Diabetes Standards of Care & Clinical Practice Resources
People with diabetes are at lifelong risk for eye and vision problems. These problems include diabetic retinopathy and macular edema. Diabetes also increases the risk of common eye conditions such as cataracts, glaucoma, and age-related macular degeneration.
Diabetic eye disease, a leading cause of visual impairment and blindness, can be prevented or delayed with optimal diabetes management. Control of glucose and blood pressure helps prevent the onset and reduce the progression of diabetic retinopathy. Treating dyslipidemia in people with diabetic retinopathy may also slow progression. Early detection, monitoring, and treatment of retinopathy and maculopathy are essential for reducing the risk of vision loss and blindness.
Eye Care Sections
Quickly jump to a section on this page by clicking on one of the links below.
- Section 1 – Clinical Practice Recommendations: Eye Care
- Section 2 – Clinician and Educator Resources: Eye Care
- Section 3 – Patient Education Resources: Eye Care
Clinical Practice Recommendations
The reported prevalence of diabetic retinopathy in American Indians/Alaska Natives (AI/ANs) has decreased by more than 50 percent since the 1980s and 1990s. However, a recent study estimated that about 20% of AI/ANs with diabetes today have retinopathy or macular edema.1
A comprehensive eye examination is necessary to screen people with diabetes for retinopathy and evaluate for other eye problems, such as glaucoma. A retinal examination (i.e., a dilated fundus examination by an eye care professional or retinal imaging with interpretation by a qualified, experienced reader) is used to detect retinopathy. Serious vision loss due to diabetic retinopathy can be nearly eliminated with timely diagnosis and treatment. According to the Diabetes Control and Outcomes Audit of the Indian Health Service, about 60% of AI/ANs with diabetes receive an eye examination each year.
At diabetes diagnosis:
- Refer patients for a comprehensive dilated eye examination by an eye care professional (ophthalmologist or optometrist).
- Refer patients for retinal imaging to screen for retinopathy if a comprehensive dilated eye examination is not available.
- Use an established teleophthalmology program in which experts review the images and make recommendations for evaluation and treatment (e.g., the Indian Health Service-Joslin Vision Network (JVN) Teleophthalmology Program).
If no retinopathy is detected, screen annually using one of the following:
- Comprehensive dilated eye examination by an eye care professional, who will determine whether this type of examination is needed annually or less often.
- Retinal imaging
- In addition to retinal imaging, patients should receive periodic eye exams by an eye care professional to evaluate for other eye problems.
- Once diabetic retinopathy is diagnosed, an eye care professional should direct the monitoring interval and type of examinations needed.
- Refer patients promptly to an eye care professional if retinal imaging identifies any of the following:
- Severe nonproliferative retinopathy
- Proliferative retinopathy
- Macular edema
Pregnancy in women with diabetes increases the risk of developing and/or worsening diabetic retinopathy.
- Refer women with diabetes for a comprehensive dilated eye examination
- When planning to become pregnant, and/or
- As early in pregnancy as possible
- Monitor women for progression of diabetic retinopathy during pregnancy and for at least one year postpartum, as directed by an eye care professional.
1. Bursell S-E, Fonda SJ, Lewis DG, Horton MB. Prevalence of diabetic retinopathy and diabetic macular edema in a primary care-based teleophthalmology program for American Indians and Alaska Natives. PLoS One 2018; 13(6):e0198551. https://doi.org/10.1371/journal.pone.0198551
Clinician and Educator Resources
Diabetes Education Lesson Plan: Diabetic Eye Disease [PDF – 618 KB]
IHS Division of Diabetes Treatment and Prevention
American Diabetes Association Standards of Medical Care in Diabetes – 2021 Diabetes Care 2021;44(Suppl.1):S151-S167. doi:10.2337/dc21-S011
American Diabetes Association
National Eye Institute
Patient Education Resources
Indian Health Service
National Eye Institute
Centers for Disease Control and Prevention