worse.

Thirty percent of people with diabetes have diabetic retinopathy.

Diabetic retinopathy happens when blood vessels that have formed and are fragile, break in the eye and start to leak fluid and blood into the retina. This impairs the retina and makes it difficult to see, this can also be permanent. Finding and treating eye problems early is very important if you want to keep your sight.

Diabetes can lead to diabetic macular edema (DME), which happens when the macula, which is in the middle of the eye, starts to swell. The macula is in charge of your center vision and color vision. When the macula takes on fluid, it can cause the blood vessels to leak, which causes vision impairment.

If your blood sugar is not under control you will be more likely to get diabetic retinopathy, but people whose diabetes is under control are still at risk over the long run.. 

Because of this, eye doctors suggest getting an eye check once a year to catch the disease early and get the best treatment results. If you check your eye health regularly, you can be sure that any changes will be noticed quickly, before they can do any harm.

Annual Eye Exams are Crucial for Diabetics

Diabetes damages the blood vessels in the back of your eyes, which can cause bleeding that could damage your vision. If you have diabetes, you are more likely to get these eye problems:

• Diabetic Retinopathy
• Cataracts and Glaucoma

Many eye problems can be fixed if they are caught early. But seeing your usual doctor is not enough to check your eyes. Optometrists and ophthalmologists are the only ones who can do a full diabetic eye test and find signs of eye problems caused by diabetes.

Finding ocular complications with diabetes as soon as possible

During your yearly eye exam, the eye doctor will look for signs of retinal damage. Most of these conditions can be avoided or made less severe by keeping your blood sugar levels healthy and your A1C below 7 percent.

For example, retinopathy can lead to blindness by leaking, bleeding, or abnormal growth in the retina’s blood vessels.

Macular Edema is when fluid occurs in the central part of the light-sensitive retina. It often happens at the same time as retinopathy. This can make the vision blurry or wavey.

Cataracts are formed from fluctuations in sugar levels that cause fluid retention in the lens.

Glaucoma: High IOP or (eye fluid pressure) that can damage the optic nerve and cause blindness if not treated.  

Dry eye: People with diabetes tend to get dry eyes due to the sugars disrupting the tear film, which usually causes blurred vision that gets better when you blink, eyes that water a lot to make up for the dryness, and severe stinging and burning. People with dry eye disease are more likely to get an infection when their blood glucose levels are high. This can happen for some reasons, such as high blood glucose and some common prescription drugs. 

Dilated Retinal Exams

Your acuity will be checked on the eye chart first.

After that, You’ll be dilated, eye drops will be used to make your pupils bigger so the doctor can see the back of your eye easier. When the drops are first put on, they may hurt. You might taste something metal in your mouth.

The doctor now uses an ophthalmoscope with a bright light and a lens to look for problems with:

• Blood vessels in the back of the eye
• The optic nerve
• The clear front part of the eye called the cornea, can also be seen with a slit lamp.

To get a better look, the doctor may take pictures of the back of your eye using a fundus camera and a computer retinal scan or OCT. This special camera doesn’t make your pupils bigger. The doctor will then review the pictures and let you know if you need more tests.

When Do You Need To See An Eye Doctor?

The American Diabetes Association says that people with diabetes should get their eyes checked once a year. You should also make an appointment with your eye doctor if any of the following things happen with your vision:

• The vision is fuzzy or double
• Having trouble reading or concentrating
• Seeing floaters or spots
• Eye pressure or pain
• You can see dark or empty spots in the distance.
• Peripheral blind spots

An eye check once a year is like seeing your primary care doctor once a year for preventative care. The test helps you keep your health in good shape, even if you aren’t aware of any specific problems.

After being told you have type 1 diabetes, you should see an eye doctor who specializes in diabetics within five years. Once you know you have type 2 diabetes, you should make an appointment with an eye doctor who works with diabetics right away. In the years to come, you should make an appointment to see your diabetic eye expert at least once a year. As soon as you notice symptoms like blurred vision, flashes, or floaters in your field of vision, you should make an appointment with your diabetes eye expert.

Diagnosis

A thorough check of enlarged pupils is the best way to find out if someone has diabetic retinopathy. For this test, drops are put in your eyes to make your pupils bigger so the doctor can see inside your eyes better. Until they wear off after a few hours, the drops may make it hard for you to see things up close.

That time, your eye doctor will check the inside and outside of your eyes for any problems.

Fluorescein angiography

A fluorescein dye is put into a vein in your arm after your pupils are made bigger. Continuous pictures are taken while the dye moves through the blood vessels in your eyes. The pictures can show which blood vessels are blocked, broken, or leaking.

