The Jackson Davenport Vision Center Team
How often should you get an eye exam if you have diabetes? Usually once a year. The 2026 ADA Standards of Care call for a dilated exam when type 2 diabetes is diagnosed, or five years after an adult's type 1 diabetes begins, then yearly; every one to two years may be considered after clear exams with blood sugar at goal. Jackson Davenport Vision Center in Summerville explains.
If you live with diabetes, you already keep a lot of appointments: blood work, medication checks, foot exams. It's easy for the eye exam to slide, especially when your vision seems fine. That's exactly the problem. The National Eye Institute puts it simply: "Diabetic retinopathy may not have any symptoms at first — but finding it early can help you take steps to protect your vision."
Here is the schedule the major guidelines set, what each kind of eye check can and can't tell you, what to know if you take a GLP-1-based medicine such as semaglutide or tirzepatide, and the symptoms that should never wait for your yearly visit.
Key points at a glance
- Most people with diabetes need an eye exam every year. Type 2 diabetes: start at diagnosis. Type 1 diabetes in adults: start five years after it begins.
- Every one to two years is an option, not the default. The American Diabetes Association (ADA) says it "may be considered" after one or more clear yearly exams with blood sugar in the goal range, and your eye doctor makes that call.
- Pregnancy changes the schedule for people with type 1 or type 2 diabetes: an exam before pregnancy and in the first trimester, with closer follow-up as needed. Gestational diabetes alone does not require eye exams during pregnancy.
- A retinal photo is a screening tool, not a full exam. The ADA says retinal photographs "are not a substitute for dilated comprehensive eye exams."
- Semaglutide and tirzepatide labels include an eye warning. The current U.S. labels we reviewed say people with a history of diabetic retinopathy should be monitored for progression. Never stop a prescribed medicine on your own.
- Sudden vision changes can't wait. Sudden vision loss, a burst of new floaters or flashes, or a curtain over your vision means calling an eye doctor right away or going to the emergency room.
How Often You Need a Diabetic Eye Exam — Type 1, Type 2 and Pregnancy, What the ADA, AAO and AOA Say, and When Every One to Two Years Is Even an Option (Your Eye Doctor Sets the Schedule)
Diabetes can damage the tiny blood vessels in the retina, the light-sensing layer at the back of the eye. That damage is called diabetic retinopathy, and in its early stages it usually doesn't hurt or blur your vision. The ADA's 2026 Standards of Care explain why that matters: "people with vision-threatening retinopathy may be asymptomatic" (ADA Standards of Care, Section 12). A regular eye exam is how it gets caught early.
Even so, many people fall behind. The American Academy of Ophthalmology (AAO) notes that "only 60% of people with diabetes mellitus have the recommended yearly screenings for diabetic retinopathy" (AAO Diabetic Retinopathy Preferred Practice Pattern).
The schedule at a glance
- Type 2 diabetes: first exam at the time of diagnosis, then yearly. Every 1–2 years may be considered after one or more clear yearly exams, with blood sugar in your goal range.
- Type 1 diabetes (adults): first exam 5 years after diabetes begins, then yearly, with the same 1–2-year option under the same conditions.
- Children and teens with diabetes: the schedule is set by the ADA's separate guidance for young people and their care team. The AAO says retinopathy progresses faster during puberty and young people "should be followed more closely."
- Type 1 or type 2 diabetes, planning a pregnancy or pregnant: an exam before pregnancy and in the first trimester. You may need checks every trimester and for a year after delivery, depending on what the exam shows.
- Gestational diabetes (diabetes that starts in pregnancy): no eye exam is required during pregnancy because of it.
- Any diabetic retinopathy found: exams at least yearly, and more often, by an ophthalmologist, if it is progressing or threatens sight.
Sources: ADA Standards of Care 2026, recommendations 12.3–12.5, 12.8 and 12.9; AAO Diabetic Retinopathy Preferred Practice Pattern.
Why type 2 starts at diagnosis, and type 1 starts later
The two types of diabetes start the clock differently. With type 2, high blood sugar may have been present, unnoticed, for years before the diagnosis. The ADA says people with type 2 "may have had undiagnosed hyperglycemia for years and have a significant risk of prevalent diabetic retinopathy at the time of diabetes diagnosis," so the first dilated exam happens right away.
Type 1 usually announces itself quickly. The ADA explains that "retinopathy is estimated to take at least 5 years to develop after the onset of hyperglycemia," which is why its recommendation for adults with type 1 is a first dilated, comprehensive exam "5 years after the onset of diabetes." The AAO's guidance lines up: annual screenings beginning five years after type 1 starts, and "a prompt screening at the time of diagnosis and at least yearly screenings thereafter" for type 2.
