Diabetic Eye Exam: What to Expect

Why does diabetes put your eyes at risk?

High blood sugar, over time, weakens and damages the tiny blood vessels that supply the retina — the light-sensing layer at the back of your eye. When these vessels leak, swell, or grow in abnormal patterns, the condition is called diabetic retinopathy. It is the leading cause of new cases of blindness among working-age adults in the United States.

The insidious part: retinopathy can progress significantly with no pain and no vision change you would notice day to day. By the time blurring or dark spots appear, meaningful damage has often already occurred. Regular screening is the only reliable way to catch it early, when treatment is most effective 1Ref 1Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS (2020).Diabetic Retinopathy Preferred Practice Pattern.Clinical staging framework for diabetic retinopathy (microaneurysms, hemorrhages, exudates, macular edema, neovascularization) and screening examination components2Ref 2American Diabetes Association Professional Practice Committee (2024).Standards of Care in Diabetes—2024.Recommended frequency of dilated eye exams for type 1 and type 2 diabetes, including timing at diagnosis and during pregnancy.

What exactly happens during the exam?

The core of a diabetic eye exam is dilation. Your provider puts drops in each eye to widen the pupil, which gives the ophthalmologist a clear view of the retina, optic nerve, and the blood vessels running through them.

Here is the typical sequence:

1. Medical history review — your most recent A1c, blood pressure, how long you have had diabetes, and any symptoms like floaters or blurred vision. 2. Vision acuity test — reading an eye chart, essentially the same test you have had since childhood. 3. Dilation drops — these take 15 to 30 minutes to work. Your vision will be blurry and you will be sensitive to light during this time. 4. Retinal examination — the ophthalmologist uses a bright light and a lens to inspect your retina in detail. Sometimes a special camera photographs the retina as part of the record. 5. Intraocular pressure check — to screen for glaucoma, which is also more common in people with diabetes.

The dilation wears off over several hours. Plan to avoid driving until your vision clears, or bring a driver 3Ref 3American Academy of Ophthalmology (2024).Eye Exam and Vision Testing Basics.Dilation process, what to expect procedurally during a comprehensive eye exam including light sensitivity and driving precautions.

What is the ophthalmologist looking for?

The eye care specialist is looking for signs across a spectrum:

• Microaneurysms — tiny balloon-like swellings in vessel walls, often the earliest visible sign.
• Retinal hemorrhages — small bleeds within the retinal layers.
• Hard exudates — fatty deposits that signal leaking vessels.
• Macular edema — swelling in the central, high-resolution part of the retina. This is the most common reason for vision loss in diabetic eye disease.
• Neovascularization — abnormal new blood vessels that are fragile and prone to bleeding. This stage is called proliferative retinopathy and is the most serious.

Findings are staged from no retinopathy through mild, moderate, and severe non-proliferative to proliferative. The stage guides how often you need follow-up and whether treatment is needed 1Ref 1Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS (2020).Diabetic Retinopathy Preferred Practice Pattern.Clinical staging framework for diabetic retinopathy (microaneurysms, hemorrhages, exudates, macular edema, neovascularization) and screening examination components.

How often do you need a diabetic eye exam?

Current American Diabetes Association guidance recommends:

• Type 1 diabetes: first dilated exam within 5 years of diagnosis, then annually.
• Type 2 diabetes: dilated exam at the time of diagnosis (because many people have had elevated blood sugar for years before diagnosis), then annually.
• During pregnancy with pre-existing diabetes: exam in the first trimester, with close follow-up through delivery.

If your last exam showed no or minimal retinopathy and your blood sugar and blood pressure are well controlled, your ophthalmologist may extend the interval to every 1–2 years. Conversely, if changes are present, more frequent monitoring — every few months — is standard 2Ref 2American Diabetes Association Professional Practice Committee (2024).Standards of Care in Diabetes—2024.Recommended frequency of dilated eye exams for type 1 and type 2 diabetes, including timing at diagnosis and during pregnancy.

Note: virtual diabetic eye screening using retinal photography and AI-assisted review is increasingly available as a supplement to in-person care, particularly in primary care settings.

Who performs the exam and where do you go?

A diabetic eye exam should be performed by an ophthalmologist (a physician specializing in eye diseases) or an optometrist with experience in diabetic eye care. Your primary care clinician can help coordinate the referral and will want to receive the results to incorporate into your overall diabetes management.

Gale's primary care clinicians do not perform eye exams, but they can help you understand your results, track your exam history, and coordinate with your eye care team to make sure your diabetes management supports your vision health.