Q: My daughter is a diabetic, and I am concerned about the effects of diabetes on her eyes. She has been diabetic for 12 years and has only been to an ophthalmologist once. How often should she have her eyes checked?
Diabetic damage to the eyes (diabetic retinopathy) is a frequent complication of both Type I (juvenile or insulin-dependent) and Type II (adult onset or non-insulin-dependent) diabetes mellitus. The frequency of retinopathy increases with the duration of diabetes. Twenty years after the diagnosis of diabetes, some retinopathy is present in nearly all persons with Type I diabetes and in more than 60 percent of those with Type II. Among adults in this country, diabetic retinopathy is the most common cause of new cases of blindness.
The success of laser surgery in preventing blindness from diabetic retinopathy provides a strong reason for regular visits to an ophthalmologist (a medical doctor who specializes in eyes) for early identification and treatment of diabetic retinopathy.
The following guidelines regarding diabetic retinopathy have been approved by the American College of Physicians, American Diabetes Association and American College of Ophthalmology:
* Type I diabetics should be screened annually beginning five years after the onset of diabetes, but generally not before the start of puberty.
* Type II diabetics should be screened soon after the diagnosis is made. The recommended frequency of subsequent examinations varies from one to four years, depending on the sophistication of the methods used in the screening tests. If blood glucose levels are consistently high or protein is present in the urine, eye examinations should be done yearly.
* When a woman with diabetes becomes pregnant, she should have an eye examination during the first trimester, and the status of her retina should be followed closely during the pregnancy.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.