OCT stands for optical coherence tomography

With this test, pictures of the retina are used to make cross-sectional photos that show how thick the retina is. This will help find out how much fluid has leaked into the retina, if any. In the future, optical coherence tomography (OCT) scans can be used to check on the progress of treatment.

Treatment of Diabetic Retinopathy

As long as blood sugar, cholesterol, and blood pressure are under control, there is no need for treatment in the first three stages of diabetes retinopathy. A laser surgery called scatter laser treatment is used to treat the fourth stage, which is called progressive retinopathy. The abnormal blood vessels are ablated, which makes them shrink, during the process. As soon as the arteries start to bleed, this method works best. It is also possible to give anti-VEGF injections into the back of the eye. If you have severe bleeding from blood vessels, you may need surgery to fix it. During this procedure, blood is taken out of your eye during a vitrectomy.

A laser technique called focus laser treatment is often used to treat macular edema. To lower the amount of fluid in the retina, several hundred small laser burns are made in the places where the retina is leaking. People who do this are less likely to lose their sight, and in some cases, they may be able to see better again. A doctor’s office is where focal laser treatment is done, and most people only need one session. It is also possible to give anti-VEGF injections into the back of the eye.

The goal of treatment for diabetic retinopathy is to slow or stop the disease from getting worse. The type of treatment depends on how bad the disease is.

Early retinopathy 

If your diabetic retinopathy is low to moderate, you may not need treatment right away. But your eye doctor will keep a close eye on them to see if you need treatment at any point.

Talk to your diabetes doctor (endocrinologist) to find out if there are ways to better take care of your diabetes. As long as you keep your blood sugar under control, you can generally stop diabetes retinopathy from getting worse.

Advanced retinopathy in diabetes

You’ll need to get treatment right away if you have progressive diabetic retinopathy or macular edema. Depending on the exact issues with your retina, you may be able to:

• Injections called anti-VEGF are approved to slow or stop the development of the new blood vessel’s growth.
• A numbing drop is given before the injection. Some minor pain, burning, or tearing can occur for up to 24 hours after the shot. A building of pressure in the eye and an infection are two possible side effects.
• Often these shots will have to be given again. The medicine is sometimes used with photocoagulation.
• A laser treatment is also called focal laser treatment.  Can stop or slow the flow of fluid and blood in the eye. Laser burns are used during the process to fix leaks from blood vessels that aren’t working right. This is known as Photocoagulation.
• Focal laser treatment is usually done in just one visit. Patients with retinal edema who had blurry vision before surgery may not be able to see normally after treatment, but the condition is likely to get better.
• Photocoagulation of the eye: This process uses a scattered pattern with the laser in the periphery to destroy the abnormal vessels and to reduce the stimulation of new blood vessel growth.
• Most of the time, it takes two or more sessions at your doctor’s office or eye center. After the surgery, your vision will be blurry for about a day. It is possible to lose some peripheral vision or night vision after the surgery.
• Vitrectomy eye surgery: This procedure removes the gel in the middle of the eye and any blood that has leaked into it. The vitreous can tug and pull on the retina and cause vessels to break. It can be done in a hospital or surgery center with either local or total anesthesia.

Diabetic Eye Test – Conclusion

Early detection of diabetic eye disease through a diabetic eye test is the best way to maintain healthy eyes.  Since damage can occur without any pain or in many cases without any symptoms it is the only way to ensure you don’t lose your vision.

FAQ’s for Diabetic Eye Test

What’s the difference between a regular eye exam and an eye exam for people with diabetes?

 In many ways, diabetic eye tests are the same as normal eye exams. Closer attention is paid to the retinal vasculature.

Does dilation have to be used for a diabetic eye exam?

There is new technology out now that lets doctors see inside your eyes without making the pupils bigger. When you go in for a diabetic eye test, your doctor may also check your vision at different distances and measure the pressure of the fluid in your eye.

References

Diabetic retinopathy – Diagnosis & treatment – Mayo Clinic. (2023, February 21). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/diagnosis-treatment/drc-20371617

(2023, March 6). UVA Health Blog: What Is a Diabetic Eye Exam? Do I Need One? – Ophthalmology. Ophthalmology. https://med.virginia.edu/ophthalmology/uva-health-blog-what-is-a-diabetic-eye-exam-do-i-need-one/

Diabetes eye exams: MedlinePlus Medical Encyclopedia. (n.d.). https://medlineplus.gov/ency/patientinstructions/000323.htm

What Is a Diabetic Eye Exam? | Austin Retina Blog. (n.d.). Austin Retina Associates. https://www.austinretina.com/blog/what-is-a-diabetic-eye-exam