Diabetic Eye Screening: How Often You Need It and How Teleophthalmology Is Changing the Game

More than 90% of vision loss from diabetes is preventable. Yet, nearly 4 in 10 people with diabetes skip their yearly eye screening. Why? It’s not because they don’t care. It’s because getting to an eye doctor can be hard-especially if you live far from a clinic, can’t take time off work, or hate the blurry vision that comes with dilation drops. But there’s a better way now, and it’s changing everything.

When Should You Get Screened? It Depends on Your Type of Diabetes

If you have type 1 diabetes, your first eye exam should happen within five years after diagnosis. After that, you need one every year-unless your doctor says otherwise. For type 2 diabetes, you should get screened right when you’re diagnosed. That’s because many people have had undiagnosed diabetes for years before they even know it, and eye damage can already be starting.

Here’s the real deal: if your eyes look normal after a full exam and your blood sugar is well-controlled (HbA1c under 7%), your doctor might stretch the next appointment to every two years. But don’t assume this applies to you. Only about 15% of patients qualify for that longer interval, and even then, it’s only if your numbers have stayed steady for at least a year.

But if you’ve been told you have early signs of retinopathy-even mild nonproliferative diabetic retinopathy (NPDR)-you’re back to yearly exams. If it’s getting worse, you might need to go every 3 to 6 months. And if you have diabetic macular edema or advanced disease, you could need checks every 1 to 2 months. Skipping even one appointment when your eyes are already damaged can mean the difference between keeping your vision and losing it.

Why So Many People Miss Their Screenings

It’s not laziness. It’s logistics.

A 2023 survey found that 68% of people with diabetes said transportation was the biggest barrier. For rural residents, the nearest eye specialist might be 50, 75, or even 100 miles away. Then there’s the cost-some insurance plans don’t cover the full exam, and copays add up. And let’s not forget the dilation drops. They blur your vision for hours. One Reddit user called it “ruining my kid’s birthday party.”

Another big problem? Misinformation. A University of Michigan study found that 58% of patients thought keeping blood sugar normal meant they didn’t need eye checks. That’s not true. Even with perfect HbA1c, you can still develop retinopathy. Genetics, how long you’ve had diabetes, blood pressure, and even your race matter. African American patients, for example, develop sight-threatening retinopathy nearly two and a half years earlier than white patients with the same blood sugar levels.

What Is Teleophthalmology-and Why It’s a Game Changer

Teleophthalmology is simple: you get your retina photographed right in your primary care clinic or pharmacy, and a specialist reviews the images remotely. No travel. No dilation (sometimes). No waiting weeks for an appointment.

It’s not new. But it’s finally working. The FDA approved the first AI system for diabetic eye screening back in 2018-IDx-DR, now called LumineticsCore. It looks at retinal photos and tells you if there’s more than mild retinopathy or macular edema. In clinical trials, it caught 87% of cases that needed referral. That’s better than some human graders.

Real-world results? Even better. In Tamil Nadu, India, a teleophthalmology program screened over 15,000 people. Remote specialists agreed with in-person doctors 98.5% of the time. In the U.S. Veterans Health Administration, screening rates jumped 32% after they rolled out the system across 136 clinics.

And it’s not just for rural areas. Urban clinics are using it too. Kaiser Permanente cut missed appointments by 27% by sending automated text reminders and offering same-day retinal photos during regular diabetes visits.

What Teleophthalmology Can’t Do

Don’t get fooled. These photos don’t replace a full eye exam.

Retinal pictures only show the back of the eye. They won’t catch glaucoma, cataracts, or dry eye. They can’t check your eye pressure. They can’t tell if your optic nerve is damaged. And they can’t diagnose other diabetes-related eye problems like retinal vein occlusions.

That’s why the American Diabetes Association still says the first exam should be done by an ophthalmologist or optometrist who can dilate your pupils and do a full check. After that, if your eyes are stable, teleophthalmology can be a great follow-up tool.

Also, not all programs are equal. Some use low-quality cameras. Others have slow turnaround times. The best ones use FDA-cleared AI tools and have trained graders reviewing images within 48 hours.

The Hidden Inequality in Access

Here’s the uncomfortable truth: teleophthalmology isn’t helping everyone equally.

A 2024 Health Affairs study found clinics serving mostly Medicaid patients were 47% less likely to offer teleophthalmology than those serving private insurance patients. Why? Startup costs. Setting up a teleophthalmology station runs about $28,500. Most safety-net clinics just can’t afford it. And even when they do, insurance coverage is spotty. Only 63% of private insurers paid for it in 2024. Medicare does-but Medicaid doesn’t always.

That means the people who need it most-low-income, rural, and minority communities-are still stuck with the old system: long drives, long waits, and missed appointments.

What’s Next? Personalized Screening

The future isn’t “once a year” for everyone.

The T1D Exchange is testing a new algorithm that uses 17 risk factors-not just HbA1c-to predict who’s at low risk for fast-progressing eye disease. If you’re young, have had diabetes for less than 10 years, have no high blood pressure, and your retinal photos are clean for two years in a row? You might only need screening every three years.

That’s a big shift. And it’s coming fast. In 2022, only 8% of Medicare diabetes screenings used AI. By 2025, that number jumped to 22%. More clinics are adopting it. More insurers are covering it. And more patients are actually showing up.

What You Should Do Right Now

If you have diabetes, here’s your action list:

1. Call your doctor and ask: “When was my last eye screening, and what did it show?”
2. If you haven’t had one in over a year, schedule it. Even if you feel fine.
3. Ask if your clinic offers teleophthalmology. If they do, get screened during your next diabetes visit.
4. If they don’t, ask if they can refer you to a nearby program. Many pharmacies and community health centers now offer retinal photography.
5. Keep your HbA1c under 7%, control your blood pressure, and don’t smoke. These do more for your eyes than any eye drop ever will.

Diabetic eye disease doesn’t hurt until it’s too late. That’s why screening isn’t optional. It’s survival.