I have diabetes and see well — do I still need an eye check?

Yes. Seeing well does not rule out diabetic retinal disease; it says something only about the centre of the retina. The changes almost always begin further out, where nobody notices them, and the second eye covers a loss over for a long time as long as both eyes are open. When vision declines, the disease is therefore rarely at its beginning. The reverse holds: exactly the time in which you feel nothing is the time in which a check brings most — because there is then still something to decide.

How often does the retina have to be checked in diabetes?

Usually the check runs as an annual appointment. What is decisive, though, is not the calendar but the findings, how long the diabetes has been present and how well the metabolism is controlled. What is regularly overlooked is the start: anyone given a diagnosis of type 2 diabetes needs the first look at the back of the eye straight away — until then the disease has often been present unnoticed for years. With type 1 diabetes the starting point is five years after diagnosis at the latest; in children and adolescents the checks begin from around the eleventh year of life or with puberty, whichever comes first. If changes are visible, the checks come closer together: with a moderate finding about every six months, with a severe non-proliferative form more like every three months. The proliferative form is no longer an interval but a treatment decision. In pregnancy separate, closer intervals apply. Your personal interval we record in the report, so that it does not stay at 'sometime again'.

What is the difference between retinopathy and macular oedema?

The retinopathy describes what happens to the vessels of the retina as a whole — bulges, haemorrhages, closed-off areas, later new vessels. The macular oedema is a build-up of fluid at the centre of the retina, the point of sharpest vision. The one is the map, the other an event at its most important point. In practice that means: a macular oedema can occur as early as an early retinopathy and can disturb reading markedly, while an extensive retinopathy without the macula involved is barely noticeable for a long time. That is why both questions belong in the same examination.

Are the pupils always dilated at the check?

For this question: yes, without exception. The diabetic changes set in far out in the retina, and the view through a narrow pupil does not reach that far. Expect around 20 to 30 minutes for the drops to take effect, and after that several hours in which near vision stays blurred and you are dazzled. So come without a car, bring sunglasses and allow around two hours for the appointment. A retinal check in diabetes without dilation is not one — even if it feels like one.

I am pregnant and have diabetes — what changes?

With pre-existing type 1 or type 2 diabetes the checks are closer together in pregnancy, because a change in the retina can develop or worsen more quickly during this time. An ophthalmic check as early as possible makes sense — ideally already when you are trying to conceive — and after that at intervals that follow the findings. Gestational diabetes, which arises only in pregnancy, is a different matter: on its own it makes no retinal check necessary, and we do not call you in for it either. It is different if the diabetes was already there before the pregnancy or persists after the birth — then the usual applies again. In any case, tell us that you are pregnant or would like to become pregnant before we set the interval.

Can a diabetic retinopathy regress?

Individual early changes can regress if blood sugar, blood pressure and blood fats are better controlled over a longer period. Closed-off vessels and scars do not regress, and what has been lost of nerve tissue does not come back. What is realistic is therefore not 'reversing' but 'halting' — and that succeeds the more readily the earlier one starts. One point needs saying with it: if a very high long-term blood-sugar value is brought down quickly, an existing change in the retina can worsen temporarily. That is no argument against the improvement but one for an eye check before and while it takes place.

What does the eye check in diabetes cost in Switzerland?

Checking the back of the eye in known diabetes is medically justified — this is follow-up and not screening on its own. Where there is a medical indication the cost is covered by basic health insurance; the deductible and co-payment apply as at any doctor's appointment. The same holds for the additional examinations that a clinical question calls for, a cross-sectional scan of the macula for instance. Spectacle lenses are as a rule not a service of basic health insurance for adults, even when your readings have changed through swinging blood sugar. If you would like to know exactly beforehand, ask us and your health insurer — that is settled in a few minutes.

Retina & Vitreous

Diabetes and the eye: why the retina stays silent for so long — and what the annual check finds

Diabetes in the eye causes no symptoms for years. No pain, no red eye, often not even worse vision — and yet during that time the finest vessels of the retina are changing. Anyone who comes only when vision declines arrives at a point where much can no longer be won back. That is why the regular check of the back of the eye in diabetes is not a precaution at the margin but a part of the treatment.