When every one to two years is even an option
You may hear that some people with diabetes can go two years between eye exams. That's an option under specific conditions. The ADA's recommendation reads: "If there is no evidence of retinopathy from one or more annual eye exams and glycemic indicators are within the goal range, then screening every 1–2 years may be considered."
Notice the words "may be considered." The ADA adds that "it is important to adjust screening intervals based on the presence of specific risk factors for retinopathy onset and worsening retinopathy," and that people who are not meeting their glycemic goals, or who have advanced retinopathy or swelling in the retina (macular edema), need more frequent exams by an ophthalmologist. Once any retinopathy is found, the ADA says exams should be repeated at least yearly. If it is progressing or sight-threatening, exams by an ophthalmologist "will be required more frequently."
The safe rule: yearly is the baseline, and your eye doctor decides whether a longer interval is right for you.
Pregnancy, and why gestational diabetes is different
Pregnancy can speed up diabetic eye disease. The ADA recommends that people with type 1 or type 2 diabetes "receive an eye exam before pregnancy as well as in the first trimester and may need to be monitored every trimester and for 1 year postpartum as indicated by the degree of retinopathy." The AAO agrees that women with diabetes who become pregnant "should be examined early and followed closely during the course of the pregnancy because the disease can progress rapidly."
Gestational diabetes, the kind that first appears during pregnancy, is different. Both the ADA and the AAO say an eye exam is not required during pregnancy because of it. If you had diabetes before you became pregnant, the closer schedule above applies.
Three organizations, one consistent message
Each group speaks for itself, so here is who says what. The ADA sets the detailed screening schedule above. The AAO (ophthalmologists) calls a dilated exam the gold standard for diabetic retinopathy screening and recommends at least yearly screening once it starts. The American Optometric Association (AOA) (optometrists) treats diabetes as a reason for at least yearly eye exams and, in a June 2025 report, added specific guidance for people starting GLP-1-based medicines (covered below). The details differ, but the through-line is the same: for most people with diabetes, plan on a yearly eye exam unless your eye doctor tells you otherwise.
To learn more about how diabetes affects the eyes, see our earlier post on how diabetes affects your eyes, and our page on what a diabetic eye exam involves.
Dilated Exam, Retinal Photo or AI Screening: What Each One Checks — and What a Photo Can’t Replace
"Eye exam" can mean several different things. Here is how they compare.
The dilated, comprehensive eye exam
In a dilated exam, drops widen your pupils so the doctor can see the retina and optic nerve at the back of the eye. As part of a comprehensive exam, the doctor also checks how well you see, your eye pressure (a glaucoma check), the front of the eye and other parts of your visual system. The AAO calls the dilated exam "the gold standard for screening" for diabetic retinopathy.
That broader look matters with diabetes. The ADA notes that "glaucoma and cataracts occur earlier and more frequently in people with diabetes," and a retinal-only check isn't designed to look for every one of them.
Retinal photos with remote reading
Some screening programs take digital photos of the retina and have them read remotely by a trained eye care professional or a reading center. The ADA calls programs that use "retinal photography with remote reading" an appropriate screening strategy, as long as they include "pathways for timely referral for a comprehensive eye examination when indicated." The AAO adds that "validated digital imaging may be an effective detection method as well."
AI screening
Some screening programs use software instead of a person to read the photos. The ADA says AI systems that detect more than mild diabetic retinopathy and macular swelling, "that have been authorized for use by the FDA represent an alternative to traditional screening approaches." The ADA also cautions that "the benefits and optimal utilization of this type of screening have yet to be fully determined."
What a photo can't replace
Retinal photos have earned a place in diabetes care, especially where an eye doctor isn't nearby. But the ADA is clear about their limits:
"In-person exams are still necessary when the retinal photographs are of unacceptable quality and for follow-up if abnormalities are detected. Retinal photographs are not a substitute for dilated comprehensive eye exams, which should be performed at least initially and at yearly intervals thereafter or more frequently as recommended by an eye care professional."
So if you had a retinal photo at your doctor's office, that's a useful screening. It answers a narrower question than a comprehensive eye exam. If it shows anything abnormal, or the picture isn't clear enough to read, the next step is an in-person exam. You can read more about how retinal imaging works and what a comprehensive eye exam includes.
