Inspiration And Expert Advice: Expert Columns

Refraction
This is the process of determining a new eyeglass prescription. Changes in blood sugar can have a dramatic impact upon your prescription, so it is important that you and the doctor know if your overall blood sugar control is good (as reflected by recent HbA1c testing), and if your blood sugar level the day of the eye exam is high, low, or relatively normal (as reflected by home blood glucose testing that day). Dramatic prescription changes may be the result of poor blood glucose control or even diabetes related eye disease.

Slit Lamp Examination
A specialized microscope gives the examiner a highly magnified view of the eyes. A measurement of internal eye pressure may be performed with this instrument or a similar hand held device.

Retinal and Optic Nerve Exam
After drops are placed into the eyes to dilate the pupils, the internal eye is examined with one or several lighted instruments, giving a stereo (3-D) view of the optic nerve and retina in considerable detail. Examination of your eyes through dilated pupils and in stereo is critical for detecting and assessing diabetic retinopathy and glaucoma. Photographs of your retina are often taken for comparison with future eye examinations.

Your eye doctor may recommend other tests depending upon your particular diagnosis. After all tests have been completed, the findings and treatment recommendations should be explained to you in understandable detail, and all your questions should be answered. You always should be advised as to the presence or absence of any diabetes related eye complications, and a letter describing your eye exam findings should be sent promptly to each of your other doctors. The bottom line is good doctors work with you and each other to give you the best possible care.

I will close this discussion with some key questions that I believe every patient with diabetes should ask his/her eye doctor:

Questions to Ask Your Eye Doctor

1. Do you have a lot of experience with diabetes and its various effects on the eyes?

2. Do you (or do other doctors in your practice) have any special interest in diabetes related eye disease?

3. Do I have any signs of eye disease? Do I have any cataract, glaucoma, corneal problems, retina problems or eye muscle problems that are being caused by diabetes?

4. Has my eyeglass prescription changed significantly? If it has, is it likely caused by poor blood sugar control?

5. If I don’t have any eye disease, when do you want to see me again?

6. If I do have diabetes related eye disease, how do you recommend we manage or treat it? When do you want to check my condition again? Are you experienced with the surgical or laser treatment of diabetes related eye disease? If my condition worsens, will you refer me to a sub-specialist?

7. Do you have any recommendations on how to avoid or reduce eye complications from diabetes? Do you have any written materials that I can review later?

8. Will you send a report of your diagnosis and recommendations to my other doctors? Would you like me to ask my diabetes doctor to send you a report of her findings and recommendations?

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