Book a retinal check Call us and clarify the appointment

Why diabetes affects the retina in particular

The retina is a wafer-thin layer of nerve tissue that lies against the inside of the eye wall and converts light into signals. It is one of the most metabolically active tissues in the body, and for that it hangs on a network of very fine blood vessels. It is precisely these fine vessels that blood sugar raised over years wears down.

The sequence is similar in all forms. First the smallest vessels lose the cells that stabilise their wall; the weakened wall bulges outwards. These microaneurysms are the earliest change that can be recognised at the back of the eye at all, and alongside them stand pinpoint haemorrhages. Only after that does the wall begin to leak as well: fluid and fatty constituents pass out into the tissue. Later, individual vessels close off completely — areas of the retina get too little oxygen. The body answers this shortage with what it has available: it lets new vessels grow. But these new vessels are fragile, they grow in the wrong place, they bleed and they form scar strands that pull on the retina. What begins as an attempt at repair thereby becomes the problem itself.

In doctors' reports and referrals you will find several names for it. The one you see most often is diabetic retinopathy; the same thing in plain words is diabetic retinal disease, and in abbreviated form it is recorded as DR. All three mean exactly what this page describes. How the retina and the vitreous are connected in the first place, and which other findings have their origin there, you can read in the overview on that, how the retina and the vitreous work together.

Two peculiarities explain why this so often becomes a late diagnosis. First, the disease begins at the outer edge. The centre of the retina, the part you read and recognise faces with, is spared for a long time — and for as long as it is spared, vision is good. Second, you see with two eyes. A loss on one side is covered over by the other eye for as long as both are open. The two together mean that the disease stays invisible in exactly the phase in which most can be achieved. It is nonetheless no footnote: diabetic changes in the retina are among the most common causes of loss of vision during working life.

One side effect is remarkable enough to be named: nowhere else in the body can small blood vessels be looked at in living tissue without a cut and without contrast medium — through the pupil, that is exactly what happens. What becomes visible there therefore says something not only about your eyes but also about the vessels at the kidneys, the nerves and the heart — one reason why the eye finding has a fixed place in diabetes care.

Warning signs that do not wait until the next appointment

Diabetic retinal disease stays silent for a long time — but when it does announce itself, it usually does so suddenly. The following signs need assessing the same day and not at the next regular appointment. None of them waits a week, and with the last one you do not wait for our call back either:

New flashes of light — short bright flashes or arcs at the edge of the field of vision, clearer in the dark, particularly together with new black dots. They arise from traction on the retina. People with diabetes have this traction just as often as everyone else — and on top of it the traction that comes from scar strands. Call the same day.
Suddenly many new black dots, flecks or a 'shower of floaters'. Behind it can lie a haemorrhage into the vitreous, of the kind that arises from new, fragile vessels. Call the same day.
A dark shadow or curtain, moving into the field of vision or growing larger. Behind it can lie a retinal detachment and its warning signs — in diabetes above all the form in which scar strands pull on the retina. Call the same day.
Suddenly distorted vision — straight lines ripple, letters jump, a grey patch sits exactly where you are looking. That points to the centre of the retina being involved, but it does not say how: a macular oedema, a wet macular degeneration and a hole at the centre of the retina cause the same symptom and are differently urgent. That is exactly why this is not sorted out by guesswork. Call the same day.
Rapid, painless deterioration of vision in one eye, without redness and without any outward cause. The same day. Besides a haemorrhage, a retinal detachment and a macular oedema, a vascular occlusion of the retina comes into question here — its risk is raised in diabetes, and with it hours count.
A red, painful eye with a feeling of pressure, nausea or rainbow rings around lights. If new vessels grow on the iris and in the anterior chamber angle, the intraocular pressure can rise sharply — a special form of glaucoma that occurs in advanced diabetic retinal disease and is an emergency. Here take a route that does not depend on whether we are open: the emergency department of an eye hospital or the ophthalmic emergency service. Do not wait for a call back. How glaucoma otherwise progresses and is monitored, you can read on the page about it.

And one sign that comes before even that: a sudden, complete loss of vision in one eye — particularly together with headache, difficulty with language or speech, or signs of paralysis — does not belong in our consultation but in an emergency department, immediately: call the ambulance (144).

