Diabetic Retinopathy is the number one cause of blindness in individuals of working age in the United States. Diabetes results in abnormally high levels of blood sugars that can damage blood vessels in the body including on the back of the eye. When diabetes causes damage to blood vessels on the back of the eye in the retina, it is called diabetic retinopathy. Diabetes can also cause diabetic macular edema, swelling in the central vision part of the eye.
Diabetic retinopathy can be subdivided into two different categories, non-proliferative diabetic retinopathy and proliferative retinopathy. Non-proliferative diabetic retinopathy is an earlier stage of diabetic retinopathy. In this stage, tiny blood vessels in the retina can leak fluid and blood, but the patient may not notice any vision changes.
Neovascularization
In the more severe stage of proliferative diabetic retinopathy, abnormal blood vessels can grow on the surface of the retina or on the optic nerve. This process is called “neovascularization”. Neovascularization occurs when normal blood vessels in the retina become very damaged from diabetes and close off, simulating the growth of new abnormal blood vessels. These new abnormal blood vessels can break open and fill the eye with blood, called a vitreous hemorrhage. These abnormal blood vessels also can cause scar tissue to form that can tug on the retina and lead to a retinal detachment where the nerve tissue comes off the back of the eye.
Diabetic Macular Edema
Diabetic macular edema can also occur in patients with diabetes. The macula is the part of the eye used for central vision that allows us to see fine details and color. Diabetes can cause small abnormalities in blood vessels near the macula that lead to these blood vessels leaking fluid and blood. This can cause swelling or thickening of the macula that can lead to decreased vision.
Treatment to Reduce Risk of Vision Loss
Both diabetic retinopathy and diabetic macular edema can be treated to reduce the risk of vision loss. Imaging studies using fluorescein angiography and optical coherence tomography (OCT) can by useful in helping diagnosis and treat diabetic changes in the eye. Retinal specialists use medicines, laser surgeries, or surgery to treat changes from diabetes in eyes. The retina physicians at the Froedtert and the Medical College of Wisconsin’s Eye Institute do active research and participate in clinical trials to better determine the best way to treat diabetic changes in the eye.
Diabetic retinopathy and diabetic macular edema can be diagnosed by having an eye doctor do a dilated eye exam. When changes first start occurring in the eye from diabetes, there may be no or very minimal symptoms or vision changes. Therefore, it is very important that people with diabetes have a dilated eye exam at least once a year to look for changes from diabetes in the eye. If you are pregnant and have diabetes, or if your eye doctor sees suspicious changes in your eye, you many need to be monitored more frequently. The earlier the detection of changes from diabetes, the more likely the chance of preserving vision.
You can reduce your chances of losing vision from diabetes by getting your eyes checked at least once a year. Maintaining strict control of your blood sugar and blood pressure and not smoking will help reduce the chance of getting changes in your eye from diabetes.
-
Understanding Your Vision and Medical Insurance
Routine Vision Exam
A routine vision exam usually covers:
- A vision screening
- An eye exam
- A refraction (the test used to determine your glasses prescription)
- A prescription for glasses
Contact Lenses
If you wear contact lenses, there may be an extra fee for a contact lens fitting. Coverage for this varies by plan, so please check with your vision insurance provider.
If a Medical Issue Is Found During Your Exam
During your eye exam, your doctor may identify a medical condition such as dry eye, an eye infection, diabetes-related changes, or another issue that requires medical care.
If this happens, your doctor may recommend one of the following options:
- Return for a separate medical visit.
- The medical visit would be billed to your medical insurance.
- Your routine vision exam would remain billed to your vision insurance.
- This is necessary because vision and medical insurance cannot both be billed on the same day.
- Address the medical issue during the current appointment.
- The current appointment would be billed to your medical insurance instead of your vision insurance.
- You would return another day for the routine vision exam, which would be billed to vision insurance.
- Please note that refraction (the test used to determine your glasses prescription) is not covered by medical insurance.
Your doctor will help you choose the option that best meets your individual care needs.
Questions About Costs
For an estimate of your out-of-pocket cost, please call Patient Financial Services at 414-777-0539. Please note, Medicare and most medical insurance plans do not cover refraction. The refraction service will be billed to you.
