Retina and Ocular Diabetes
I was diagnosed with type 2 diabetes: how to prepare for my first retinal exam
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Retina and Ocular Diabetes
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In brief: If you were diagnosed with type 2 diabetes, the guidelines of the American Academy of Ophthalmology (AAO) and the American Diabetes Association (ADA) recommend that you have your first retinal exam at the time of diagnosis, not later. Diabetic retinopathy may be present from the very beginning and causes no early symptoms, so a timely exam is the only way to detect it early.
Receiving a diagnosis of type 2 diabetes can raise many questions all at once: blood sugar, nutrition, medications. At that moment, eye health often takes a back seat. However, the first retinal exam related to type 2 diabetes is one of the most important steps you can take in the first few weeks after diagnosis.
Type 2 diabetes damages the blood vessels in the retina because excess blood glucose gradually damages their inner walls. The problem is that this damage can develop silently for years, even before a doctor confirms the diagnosis.
People with type 2 diabetes may have had undiagnosed hyperglycemia for years, putting them at significant risk of diabetic retinopathy at the time of diagnosis. (12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2026) This clearly distinguishes type 2 diabetes from type 1 diabetes: people with type 1 diabetes should begin annual exams five years after the disease begins; in contrast, those with type 2 diabetes should have an exam at the time of diagnosis and at least once a year thereafter. (Diabetic Retinopathy PPP 2024 - American Academy of Ophthalmology)
Diabetic retinopathy occurs when diabetes damages the small blood vessels inside the retina, the light-sensitive tissue at the back of the eye. (Diabetic Retinopathy: What you should know) When these vessels weaken, they may leak or close off, affecting the eye’s ability to transmit clear images to the brain.
Diabetic retinopathy affects 1 out of every 3 people with type 2 diabetes mellitus. In Mexico, diabetic retinopathy has a prevalence of 31.5%, according to ENSANUT MC 2016. (Diabetic Retinopathy)
You should have an exam at the time of diagnosis; don’t wait for symptoms or for a certain amount of time to pass. This recommendation is supported by multiple international ophthalmology and diabetes organizations.
Patients with type 2 diabetes should have a comprehensive dilated eye exam by an ophthalmologist at the time of diabetes diagnosis. (Diabetic Retinopathy: A Position Statement by the American Diabetes Association) This recommendation has a Level B evidence rating in the American Diabetes Association’s Standards of Care.
After the first exam, follow-up frequency depends on the findings: if there is no evidence of retinopathy on one or more annual exams, a two-year interval may be considered; if any degree of diabetic retinopathy is detected, exams should be repeated at least once a year. (Diabetic Retinopathy: A Position Statement by the American Diabetes Association)
It is important to note that only 60% of people with diabetes mellitus have the recommended annual exams for diabetic retinopathy. (Diabetic Retinopathy PPP 2024 - American Academy of Ophthalmology) Getting screened on time makes a real difference in your visual prognosis.
Diabetic retinopathy often causes no symptoms in its early stages. This makes it especially dangerous: by the time a patient notices something, the damage may already be advanced.
The early stages of diabetic retinopathy generally have no symptoms. Some people notice changes in their vision, such as difficulty reading or seeing distant objects. These changes may come and go. (Diabetic Retinopathy - National Eye Institute - NIH)
When symptoms occur, they may be confused with other eye conditions, such as presbyopia, early cataracts, or dry eye. The following table describes the most relevant differences to help guide patients:
Symptom: Fluctuating blurred vision
May indicate diabetic retinopathy: Yes, especially in the early stages
May also be related to: Changes in blood glucose, dry eye, presbyopia
Symptom: Dark spots or floaters
May indicate diabetic retinopathy: Yes, a sign of bleeding in advanced stages
May also be related to: Posterior vitreous detachment (normal aging)
Symptom: Flashes of light
May indicate diabetic retinopathy: Yes, requires urgent assessment
May also be related to: Migraine with aura, retinal traction
Symptom: Difficulty seeing colors
May indicate diabetic retinopathy: Yes, with macular damage
May also be related to: Cataracts, inherited color blindness
Symptom: Reduced night vision
May indicate diabetic retinopathy: Possible in advanced stages
May also be related to: Vitamin A deficiency, cataracts
Diabetic eye disease or vision loss often has no warning signs when damage begins to develop. A comprehensive dilated eye exam helps detect and treat eye problems early, often before significant vision loss occurs. (Diabetic Eye Disease - NIDDK)
Some symptoms require assessment the same day, without waiting for a scheduled appointment. These are not symptoms to put off or manage at home.
Call your doctor right away if you notice sudden changes in your vision, including flashes of light or many more floaters than usual. (Diabetic Eye Disease - NIDDK)
Seek urgent eye care for any of the following:
In advanced stages, blood vessels in the retina begin to bleed into the vitreous. If this happens, you may see floating dark spots or lines that look like spiderwebs. Sometimes the spots clear on their own, but it is important to get treatment right away. (Diabetic Retinopathy - National Eye Institute - NIH) Do not put off these symptoms while waiting for your next scheduled appointment.