The reverse holds just as much: Blurred vision over a few days, coming and going, is common when blood sugar swings widely and is usually no emergency — the water content of the lens changes with the blood-sugar level, and with it the refractive power. Do not have new glasses fitted in this phase; the readings are not stable. If it is unclear to you which of the two categories your symptom falls into, call and describe what has changed and since when. Sorting that out is our job, not yours.

The stages — first in plain words

Findings carry abbreviations that hardly anyone explains. They describe how far the vessel changes have progressed — and from that follow the interval between checks and the question of whether to treat. Important first: the stage says little about how well you see at the moment. The two do not run in parallel.

The early form: damage to the vessels, no new vessels yet

The report calls this non-proliferative diabetic retinopathy, abbreviated to NPDR — 'non-proliferative' simply means: no new vessels are growing yet. What is visible are small bulges in the vessel walls, pinpoint haemorrhages, fatty deposits and areas with a poorer blood supply. As a rule this causes no symptoms. Depending on its extent this form is divided into mild, moderate and severe; the severe form carries a markedly raised risk of moving into the next stage, and is checked correspondingly more closely. Treatment here is usually not at the eye but at the metabolism.

The advanced form: new, fragile vessels

Here the report says proliferative diabetic retinopathy, abbreviated to PDR. 'Proliferative' means the growth of new vessels in answer to the shortage of oxygen. These vessels are thin-walled and grow where they have no business being — onto the surface of the retina, into the vitreous, sometimes as far as the iris. Two things can follow from that: a haemorrhage into the vitreous, which veils vision from one moment to the next, and scar strands that pull on the retina and can lift it off. This form is the reason why checks are kept up so consistently at all — it is treatable, and the earlier it is recognised the better.

Macular oedema: independent of the stage, and the part you notice

The macula is the point of sharpest vision, a few millimetres across and responsible for reading, faces and road signs. If fluid collects there, that is called diabetic macular oedema. That can happen as early as an early retinopathy and is the most common reason why people with diabetes actually notice a deterioration: letters blur, straight lines ripple, colours look duller. Such swelling becomes visible and measurable above all in the cross-sectional image of the retina, the OCT — from the outside and from visual acuity alone it cannot be assessed reliably.

Distorted vision, incidentally, is no proof of a macular oedema. The same symptom arises with several changes at the centre of the retina, among them age-related macular degeneration (AMD) and the folding caused by a fine membrane on the retina. Both occur alongside diabetes, and both are treated differently. Which of the causes is present is something the examination separates — not the description of the symptom.

The annual check: what is examined

The check of the back of the eye in diabetes answers four questions: are there changes? If so, at which stage? Is the centre of the retina involved? And when does the next check have to be? Everything else follows from the answers — the interval, any treatment there may be, and the report to your GP or your diabetes team.

History and visual acuity. How long has the diabetes been known, how well is it controlled, which medicines are you taking, is there high blood pressure, are the kidneys affected? These details help determine how closely we look and how closely we check. Bring your current long-term blood-sugar value and your list of medicines with you if you have them.
Dilation of the pupil (mydriasis). Without it the periphery of the retina — where the changes begin — cannot be assessed reliably. The drops need around 20 to 30 minutes. After that, for several hours: no driving yourself, blurred vision at near, sensitivity to light. That is the honest price of this examination, and we would rather say it beforehand than afterwards.
Assessment of the whole of the back of the eye. The retina is looked at far out to its edge: bulges, haemorrhages, fatty deposits, areas with a poor blood supply, new vessels. This is where the stage is decided.
OCT (optical coherence tomography). A contact-free cross-sectional image of the retina at microscopic resolution, without radiation and without an injection. It answers above all the question about the macula — whether fluid has collected there — and makes the progression comparable over years. It is exactly that comparability which makes an earlier finding worth so much.
Fluorescein angiography (FA), where it changes the treatment. An image of the retinal vessels using a dye, which makes leaking areas and areas with a poor blood supply visible. It does not belong in the routine but where the answer really changes what happens next — and there is a reason for that: the dye is injected into a vein in the arm, can cause nausea and colours the skin and urine for one to two days. Allergic reactions are rare, but they do occur. If we suggest an FA to you, we tell you beforehand which question it is meant to answer.
Intraocular pressure and the front of the eye. The lens and the iris are assessed along with it: whether the lens is clouding over, which can happen earlier in diabetes, and whether new vessels can be seen on the iris — a finding that changes something straight away.

