Diabetic Eye Care

Diabetic Eye Exams

Patients with diabetes require special eye exams that check for eye conditions typically caused by diabetes. Overtime, high blood sugar can damage the blood vessels in the eye leading to conditions such as diabetic retinopathy and diabetic macular edema. While you can lower your risk for these conditions by controlling your blood sugar and blood pressure, most diabetic patients are also at a higher risk of developing glaucoma and cataracts. This is why we recommend regular yearly visits where Dr. Sherman will dilate your eyes to examine your retina for early signs of damage. When found in early stages many of these conditions can easily be managed with medicine which significantly increases quality of life for our patients. At Physician Eye Care Associates we offer various tests to make sure our patients are receiving the best diabetic eye care possible.

Dr. Sherman examining patient's eyes

Diabetic Retinopathy

If you have Diabetes, your body does not use and store sugar properly. High blood-sugar levels can damage blood vessels in the retina, the nerve layer at the back of the eye that senses light and helps to send images to the brain. The damage to the retinal vessels is referred to as Diabetic Retinopathy. There are two types of Diabetic Retinopathy: Nonproliferative Diabetic Retinopathy (NPDR) and Proliferative Diabetic Retinopathy (PDR).

Types of Diabetic Retinopathy

NPDR, commonly known as background retinopathy, is an early stage of Diabetic Retinopathy. In this stage, tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell or to form deposits called exudates.

PDR is present when abnormal new vessels (neovascularization) begin growing on the surface of the retina or optic nerve. The main cause of PDR is widespread closure of retinal blood vessels, preventing adequate blood flow. The retina responds by growing new blood vessels in an attempt to supply blood to the area where the original vessels closed. Common symptoms of Diabetic Retinopathy include fluctuating vision and trouble focusing.

4 Stages of Diabetic Retinopathy

  • Mild Nonproliferative Retinopathy: At this stage patients have at least one microaneurysm but no other findings. This indicates that the blood vessels within the retina have begun to swell.
  • Moderate Nonproliferative Retinopathy: Here patients have microaneurysms or hemorrhages in up to three areas of the retina. The swell has begun to block the retinal blood vessels.
  • Severe Nonproliferative Retinopathy: By this stage the patient has hemorrhages in all four retinal quadrants, venous beading in at least 2 quadrants, or an IRMA in one or more quadrants. The swelling has continued to block more blood vessels which has impacted blood flow to multiple areas of the retina.
  • Proliferative Retinopathy: Here patients have progressed from nonproliferative diabetic retinopathy to proliferative diabetic retinopathy. At this stage a considerable amount of new blood vessels have been created to compensate for the lack of blood supply to the eye. These blood vessels are weak and leak fluid into the retina which causes vision loss.


If you have diabetes it is important that you have a diabetic eye exam at least every year. Dr. Sherman will dilate your eyes and take photographs of your retina. He will then exam the images for signs of swelling, blockages, abnormal blood vessels, and retinal detachment. Depending on which stage of diabetic retinopathy you are at you may have to be examined every 3-6 months.


In the early stages of diabetic retinopathy you may not require treatment but controlling your blood pressure will slow the progression. You should speak with your endocrinologist about better ways to control your diabetes. If you are at an advanced stage and have proliferative diabetic retinopathy or macular edema then your treatment will require surgery.


Dr. Sherman performs the latest and most advanced techniques to stop fluid leakage and to shrink abnormal blood vessels. We may also recommend VEGF therapy which are injections of medicine directly into the eye to stop the growth of new blood vessels. Injections can be a standalone treatment or they can be paired with laser surgery depending on your specific case.

Diabetic Macular Edema

Patients in advanced stages of diabetic retinopathy can develop macular edema. When blood sugar is not controlled the blood vessels in the retina become blocked which signals the brain to create abnormal blood vessels. This is called retinopathy and is very common among diabetic patients with consistent levels of high blood sugar. These abnormal blood vessels are weak and leak fluid that accumulates at the back of the eye in the central part of the retina (macula) and causes swelling (edema). If left untreated a macular edema can cause serious visual impairment. There are two types of macular edema: Focal DME which is caused by abnormalities in the blood vessels and Diffuse DME which is caused by swelling of tiny blood vessels.


If you have diabetes it is important to come in for regular yearly eye exams to check for signs of a macular edema. Dr. Sherman will dilate your eyes and check your retina for signs of swelling and leaking blood vessels. He will also check your macula for signs of bleeding as this is the area damaged by macular edemas.


The treatment for diabetic macular edema includes laser surgery to stop the fluid leakage that is occuring in the retina and VEGF therapy which are injections that shrink abnormal blood vessels. It is also important to meet with your endocrinologist to discuss better ways to manage your blood sugar levels.

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