Do I need an annual eye exam to detect diabetic retinopathy if my blood sugar levels are under control?

Yes, it is essential to have a comprehensive dilated eye exam annually to detect diabetic retinopathy, even if your blood sugar levels are well-controlled. The main reason for this is that diabetic retinopathy often shows no symptoms in its early stages [1]. This damage to the micro-blood vessels in the retina (the light-sensitive layer at the back of the eye) can progress without you noticing any changes in your vision [2].

Good control of blood sugar levels is the best defense against the development and worsening of diabetic retinopathy [2], but it does not completely eliminate the risk. Elevated blood sugar levels over time can damage the blood vessels in the eye, which may lead to fluid leakage, blood vessel blockage, or the growth of abnormal new blood vessels [3]. If left untreated early, these changes can cause serious vision loss or even blindness [1].

Why is an annual exam necessary?

A comprehensive annual eye exam allows your ophthalmologist to examine the inside of your eye for any early signs of diabetic retinopathy or other diabetes-related problems, such as diabetic macular edema, glaucoma, or cataracts [1]. This is done using drops to dilate the pupils, which gives the doctor a clear view of the retina [2]. By detecting these issues early, treatment can be started before significant damage to your vision occurs [2].

What happens if the exam is not performed?

If annual exams are not performed, diabetic retinopathy may progress to advanced stages without you realizing it. In later stages, symptoms such as floaters (dark spots or wavy lines in vision), blurry vision, dark areas in your field of vision, poor night vision, faded colors, or vision loss may appear [3]. These symptoms often indicate that the disease has progressed, and the damage to the eye may be more difficult to treat [2]. In some cases, severe bleeding in the eye may lead to sudden vision loss [3].

Other risk factors

In addition to the duration of diabetes and poor blood sugar control, other risk factors increase the likelihood of developing diabetic retinopathy, including high blood pressure, high cholesterol, pregnancy, and smoking [1]. If you are a woman with diabetes who becomes pregnant, or if you develop gestational diabetes, it is important to have a comprehensive eye exam as soon as possible after the pregnancy is detected, and you may need additional exams during pregnancy [2].

When should I seek emergency care?

Although the annual exam is important, you should contact your eye care professional immediately if you notice any sudden changes in your vision, such as the appearance of many new floaters or dark wavy lines, light flashes, a dark shadow covering part of your vision (like a curtain), vision loss, or eye pain and redness [1]. These symptoms may be signs of emergency conditions that require immediate intervention.

For more information on diabetic retinopathy, you can visit the page Diabetic Retinopathy: The Importance of Annual Eye Exams Before Symptoms Appear (Arabic).

Medical references

• Diabetic Eye Problems
• Diabetic Retinopathy
• Diabetic Retinopathy: Causes, Symptoms, Treatment