This check is not an eye test with an add-on. An eye test measures what the centre of the retina is managing at that moment; it says nothing about the periphery and nothing about the vessels. Anyone with known diabetes who has had an examination without dilation has not had the examination that decides it. Which examinations are due when and in which starting situation, and which of them are medically justified, is set out on our page on which check is due when in diabetes.

If you cannot say when the back of your eye was last examined with the pupil dilated, that is the moment for the appointment — not the moment for another wait on a symptom that stays away for a long time: Book an appointment for a retinal check or call us on +41 44 500 69 00. You can reach us in Zurich, Wetzikon and Meilen, Mon–Fri 08:00–12:00 and 13:00–17:30; in Meilen Wednesday varies — ask there by phone.

When the checks are closer together

The annual check is the normal case, not the rule for everyone. There are constellations in which a year is too long — and in which we therefore suggest a shorter interval to you:

Pregnancy and trying to conceive. With pre-existing diabetes, a change in the retina can develop or worsen more quickly in pregnancy. A check as early as possible makes sense — ideally already when you are trying to conceive — and after that at intervals set by the findings. Gestational diabetes on its own expressly does not belong here.
Children and adolescents with type 1 diabetes. The rule 'five years after diagnosis at the latest' is the one for adults. In childhood the start follows puberty: the checks usually begin from around the eleventh year of life or with the onset of puberty, whichever comes first. Before puberty, changes that need treatment arise only exceptionally.
A finding already made. The further the changes have progressed, the shorter the interval: with a moderate non-proliferative form about every six months, with a severe non-proliferative form more like every three months, with the centre of the retina involved according to the findings and the course. The proliferative form is no longer an interval but a treatment decision — it needs assessing promptly and does not belong in the next calendar round. After treatment the rhythm follows the course.
Long duration of diabetes and difficult control. Both raise the likelihood of changes. A high long-term blood-sugar value over a longer period is the strongest reason not to let a year go by.
A rapid improvement in control. That sounds contradictory and is not: if a very high long-term blood-sugar value is brought down sharply within a short time, an existing change in the retina can worsen temporarily. Better control remains right — it simply belongs under ophthalmic supervision.
High blood pressure, raised blood fats, impaired kidney function. These factors act on the same vessels as the sugar does and intensify the changes. They belong in the judgement about the interval.
Before and after an operation on the eye. If cataract treatment is coming up, the back of the eye needs assessing beforehand and checking afterwards — an existing change in the retina can alter after the procedure, and a macular oedema explains many a disappointment with the result.
New symptoms, regardless of the calendar. Any of the signs from the section above overrides the interval. An appointment in four months is no reason to wait four months with a new shadow.

An interval is not a promise and not a guarantee — it is a judgement we make together with you and, where it makes sense, with your diabetes team. We record it in the report so that it stays traceable and so that you do not have to guess when you are next due.

Treatment: what is possible, and where we refer you

Treatment follows the stage and whether the centre of the retina is affected. One point first, because it tends to get lost in brochures — and because it reads differently depending on the method.

The laser treatment preserves, it does not improve. It is meant to halt further loss and does not make good vision that is already lost. Anyone expecting to see more sharply after laser treatment will be disappointed — even when it has done exactly what it is meant to do. With a build-up of fluid at the centre of the retina it is different: the drug injection can push the swelling back, and some of those treated see better again afterwards. That succeeds most readily when treatment is early; the longer the swelling has been present and the more tissue is already damaged, the less can be won back. It cannot be promised to anyone in advance — the honest answer is that an improvement is possible and should not be an expectation.

First: blood sugar, blood pressure, blood fats

The most effective treatment of the early forms does not take place at the eye. Better control of blood sugar and blood pressure over a longer period influences the course more strongly than any procedure we could offer you. That is not a way of putting you off but the order in which things work. You conduct this part with your GP or your diabetes team — we supply the eye finding that shows whether the effort is getting through.

