Why do I need a yearly eye exam?

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Why do I need a yearly eye exam?

Question:

Dear CDE,

My endocrinologist keeps telling me that I need to get eye exams on a yearly basis.  Every time I see my endo my A1c is fine and all of my labs come back normal.  I don't feel like seeing another doctor when it doesn't seem necessary.  Why is it important to get an annual eye exam and what will happen during the exam?

Answer:

The American Diabetes Association and the American Optometric Association recommends dilated eye exams for diabetes patients at least once a year, but only 47% in 1998 got exams.  The goal is to increase to 75% in 2010.  The best cure for diabetes related complications is prevention.  Eye exams should include dilation as part of the evaluation.  By dilating or enlarging the pupil, the doctor is able to see the very back of the eye called the retina.  Exams also may include checking the pressure in the eyes.  Diabetic eye disease can be detected, which refers to a group of eye problems including cataracts (clouding of the eye’s lens), glaucoma (increase of fluid pressure inside the eye leading to optic nerve damage and loss of vision), and diabetic retinopathy (the most common diabetic eye disease).

Diabetic Retinopathy can be seen in diabetes patients whose blood glucose are not well controlled or the patient has had longstanding diabetes.  This occurs when the blood vessels weaken, leak, or burst in the retina.  The retina works like film in a camera and sends images of what we see to the brain.  In diabetic retinopathy blood vessels that supply oxygen to the retina are affected.  Lack of oxygen can cause vision changes such as blurry, darkened, or cloudy images.  Floaters, which are dark spots or lines in the visual field can indicate early diabetic retinopathy or someone may not have any indication at all.  Dilated eye exams are important because early diagnosis of diabetic retinopathy can save vision.  Diabetic retinopathy is the leading cause of new cases of blindness among American adults.
There are several treatment options available for diabetic retinopathy.  In early stages, no treatment may be necessary.  Patients are monitored frequently to determine progression if any.  Advanced diabetic retinopathy needs prompt surgical treatment.  Focal laser treatment also known as photocoagulation, can stop the leakage of blood and fluid in the eye.  This is an outpatient procedure.  Leaks from abnormal blood vessels are sealed with laser burns.  Vision can be blurry for a day after the surgery and spots may be seen, but they usually fade away.  If blurred vision from the swelling of the macula occurred before surgery, the patient may not recover to normal vision.  Another type of laser treatment is scatter or panretinal photocoagulation.  This type is when abnormal blood vessels are shrunk.  This is also an outpatient procedure.  During the procedure, the areas distant from the macula are treated with scattered laser burns.  The burns cause the new blood vessels to shrink and disappear.  Vision can be blurry for a day.  Some loss of peripheral vision or night vision is possible.  Another treatment is a vitrectomy.  This procedure removes blood from the center of the eye (vitreous) and possible scar tissue.  This is done in a surgery center or hospital under local or general anesthesia.  During this procedure, an incision is made in the eye and any blood filled tissue or scar tissue is removed and replaced with a salt solution to maintain eyes normal shape.  A gas bubble may need to be placed in the eye, which would require a patient to remain facedown until the bubble disappears, which could be several days.  After surgery, an eye patch and medicated eyedrops are needed for a few days or weeks.

You can greatly reduce your risk of vision loss from diabetic retinopathy by managing overall health.  Controlling risk factors such as high blood pressure, high cholesterol, and smoking can help.  The key is checking blood glucose frequently, keeping glucose levels in a healthy range and working closely witha health care team.