Hosted by Ray Shields, MD

Complications of diabetes include several visual disorders, such as retinopathy, cataracts, and glaucoma, which may lead to blindness.  Approximately 15–28% of people with type 2 diabetes have retinopathy at the time diabetes is diagnosed.  This may be due to the extended period of time these individuals have diabetes, but remained undiagnosed and uncontrolled.  The risk factors associated with the severity of retinopathy include high mean fasting blood sugar, high A1c level, elevated systolic blood pressure, high urinary albumin-to-creatinine ratio (UACR), as well as whether the patient is on kidney dialysis or has had a long duration of diabetes.

Adults with diabetes should have a comprehensive dilated examination by an ophthalmologist or optometrist shortly after the diagnosis of diabetes. Re-examinations should be repeated annually.  Examinations will be required more frequently if retinopathy is progressive.

Examinations can also be done by the taking of retinal photographs and having these read by experienced experts in this field.  In-person exams are still necessary when the photos are unacceptable and for follow up of detected abnormalities. This technology has its greatest potential in areas where qualified eye care professionals are not available. Results of eye examinations should be documented and transmitted to the referring health care professional.

Women with gestational diabetes are at very low risk for the development of diabetic retinopathy during pregnancy due to the very limited exposure to increased blood glucose.  Retinopathy screening is therefore not indicated.  However, women with pregestational diabetes who are planning pregnancy or who have become pregnant should have a comprehensive eye examination and should be counseled on the risk of development and/or progression of diabetic retinopathy.  Eye examination should occur in the first trimester with close follow-up throughout pregnancy and for one year postpartum.