Laser treatment of the retina

In laser coagulation, fine burns are placed on the retina in a targeted way. In the advanced form this serves to shut down areas with a poor blood supply, so that the stimulus for new vessels to grow subsides — the new vessels often regress as a result. The procedure is done as an outpatient at the slit lamp, with anaesthetic eye drops and a contact lens. Laser treatments on the retina we carry out ourselves; how extensive a treatment turns out to be, in how many sessions it is done, and whether with your finding it is better placed in our clinic or at a retinal surgery centre, we tell you beforehand and not afterwards.

Honesty requires saying what such a treatment costs — not in francs but in vision: an extensive laser treatment can impair the visual field at its edge and vision at dusk. That is a deliberate trade, and it needs explaining to you beforehand: peripheral vision against preserving the central.

With a build-up of fluid at the centre of the retina the laser plays only a secondary role today. It is used in selected cases — with individual leaking points away from the centre, for instance — and then usually alongside the drug treatment, not in its place.

Drug injections into the eye

With a build-up of fluid at the centre of the retina, the drug injection into the eye is today the usual approach. The medicine acts against the messenger substance that makes the vessels leak and lets new vessels grow. The injection is given under local anaesthetic, takes a few minutes and is done as an outpatient. It is not a one-off: treatment comes in series and over a longer period, with checks in between that decide the next intervals. Anyone who knows that beforehand experiences it as treatment; anyone who does not, as an imposition.

One sign belongs with this treatment, and it needs saying before the first injection is given: If pain, redness or worsening vision increase in the days after an injection instead of subsiding, get in touch at once — outside consulting hours with the ophthalmic emergency service, or directly at the emergency department of an eye hospital. Behind it can lie an inflammation inside the eye. It is rare, and it is the reason why nobody waits with this until the next check-up appointment.

What we take on is the diagnostics that justify such a treatment in the first place, the conversation about whether it is indicated in your situation, and the follow-up checks close to where you live in Zurich, Wetzikon or Meilen. Where the injections themselves take place we tell you concretely before a treatment begins — and if another centre is the right place for them, we arrange the referral, so that you do not have to see to it yourself.

Surgery inside the eye

If a haemorrhage in the vitreous persists so that the retina can no longer be assessed, or if scar strands pull the retina away from the layer beneath it, there is no way round an operation inside the eye — the vitrectomy, in which the vitreous is removed and the retina is dealt with from inside. We do not carry out operations inside the eye ourselves. If your finding calls for one, we tell you in the same conversation and arrange the referral to a retinal surgery centre. The diagnostics beforehand and the checks afterwards we take on close to where you live, at our three locations.

We promise you a result on none of these routes. What we can promise is a prompt assessment, a reasoned recommendation and a clear next step — including when that step leads out of our clinic.

What you can do yourself

Most of what influences the course at the eye is not decided at the eye. That is the uncomfortable and at the same time the encouraging message of this page: much of it lies in your hands, and none of it requires a device.

Keep an eye on the long-term blood-sugar value. Better blood-sugar control over years has an effect on the retinal vessels. Which target value makes sense for you belongs in the hands of your GP or your diabetes team — we do not set it for you at the eye.
Take blood pressure seriously. It acts on the same fine vessels as the sugar does. Well-treated high blood pressure is among the most effective measures for the retina, and it costs you no extra appointment with us.
Blood fats and smoking. Raised blood fats encourage deposits in the retina. Smoking puts an additional strain on the vessels; stopping smoking is one of the few measures that act on the eyes, the heart and the kidneys at the same time.
Keep appointments, even when nothing hurts. That is precisely the peculiarity of this disease. Put the check firmly in your diary, the way you enter a dental appointment — and do not move it because you happen to see well at the moment.
Test each eye separately once a week. Cover one eye and look with the other at a pattern of straight lines, a window frame or tile joints for instance; then swap. If you notice a new distortion, a patch or a blur, get in touch. This does not replace an examination — it only finds what arises between two appointments.
No new glasses while blood sugar is swinging. Refractive power changes with the blood-sugar level. Wait until the readings have been stable for a few weeks — otherwise you pay for glasses that no longer fit by the time you collect them.

What you can spare yourself: food supplements that hold out an improvement of the retina in diabetes. For this disease there is no solid basis for that, and the money is better spent on a blood-pressure monitor. If you have seen something that strikes you as plausible, bring the packet to the appointment — we look at it with you rather than dismissing it out of hand.

