Screenings if you have diabetes
Diabetic eye exam results: what each finding means
Diabetes can damage the small blood vessels in the retina, the back part of the eye. This is called diabetic retinopathy, and a regular eye exam looks for it. (MedlinePlus, 2025) Here is who needs the exam, how often, and what each result means in the sources' words.
Who needs it and when
- Type 2 diabetes: a first dilated, comprehensive eye exam by an ophthalmologist or optometrist at the time of diagnosis. (ADA, 2026) MedlinePlus says some people whose type 2 diabetes develops slowly already have eye damage when first diagnosed. (MedlinePlus, 2025)
- Type 1 diabetes: adults should have a first exam 5 years after the onset of diabetes. (ADA, 2026)
- Children and teens: the ADA says children and adolescents with type 1 or type 2 diabetes are also at risk and need screening. (ADA, 2026) The NHS invites everyone with diabetes aged 12 and over. (NHS programme)
- Why it matters without symptoms: most often diabetic retinopathy has no symptoms until the damage is severe. (MedlinePlus, 2025) The ADA calls it the most frequent cause of new cases of blindness among adults aged 20 to 74 in high-income countries. (ADA, 2026)
The other checks for people with diabetes are on screenings if you have diabetes.
What the exam involves
- Dilated exam: you may read an eye chart, then get drops that widen your pupils. Tests can include eye pressure, a slit lamp exam and photos of the retina. (MedlinePlus, 2025) The general steps are on eye exam: what to expect.
- Extra scans: optical coherence tomography (OCT) scans the retina to find and measure swelling of the macula. (AAO) If severe retinopathy or macular edema is suspected, a fluorescein angiogram shows pictures of the retina's blood vessels. (NEI)
- Retinal photo screening: in the NHS programme, an appointment usually takes about 30 minutes: reading letters on a chart, eye drops, then photos of the back of the eyes with a camera that does not touch your eyes. A clinical expert checks the photos, and results go to you and your GP, with the aim of sending them within 3 weeks. (NHS screening guide)
- AI screening: the ADA says programs that use retinal photos read remotely, or FDA-approved AI, are appropriate screening strategies, as long as they give a path to a timely full eye exam. AI systems authorized by the FDA detect more than mild retinopathy and macular edema; their benefits and best use are not yet fully determined. (ADA, 2026)
What the results mean, in plain words
US sources describe two main stages, nonproliferative and proliferative, with macular edema possible at any point. (AAO) (ADA, 2026) NHS screening letters use no retinopathy, background (stage 1), pre-proliferative (stage 2) and proliferative (stage 3); stages 2 and 3 are called referable retinopathy. (NHS screening guide)
| Result | What the sources say |
|---|---|
| No diabetic retinopathy | No diabetic changes were seen. The ADA says that if one or more yearly exams show no retinopathy and glucose is in the goal range, screening every 1 to 2 years may be considered. The NHS invites you every 2 years if diabetic retinopathy was not found at your last 2 tests. (ADA, 2026) (NHS programme) |
| Mild nonproliferative (NHS: background retinopathy, stage 1) | The earliest stage. Small blood vessels in the retina may bulge slightly (microaneurysms), leak blood or leak fluid. It does not affect your sight but means a greater risk of more serious changes. The ADA says that if any level of retinopathy is present, dilated exams should be repeated at least yearly. (NHS retinopathy guide) (ADA, 2026) |
| Moderate or worse nonproliferative (NHS: pre-proliferative, stage 2) | Changes are more extensive, so you may need to be monitored more closely. The ADA calls moderate or worse nonproliferative retinopathy a precursor of proliferative retinopathy and advises prompt referral to an ophthalmologist experienced in diabetic retinopathy. (NHS retinopathy guide) (ADA, 2026) |
| Proliferative (NHS: stage 3) | The retina starts growing new blood vessels. These fragile vessels can bleed into the gel inside the eye and can form scar tissue. It is more serious and can cause loss of sight. The NHS says treatment reduces the risk of sight loss, particularly if given before your vision is affected. (AAO) (NHS retinopathy guide) |
| Diabetic macular edema (NHS: maculopathy) | Fluid leaks into the macula, the part of the retina needed for sharp, central vision, and causes blurry vision. It can happen at any stage. The ADA advises prompt referral for any level of macular edema; the NHS says you may need closer monitoring or be offered treatment. (NEI) (ADA, 2026) (NHS retinopathy guide) |
| Unclear photos | If the photos do not give a clear result, the NHS may call you back for another assessment. The ADA says an in-person exam is still needed when retinal photos are of unacceptable quality. (NHS screening guide) (ADA, 2026) |
Why the next exam may come sooner or later
The ADA says exams every 1 to 2 years may be cost-effective after one or more normal exams, but intervals should be adjusted for risk factors. More frequent exams by an ophthalmologist are needed if retinopathy is progressing, or with risk factors such as not meeting glucose goals, advanced retinopathy or macular edema. (ADA, 2026) The NEI says some people with diabetic retinopathy may need a dilated exam as often as every 2 to 4 months. (NEI)
Risk is higher the longer you have had diabetes, with poorly controlled blood sugar, and with smoking, high blood pressure or high cholesterol. (MedlinePlus, 2025) The ADA adds kidney disease. (ADA, 2026) Your A1C result is explained on A1C and blood sugar test results.