GLP-1-Based Medicines and Your Eyes: What the FDA Labels for Semaglutide and Tirzepatide Say About Diabetic Retinopathy, What the 2025 Safety Reviews Said About NAION, and Why You Never Stop a Medicine on Your Own
Many people with diabetes now take a GLP-1-based medicine. Semaglutide, a GLP-1 receptor agonist, is sold as Ozempic injection and as Rybelsus and Ozempic tablets for type 2 diabetes, and as Wegovy for weight management. Tirzepatide acts on two receptors, GIP and GLP-1; it is sold as Mounjaro for type 2 diabetes and as Zepbound for weight management. In this section, "GLP-1-based medicines" covers both, the way the FDA's own safety communications group them. These medicines can do a lot of good, and they also come with eye-related cautions worth knowing.
What the U.S. labels say about diabetic retinopathy
The FDA labels for these medicines include a warning about diabetic retinopathy complications. The semaglutide labels say: "Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy. The effect of long-term glycemic control with semaglutide on diabetic retinopathy complications has not been studied. Patients with a history of diabetic retinopathy should be monitored for progression of diabetic retinopathy" (Ozempic label).
The tirzepatide labels (Mounjaro and Zepbound) say the same thing in their own words: "Temporary worsening of diabetic retinopathy has been reported with rapid improvement in glucose control. Patients with a history of diabetic retinopathy should be monitored for progression of diabetic retinopathy" (Zepbound label). The Zepbound label also tells prescribers to have patients with type 2 diabetes "contact their healthcare provider if changes in vision are experienced during treatment."
The AAO's guidance makes the same point about how fast blood sugar comes down: "rapid, tight glucose control can lead to accelerated or early onset of DR as seen with the semaglutides and other newer agents." In plain terms, bringing blood sugar into range is a goal of diabetes care, but a rapid drop has been linked to temporary worsening of retinopathy, and the labels single out people who already have retinopathy for monitoring. That's why the timing of your eye exam matters.
The other warnings on these labels
The eye warning isn't the only one, and it helps to see it in context. Each of these labels carries a boxed warning titled "Risk of Thyroid C-Cell Tumors." Semaglutide and tirzepatide caused thyroid C-cell tumors in rodent studies, and the labels say it is unknown whether they cause these tumors, including medullary thyroid carcinoma (MTC), in humans. The medicines are not to be used by anyone with a personal or family history of MTC or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). The most common side effects are digestive, such as nausea, diarrhea, vomiting, constipation and stomach pain. Your prescriber is the right person to walk you through the full balance of benefits and risks for your situation.
What the ADA's 2026 Standards say
The ADA's 2026 Standards describe the evidence on GLP-1 receptor agonists as mixed. They note "conflicting data on the impact of glucagon-like peptide 1 receptor agonist (GLP-1 RA) treatment on various facets of eye health," including retinopathy progression, glaucoma, macular degeneration and an optic nerve condition called NAION. GLP-1 receptor agonists including liraglutide, semaglutide and dulaglutide "have been shown to be associated with a risk of mildly worsening diabetic retinopathy in randomized trials," and the ADA recommends that "retinopathy status should be assessed when glucose-lowering therapies are intensified, such as those using GLP-1 RAs." It also notes that some studies have linked these medicines to lower eye pressure and a reduced risk of glaucoma.
What regulators said about NAION in 2025
NAION (non-arteritic anterior ischemic optic neuropathy) happens when blood flow to the front of the optic nerve is reduced. The AOA lists its common signs, starting with "sudden, unilateral painless loss of vision," meaning sudden, painless vision loss in one eye. The AOA also lists diabetes itself among the risk factors for NAION.
In June 2025, the European Medicines Agency's safety committee concluded that NAION "is a very rare side effect of semaglutide (meaning it may affect up to 1 in 10,000 people taking semaglutide)," and recommended updating the European product information for Ozempic, Rybelsus and Wegovy. Its advice to patients: "If patients experience a sudden loss of vision or rapidly worsening eyesight during treatment with semaglutide, they should contact their doctor without delay." The agency added that treatment should be stopped if NAION is confirmed, a decision for the prescribing doctor (EMA).
That was a European action. In the U.S., the FDA labels we reviewed in October 2026 for Ozempic, Rybelsus, Wegovy, Mounjaro and Zepbound do not list NAION among their warnings. The ADA's 2026 Standards call the data linking GLP-1 receptor agonists to NAION "limited."
What the AOA recommends if you're starting a GLP-1-based medicine
In a June 2025 clinical report, the American Optometric Association recommended that "any patient initiating a GLP-1RA, especially those with diabetes or any form of age-related macular degeneration (AMD), should have an in-person, comprehensive, dilated eye examination either within the 12 months prior to starting therapy or a baseline examination within one month of initiating therapy" (AOA).
Why you never stop a medicine on your own
Don't change or stop a prescribed medicine based on this article or on your own. Medication decisions belong to the clinician who prescribed it, and diabetes medicines help keep blood sugar in range, which matters for your eyes: the ADA lists chronic high blood sugar among the main risk factors for retinopathy. Instead:
- Bring medication questions to your prescriber, rather than stopping or skipping doses on your own.