For referring physicians

This section is addressed to GP practices, diabetes clinics and opticians. It describes what you can expect from a referral for a diabetic retinal examination — and it deliberately describes nothing that goes beyond what our referring physicians' area for practices and opticians already promises.

What we promise — and what we do not

Three points hold for every referral to us, whatever the question:

Appointments at short notice. For urgent cases we keep short-notice appointments available and coordinate directly with your practice. Where a vitreous haemorrhage, a tractional retinal detachment or new vessels on the iris are suspected, the phone call is the quickest route — not the form.
Structured reports. You receive a detailed report promptly for every patient you refer.
Close collaboration. We see ourselves as a partner to your practice and coordinate diagnostics and treatment closely with you. With diabetes that means, concretely: we do not set the interval between checks against your planning but with it.

On turnaround times we deliberately give no figure here. What the referring physicians' area says holds good: a detailed report promptly, and for urgent cases direct coordination with your practice. A deadline in working days that we write here and carry nowhere else would be worthless to you. If you need to know for a particular case by when the report will be with you, ask for it on the phone — then you get an answer that is right for that case.

What a report goes by for this question

An ophthalmic report on a diabetic retinal examination is usable in your practice when it answers four questions. These are what we go by:

Stage, for each side separately. Early or advanced form, and with the early form its extent — for each eye separately.
Centre of the retina involved or not. The question that decides the urgency and the treatment option, together with the findings of the cross-sectional scan.
What was arranged. Whether treatment was started, further diagnostics arranged or a referral to a retinal surgery centre organised.
The next interval, with reasons. So that what is known in your practice is not the date but the reason for it — and so that the check does not fall between two responsibilities.

In return we ask for two details on the referral, because they change the appointment: how long the diabetes has been present and how it is currently controlled, and an existing or planned pregnancy. Both shift the urgency markedly, and otherwise we learn of both only in the consultation. The form for it is ready in the referring physicians' area: Referral form (PDF).

Costs & health insurance

What does the insurer pay for — and what not?

Checking the back of the eye in known diabetes is medically justified — it is follow-up of an underlying condition and not screening on its own. That is the difference that decides the billing. What you should know therefore concerns above all the deductible, the co-payment and the few services that do not run through basic health insurance (OKP).

Service	Coverage	What this means for you
Annual check of the back of the eye in diabetes	Basic insurance (OKP)	Examination with the pupil dilated and assessment of the whole of the back of the eye. With known diabetes there is a medical indication, even when you see well and have no symptoms. Your deductible and co-payment apply as at any doctor's appointment.
Cross-sectional image of the centre of the retina (OCT)	Basic insurance (OKP)	Not an extra you book on top but an examination that a clinical question calls for — here the question of a build-up of fluid at the macula. Where there is such a question, it runs through basic health insurance; in screening alone, without an indication, it does not.
Fluorescein angiography (FA)	Basic insurance (OKP)	An image of the retinal vessels using a dye where the indication is confirmed. We use it selectively, when the answer changes what happens next, and not as a routine.
Laser treatment of the retina	Basic insurance (OKP)	An outpatient procedure where the indication is confirmed. It is billed against the same deductible as the assessment it follows from. If several sessions are needed, that changes nothing about the basis of billing.
Drug injections into the eye	Basic insurance (OKP)	A mandatory benefit where the indication is confirmed — including when the treatment runs in series over a longer period. Where the injections are given we discuss with you beforehand; if they are given at another centre, that centre bills them.
Surgery inside the eye (vitrectomy)	Basic insurance (OKP)	The operation is billed by the centre that carries it out. If it is inpatient, your room and choice of doctor follow your insurance model — the operation itself is not affected by that. With inpatient treatment the statutory hospital contribution of CHF 15 per day is added as well (adults).
New spectacle lenses when the readings have changed	Usually not	Spectacle lenses are as a rule not a service of basic health insurance for adults. For individual medical indications the MiGeL provides for contributions; whether your situation is one of them is for you to clarify with your insurer, and we put together the details needed. Where blood sugar swings widely, waiting is worthwhile anyway: the readings are then not stable.

The deductible and co-payment you bear yourself. Whether supplementary insurance contributes anything is for your health insurer to tell you — and if you would like to know exactly before the appointment, ask us: +41 44 500 69 00 or through the contact form. We would rather you asked about the cost beforehand than put off a check because of it.