A retinal exam for type 2 diabetes requires dilating the pupils with eye drops to examine the fundus precisely. This is the diagnostic standard recommended by the AAO and ADA.
The gold standard for screening is a dilated fundus exam; however, validated digital imaging can also be an effective screening method. (Diabetic Retinopathy PPP 2024 - American Academy of Ophthalmology)
During the first exam, the specialist may order one or more of the following tests:
Test: Dilated fundus exam
What does it evaluate?: Retina, blood vessels, optic nerve, and macula
What is it for?: Detect early signs of vascular damage
Test: Optical coherence tomography (OCT)
What does it evaluate?: Retinal layers and thickness
What is it for?: Identify diabetic macular edema
Test: Retinal photography (fundus photography)
What does it evaluate?: Documented image of the retina
What is it for?: Compare changes at future follow-up visits
Test: Fluorescein angiography
What does it evaluate?: Retinal circulation
What is it for?: Locate leaking or blocked blood vessels
Optical coherence tomography (OCT) produces cross-sectional images of the retina that show its anatomy and thickness. This helps determine whether fluid has leaked into the retinal tissue and how much is present. (Diabetic retinopathy - Diagnosis and treatment - Mayo Clinic)
The American Academy of Ophthalmology notes that retinal photographs do not replace a comprehensive dilated eye exam, which should be performed at least initially and at annual intervals or more often as recommended by the specialist. (12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2026)
Eye care for type 2 diabetes rests on three pillars: blood glucose control, regular ophthalmologic follow-up, and recognition of warning signs. None replaces the others.
Blood glucose control is the modifiable factor with the greatest impact on the retina. ADA guidelines also recommend monitoring blood pressure and blood lipids, since both accelerate vascular damage in the retina when not controlled.
Some habits that support eye care with type 2 diabetes:
Diabetic retinopathy progresses slowly and silently. However, it takes several years to progress to a stage where vision is threatened. (Type 2 Diabetic Retinopathy Screening in a General Practice: A Five-Year Retrospective Analysis) That time is the window when timely detection and follow-up make all the difference.
As the U.S. National Eye Institute (NEI) notes: "If you have diabetes, it is important to have a comprehensive dilated eye exam at least once a year. Diabetic retinopathy may not have symptoms at first, but finding it early can help you take steps to protect your vision." (Diabetic Retinopathy - National Eye Institute - NIH)
If you were recently diagnosed with type 2 diabetes and have not yet had your first retinal exam, now is the time to schedule one. At High Vision, we have retina specialists and diagnostic technology to support you from the start of your eye care journey. Schedule an assessment to review your case.
At the time of diagnosis, without waiting for symptoms. AAO and ADA guidelines state that, unlike type 1 diabetes, type 2 diabetes requires an immediate exam because there may have been years of silent hyperglycemia before diagnosis.
It is not painful. Drops are used to dilate the pupil, which may cause light sensitivity and blurred near vision for a few hours. It is advisable to have someone accompany you and not to drive immediately afterward.
Yes. With type 2 diabetes, retinal damage may already be present at the time of diagnosis because the disease often develops over years without symptoms. That is why the exam should not be delayed: the risk exists from day one.
At least once a year. If the first exam shows no retinopathy and blood sugar is well controlled, the specialist may space appointments out to every two years. If there is any degree of retinopathy, follow-up is annual or more frequent.
There is no cure, but it can be stabilized and its progression prevented with good blood sugar control, controlled blood pressure, and timely treatment. Early detection is the factor that has the greatest impact on visual prognosis.
No. For type 1 diabetes, the first exam is performed five years after diagnosis. For type 2 diabetes, it should be done at the time of diagnosis. This distinction is clinically important, and the recommendations for the two types should not be interchanged.
American Academy of Ophthalmology. (2024). Diabetic Retinopathy Preferred Practice Pattern®. Ophthalmology. https://www.aao.org/education/preferred-practice-pattern/diabetic-retinopathy-ppp
American Diabetes Association. (2026). Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2026. Diabetes Care, 49(Supplement 1). https://diabetesjournals.org/care/article/49/Supplement_1/S261/163919/
National Eye Institute (NEI). (2024). Diabetic Retinopathy. National Institutes of Health. https://www.nei.nih.gov/eye-health-information/eye-conditions-and-diseases/diabetic-retinopathy
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2024). Diabetic Eye Disease. National Institutes of Health. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-eye-disease
Mexican Social Security Institute (IMSS). (2023). Diabetic Retinopathy. PAI-IMSS-001-23. https://www.imss.gob.mx/sites/all/statics/profesionalesSalud/investigacionSalud/historico/programas/16-pai-retinopatia-diabetica.pdf
Graue-Hernandez, E. O., et al. Prevalence of diabetic retinopathy and macular edema in patients with recently diagnosed type 2 diabetes. Gaceta Médica de México. Cited in: Scielo México. https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0016-38132023000300207