Diabetic Eye Care in Olympia

Diagnosing Diabetic Eye Disease

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Diagnosing Diabetic Retinopathy begins with a comprehensive dilated eye exam. For this exam, drops are placed in your eyes to widen (dilate) your pupils to allow your doctor a better view inside your eyes. The drops can cause your close vision to blur for several hours until they wear off.

During the exam, your eye doctor will look for abnormalities in the inside and outside parts of your eyes.

From there, your doctor may order a fundus photo and/or an optical coherence tomography (OCT) exam. 

 

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Fundus Photography

A fundus photo (also called fundus photography or a retinal photograph) is a simple, non-invasive eye imaging test that takes a color picture of the back of your eye, known as the fundus. The fundus includes the retina, optic nerve, macula, and retinal blood vessels.

It’s one of the quickest and most common tests in eye exams, often used as a baseline tool to document eye health.

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How the Test Works

• • You place your chin on a rest and look into the camera.
  • A bright flash of light captures a detailed image of your retina.
  • The entire process typically takes just a few seconds.
  • Your pupils will likely need to be dilated for clearer photos.

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What Fundus Photos Are Used For

• • Diabetic retinopathy

  • Hypertensive retinopathy

  • Glaucoma (by documenting the optic nerve)

  • Age-related macular degeneration (AMD)

  • Retinal tears, holes, or detachments

  • Macular changes (swelling, pigment changes)

  • Optic nerve abnormalities

  • Baseline documentation of retinal health

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What You Experience

• • A bright flash of light, similar to a camera flash.

  • No pain, and usually no contact with the eye.

  • If dilation is performed, your vision may be blurry or light-sensitive for a few hours.

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What the Results Mean

Normal Findings

• • • Clear retina with healthy blood vessels

    • Normal optic nerve shape and color

    • Healthy macula with no swelling or deposits

    • No bleeding or exudates

Abnormal Findings May Include

• • • Hemorrhages (bleeding)

    • Exudates (fatty yellow deposits seen in diabetic retinopathy)

    • Drusen (AMD)

    • Optic nerve cupping (possible glaucoma)

    • Swelling of the optic nerve or retina

    • Tears, holes, or scars

    • Pale or narrowed blood vessels

 

 

 

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Optical Coherence Tomography (OCT)

OCT is a non-invasive imaging test that uses light waves to take cross-sectional pictures of the retina.

It’s one of the most commonly used tools in modern eye care because it gives extremely detailed images of the retina, similar to an optical “ultrasound,” but using light instead of sound.

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How the Test Works

• • You place your chin on a rest and look at a small target light inside the machine.

  • The OCT device scans your eye using safe, low-energy light waves.

  • The reflected light is processed to create high-resolution, cross-sectional images of the retina and sometimes the optic nerve.

  • The test usually takes 5–10 minutes and does not involve touching your eye.

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What OCT Is Used For

• • Age-related macular degeneration (AMD)

  • Diabetic macular edema and diabetic retinopathy

  • Macular holes or macular puckers (epiretinal membranes)

  • Retinal swelling or fluid accumulation

  • Glaucoma (by measuring optic nerve and retinal nerve fiber layer thickness)

  • Retinal detachment or structural abnormalities

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What You Experience 

• • You will likely be dilated, which will result in better images for a more accurate diagnosis

  • No injections, dye, or contact with the eye

  • You may need to blink less frequently during the scan, but the process is painless

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What the Results Mean

Normal Results

• • • Smooth, well-defined retinal layers.

    • Normal thickness of the macula and nerve fiber layer.

    • No fluid, swelling, or abnormal membranes.

Abnormal Findings May Show

• • • Retinal swelling or fluid pockets → seen in macular edema or AMD.

    • Thinning of retinal nerve fibers → possible sign of glaucoma.

    • Macular holes or structural distortions → may require monitoring or surgery.

    • Scar tissue or membrane formation on the retina.

    • Drusen (deposits in AMD).

Your doctor interprets these images to guide diagnosis, track changes over time, and determine whether treatment is needed.

Patients who have been diagnosed with diabetic eye disease will undergo a fluorescein angiography (FA) test. 

Fluorescein angiography is an eye imaging test used to examine the retina and choroid. It helps your doctor detect and monitor various retinal conditions.

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How Fluorescein Angiography (FA) Testing Works

• A fluorescent dye called fluorescein is injected into a vein in your arm.
• The dye travels through your bloodstream and reaches the blood vessels in the eye.
• A special camera takes a rapid series of images as the dye passes through the retinal vessels.
• The images show how well blood is flowing and whether there are any leaks, blockages, or abnormal vessels.

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What it’s used for

• Diabetic retinopathy

• Age-related macular degeneration (AMD)

• Retinal vein or artery occlusion

• Macular edema

• Tumors or inflammation in the retina or choroid

• Unexplained vision loss

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What you experience 

• Your pupils are dilated with eye drops.

