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Diabetes Standards of Care & Clinical Practice Resources

Eye Care

People with diabetes are at lifelong risk for eye and vision problems, including diabetic retinopathy, cataracts, glaucoma, age-related macular degeneration, and blindness. Good control of glucose and blood pressure helps to prevent onset and reduce progression of diabetic retinopathy. In addition, early detection, monitoring, and treatment of retinopathy are essential to reducing the risk of blindness.

A retinal examination (i.e., a dilated fundus examination by an eye care professional or retinal imaging with interpretation by a qualified, experienced reader) should be used to detect retinopathy. Although serious vision loss due to diabetes can nearly be eliminated through timely diagnosis and treatment, only about half of all American Indian and Alaska Native people with diabetes receive an annual retinal examination.

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Clinical Practice Recommendations

Recommendations for Eye Care

  • Refer people with diabetes for a comprehensive dilated retinal examination by an ophthalmologist or optometrist:
    • at diabetes diagnosis, and
    • annually, or more or less often, as recommended by the patient’s eye professional.
  • Retinal imaging may be used to screen for and monitor retinopathy; a comprehensive eye examination is still needed to screen for and evaluate other eye problems.

Women with pregestational diabetes, who either are planning a pregnancy or have become pregnant, should have a comprehensive eye examination, and be counseled on the risk of development and/or progression of diabetic retinopathy. This examination should occur in the first trimester, and the patient should be followed throughout pregnancy and for one year postpartum by her eye care professional.

Women with true gestational diabetes (GDM), however, are at very low risk for developing diabetic retinopathy during pregnancy due to the limited exposure to increased blood glucose. Therefore, retinopathy screening is not indicated in GDM.