Related conditions

Retina & vitreous Eye screening Age-related macular degeneration (AMD)

Medically reviewed by PD Dr. med. Andrea von Rückmann

Your ophthalmologistPD Dr. med. Andrea von RückmannView profile

Frequently asked questions

: Yes. Seeing well does not rule out diabetic retinal disease; it says something only about the centre of the retina. The changes almost always begin further out, where nobody notices them, and the second eye covers a loss over for a long time as long as both eyes are open. When vision declines, the disease is therefore rarely at its beginning. The reverse holds: exactly the time in which you feel nothing is the time in which a check brings most — because there is then still something to decide.
: Usually the check runs as an annual appointment. What is decisive, though, is not the calendar but the findings, how long the diabetes has been present and how well the metabolism is controlled. What is regularly overlooked is the start: anyone given a diagnosis of type 2 diabetes needs the first look at the back of the eye straight away — until then the disease has often been present unnoticed for years. With type 1 diabetes the starting point is five years after diagnosis at the latest; in children and adolescents the checks begin from around the eleventh year of life or with puberty, whichever comes first. If changes are visible, the checks come closer together: with a moderate finding about every six months, with a severe non-proliferative form more like every three months. The proliferative form is no longer an interval but a treatment decision. In pregnancy separate, closer intervals apply. Your personal interval we record in the report, so that it does not stay at 'sometime again'.
: The retinopathy describes what happens to the vessels of the retina as a whole — bulges, haemorrhages, closed-off areas, later new vessels. The macular oedema is a build-up of fluid at the centre of the retina, the point of sharpest vision. The one is the map, the other an event at its most important point. In practice that means: a macular oedema can occur as early as an early retinopathy and can disturb reading markedly, while an extensive retinopathy without the macula involved is barely noticeable for a long time. That is why both questions belong in the same examination.
: For this question: yes, without exception. The diabetic changes set in far out in the retina, and the view through a narrow pupil does not reach that far. Expect around 20 to 30 minutes for the drops to take effect, and after that several hours in which near vision stays blurred and you are dazzled. So come without a car, bring sunglasses and allow around two hours for the appointment. A retinal check in diabetes without dilation is not one — even if it feels like one.
: With pre-existing type 1 or type 2 diabetes the checks are closer together in pregnancy, because a change in the retina can develop or worsen more quickly during this time. An ophthalmic check as early as possible makes sense — ideally already when you are trying to conceive — and after that at intervals that follow the findings. Gestational diabetes, which arises only in pregnancy, is a different matter: on its own it makes no retinal check necessary, and we do not call you in for it either. It is different if the diabetes was already there before the pregnancy or persists after the birth — then the usual applies again. In any case, tell us that you are pregnant or would like to become pregnant before we set the interval.
: Individual early changes can regress if blood sugar, blood pressure and blood fats are better controlled over a longer period. Closed-off vessels and scars do not regress, and what has been lost of nerve tissue does not come back. What is realistic is therefore not 'reversing' but 'halting' — and that succeeds the more readily the earlier one starts. One point needs saying with it: if a very high long-term blood-sugar value is brought down quickly, an existing change in the retina can worsen temporarily. That is no argument against the improvement but one for an eye check before and while it takes place.
: Checking the back of the eye in known diabetes is medically justified — this is follow-up and not screening on its own. Where there is a medical indication the cost is covered by basic health insurance; the deductible and co-payment apply as at any doctor's appointment. The same holds for the additional examinations that a clinical question calls for, a cross-sectional scan of the macula for instance. Spectacle lenses are as a rule not a service of basic health insurance for adults, even when your readings have changed through swinging blood sugar. If you would like to know exactly beforehand, ask us and your health insurer — that is settled in a few minutes.

The retina does not announce itself. The appointment has to come from you.

If you have diabetes and are not sure when the back of your eye was last examined, that is already the answer. Tell us on the phone how long the diabetes has been known and when the last check was — we will tell you how urgent the next appointment is. And if you suddenly see flashes of light, a shower of floaters, a shadow or distorted lines, that does not belong in the annual diary but on the same day.

Book a retinal check

+41 44 500 69 00 — Mon–Fri 08:00–12:00 / 13:00–17:30. Or book an appointment online.