• You may feel warm or briefly nauseated after the dye injection—this is common and usually passes quickly.

• Vision may be blurry for a few hours due to dilation.

• Your skin and urine may appear slightly yellow for several hours due to the dye.

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Risks

The test is generally safe. Rarely, people may experience:

• Allergic reactions to the dye

• Severe nausea

• Very rarely, anaphylaxis (severe allergic reaction)

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How to Prepare

• Bring sunglasses: Your pupils will remain dilated for several hours after the test.

• Arrange transportation: You may not be able to drive safely because of dilation and light sensitivity.

• Eat lightly before the test: A small snack is fine unless your doctor gives other instructions; heavy meals right before can increase nausea in some people.

• Inform your doctor if you:

  • Have had previous reactions to fluorescein dye

  • Are pregnant or breastfeeding

  • Have kidney issues or asthma

  • Are taking any medications or have significant allergies

• Remove contact lenses before the test if asked (policies vary by clinic).

• No fasting is normally required.

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What the Results Mean

Normal Results

• • Dye moves smoothly through all vessels.

  • No leakage, blockage, or abnormal vessel growth.

  • Well-defined, healthy retinal and choroidal structures.

Abnormal Results May Show

• • Leaking blood vessels → common in diabetic retinopathy or macular edema.

  • Blocked or narrowed vessels → can indicate retinal artery or vein occlusion.

  • New, fragile abnormal vessels (neovascularization) → seen in advanced AMD or diabetic eye disease.

  • Areas of non-perfusion (poor blood flow) → signal damaged retinal tissue.

  • Inflammatory changes → may appear in uveitis or other retinal inflammatory conditions.

  • Tumors or structural abnormalities → can alter dye patterns.

Your doctor will explain how these findings relate specifically to your condition and whether treatment (like injections, laser therapy, or monitoring) is recommended.

Treatment, which depends largely on the type of diabetic retinopathy you have and how severe it is, is geared to slowing or stopping the progression.

Early diabetic retinopathy

If you have mild or moderate nonproliferative diabetic retinopathy, you might not need treatment right away. However, your eye doctor will closely monitor your eyes to determine when you might need treatment.

Work with your diabetes doctor (endocrinologist) to determine if there are ways to improve your diabetes management. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the progression.

Advanced diabetic retinopathy

If you have proliferative diabetic retinopathy or macular edema, you'll need prompt treatment. Depending on the specific problems with your retina, options might include:

• Injecting medications into the eye. These medications, called vascular endothelial growth factor inhibitors, are injected into the vitreous of the eye. They help stop growth of new blood vessels and decrease fluid buildup.Two drugs are approved by the U.S. Food & Drug Administration (FDA) for treatment of diabetic macular edema — ranibizumab (Lucentis) and aflibercept (Eylea). A third drug, bevacizumab (Avastin), can be used off-label for the treatment of diabetic macular edema.These drugs are injected using topical anesthesia. The injections can cause mild discomfort, such as burning, tearing or pain, for 24 hours after the injection. Possible side effects include a buildup of pressure in the eye and infection.

  These injections will need to be repeated. In some cases, the medication is used with photocoagulation.

• Photocoagulation. This laser treatment, also known as focal laser treatment, can stop or slow the leakage of blood and fluid in the eye. During the procedure, leaks from abnormal blood vessels are treated with laser burns.Focal laser treatment is usually done in your doctor's office or eye clinic in a single session. If you had blurred vision from macular edema before surgery, the treatment might not return your vision to normal, but it's likely to reduce the chance of the macular edema worsening.
• Panretinal photocoagulation. This laser treatment, also known as scatter laser treatment, can shrink the abnormal blood vessels. During the procedure, the areas of the retina away from the macula are treated with scattered laser burns. The burns cause the abnormal new blood vessels to shrink and scar.It's usually done in your doctor's office or eye clinic in two or more sessions. Your vision will be blurry for about a day after the procedure. Some loss of peripheral vision or night vision after the procedure is possible.
• Vitrectomy. This procedure uses a tiny incision in your eye to remove blood from the middle of the eye (vitreous) as well as scar tissue that's tugging on the retina. It's done in a surgery center or hospital using local or general anesthesia.

While treatment can slow or stop the progression of diabetic retinopathy, it's not a cure. Because diabetes is a lifelong condition, future retinal damage and vision loss are still possible.

Even after treatment for diabetic retinopathy, you'll need to come in for a regular diabetic eye exam. At some point, you might need additional treatment. Lucky for you, you’ll find us in a quick search for, “diabetic eye exam near me.” The Retina Service in Lacey, Washington is your diabetic eye screening clinic!