Examination Schedule for Diabetic Patients

Type 1 (Diabetes Onset Usually Before Age 30 Years)

Many studies of patients with type 1 diabetes have reported a direct relationship between the prevalence and severity of retinopathy and the duration of diabetes.  The development of vision-threatening retinopathy is rare in children prior to puberty.  Among patients with type 1 diabetes, substantial retinopathy may become apparent as early as 6 to 7 years after onset of the disease.  Ophthalmic examinations should be performed beginning 3 to 5 years after the diagnosis of type 1 diabetes and will discover the vast majority of type 1 patients who require therapy at that time.

Type 2 (Diabetes Onset Usually at Age 30 Years or Older)

The time of onset of type 2 diabetes is often difficult to determine and may precede the diagnosis by a number of years.  Up to 3% of patients whose diabetes is first diagnosed at age 30 or later will have CSME or high-risk characteristics at the time of the initial diagnosis of diabetes.  About 30% of patients will have some manifestation of diabetic retinopathy at diagnosis. Therefore, the patient should be referred for ophthalmologic examination at the time of diagnosis.

Diabetes Associated with Pregnancy

Diabetic retinopathy can worsen during pregnancy because of the pregnancy itself or changes in metabolic control.  Patients with diabetes who are planning to become pregnant should be encouraged to have their eyes examined prior to conception, should be counseled on the risk of development and/or progression of diabetic retinopathy, and should be told to make every attempt to lower their blood glucose levels to as near normal as possible for their own health and the health of the fetus.  During the first trimester, another eye examination should be performed; subsequent follow-up will depend on the level of retinopathy found.  Women who develop gestational diabetes do not require an eye examination during pregnancy, because such individuals are not at increased risk for diabetic retinopathy during pregnancy.  After the examination is completed, the ophthalmologist should discuss the results and their implications with the patient.  Both eyes should be classified according to the categories of diabetic retinopathy and macular edema.  Each category has an inherent risk for progression. The diagnostic category determines the timing for both the intervention and for follow-up examinations.