Pregnancy with diabetes that started before pregnancy
The ADA says people with type 1 or type 2 diabetes should have an eye exam before pregnancy and in the first trimester, and may need monitoring every trimester and for 1 year after birth, depending on the degree of retinopathy. It also says people who develop gestational diabetes do not need eye exams during pregnancy. (ADA, 2026) MedlinePlus says women with diabetes who become pregnant should have more frequent eye exams during pregnancy and for a year after delivery. (MedlinePlus, 2025) The glucose test for gestational diabetes is on gestational diabetes glucose test results.
Your doctor decides what your result means for you, and how often you are checked. This page does not give treatment advice. If a result worries you, see after an abnormal screening result for questions to ask.
When to contact a provider
MedlinePlus says: (MedlinePlus, 2025)
Contact an eye doctor (optometrist or ophthalmologist) if you have diabetes and you have not seen an optometrist or ophthalmologist in the past year.
Contact your provider if any of the following symptoms are new or are becoming worse:
- You cannot see well in dim light.
- You have blind spots.
- You have double vision (you see two things when there is only one).
- Your vision is hazy or blurry and you cannot focus.
- You have pain in one of your eyes.
- You are having headaches.
- You see spots floating in your eyes.
- You cannot see things on the side of your field of vision.
- You see shadows.
Where they differ:
- With no retinopathy: the ADA says every 1 to 2 years may be considered after one or more normal yearly exams with glucose in the goal range; (ADA, 2026) the NEI says to get a comprehensive dilated eye exam at least once a year; (NEI) the NHS invites you every 2 years if none was found at your last 2 tests. (NHS programme)
- Who does it: the ADA names a dilated, comprehensive exam by an ophthalmologist or optometrist, with photo or AI programs as an option; (ADA, 2026) the NHS uses a separate photo screening programme for retinopathy only, alongside your usual optician visits. (NHS screening guide)
- Starting age: the NHS invites everyone with diabetes from age 12; (NHS programme) the ADA times the first exam from diagnosis of type 2 diabetes, or 5 years after onset of type 1 in adults. (ADA, 2026)
- Gestational diabetes: the ADA says no eye exams are needed during pregnancy; (ADA, 2026) the NEI says women who develop gestational diabetes are at high risk. (NEI)
Questions people ask
How often do I need a diabetic eye exam?
The ADA advises a first dilated exam at diagnosis of type 2 diabetes and 5 years after onset of type 1 diabetes in adults. If one or more yearly exams show no retinopathy and glucose is in the goal range, every 1 to 2 years may be considered; with any retinopathy, at least once a year. (ADA, 2026)
Is a diabetic eye exam the same as a vision test for glasses?
No. MedlinePlus says the eye exam for people with diabetes is different from having your vision checked for new glasses, and to tell an optometrist you have diabetes. The NHS says its screening does not look for other eye conditions, so you should keep seeing your optician as well. (MedlinePlus, 2025) (NHS screening guide)
Can I have diabetic retinopathy without symptoms?
Yes. The early stages usually have no symptoms, and damage to much of the retina can occur before vision is affected. That is why regular eye exams are advised. (NEI) (MedlinePlus, 2025)
Can retina photos or AI replace a dilated exam?
The ADA says programs using retinal photos read remotely, or FDA-approved AI, are appropriate ways to screen if they offer timely referral for a full exam. It also says retinal photos are not a substitute for a dilated comprehensive exam, and that the benefits of AI screening are not yet fully determined. (ADA, 2026)
How long does the dilation blur last?
The NHS says your sight may be blurry for up to 6 hours after the drops, so do not drive until it returns to normal; sunglasses can help with brightness. (NHS screening guide)
Do I need eye exams if I have gestational diabetes?
The ADA says people who develop gestational diabetes do not need eye exams during pregnancy. The NEI says women who develop gestational diabetes are at high risk for diabetic retinopathy. (ADA, 2026) (NEI)
When do children with diabetes start eye screening?
The NHS invites everyone with diabetes aged 12 and over. The ADA says children and adolescents with type 1 or type 2 diabetes are also at risk and need to be screened. (NHS programme) (ADA, 2026)