- Tell your eye doctor what you take, including any GLP-1-based medicine and when you started it, and tell your prescriber about your eye exam results.
- Report vision changes promptly, and treat sudden changes as urgent (see the next section).
Symptoms That Can’t Wait for Your Yearly Visit — and How Coverage Usually Works (Medicare’s Yearly Diabetic Eye Exam; Medical Insurance vs. Vision Plans)
Your yearly exam is for catching problems before you notice them. Some symptoms mean you shouldn't wait for it.
Sudden symptoms: call an eye doctor right away or go to the emergency room
- Sudden vision loss in one or both eyes, painful or painless.
- A lot of new floaters (small dark spots or squiggly lines) or flashes of light.
- A dark shadow or "curtain" over part of your vision.
- Sudden severe eye pain with redness and nausea or vomiting.
- Sudden double vision.
- Sudden distortion of your central vision, where straight lines look wavy.
- An eye injury, or a chemical splash in the eye. For a chemical splash, flush the eye with water right away and get emergency care immediately.
These are reasons to contact an eye doctor right away or seek emergency care. The National Eye Institute calls retinal detachment, which can cause floaters, flashes and a curtain over your vision, "a medical emergency." It says that if you have those symptoms, "it's important to go to your eye doctor or the emergency room right away" (NEI).
With diabetes in particular, the NEI notes that advanced retinopathy can cause bleeding inside the eye: "you may see dark, floating spots or streaks that look like cobwebs. Sometimes, the spots clear up on their own — but it's important to get treatment right away" (NEI).
Changes that should prompt an appointment soon
Not every change is an emergency. The NEI says that in early diabetic retinopathy, "some people notice changes in their vision, like trouble reading or seeing faraway objects. These changes may come and go." Changes like these, or blurriness, redness or watering that persists, are reasons to book an eye exam soon rather than wait for your yearly visit. A helpful rule of thumb: sudden and severe means now; persistent means soon.
Only an eye exam can tell what is causing a change in your vision. Treatment for advanced retinopathy or swelling in the retina is handled by an ophthalmologist experienced in diabetic retinopathy. The ADA calls for prompt referral to one when moderate or worse retinopathy, or any swelling in the retina, is found.
How Medicare covers diabetic eye exams
If you have Medicare:
- Diabetic eye exam: Medicare Part B covers an eye exam for diabetic retinopathy once a year if you have diabetes. It must be done by "an eye doctor who's legally allowed to do the test in your state." After you meet the Part B deductible, you pay 20% of the Medicare-approved amount, plus a copayment in a hospital outpatient setting (Medicare).
- Glaucoma screening: Medicare also covers a glaucoma screening once every 12 months for people at high risk, and diabetes is one of the qualifying risks (Medicare).
- Routine exams for glasses or contacts: Original Medicare "doesn't cover routine eye exams (sometimes called 'eye refractions') for eyeglasses or contact lenses." Some Medicare Advantage plans offer extra vision benefits (Medicare).
Private insurance: vision plans and medical insurance
Private coverage varies by plan. Many people have a vision plan for routine eye care as well as medical insurance. Before your appointment, ask your insurer which plan covers a diabetic eye exam, and see the practice's insurance and benefits page or call the office with questions.
How Often Should You Get an Eye Exam If You Have Diabetes? Common Questions
My vision is fine. Do I still need a yearly eye exam? Yes, in most cases. Early diabetic retinopathy usually has no symptoms, which is why the guidelines set a schedule instead of waiting for symptoms. Your eye doctor may consider stretching the interval to every one to two years after clear exams, if your blood sugar is in the goal range.
I was just diagnosed with type 2 diabetes. When should I get my eyes checked? Now. The ADA recommends a dilated, comprehensive eye exam at the time of diagnosis, because high blood sugar may have been present for years before it was found.
Is the retinal photo my primary care doctor took enough? It is a useful screening, but it isn't a comprehensive eye exam. The ADA says retinal photographs "are not a substitute for dilated comprehensive eye exams," and an in-person exam is needed if a photo shows anything abnormal or can't be read.
I'm pregnant and have type 1 diabetes. How often do I need my eyes checked? The ADA recommends an exam before pregnancy and in the first trimester. Depending on what the exam shows, you may need checks every trimester and for a year after delivery. Gestational diabetes on its own does not require eye exams during pregnancy.
Should I stop my semaglutide or tirzepatide medicine because of my eyes? That decision belongs to your prescriber, not to this article. Don't change or stop a prescribed medicine on your own. Tell your eye doctor and your prescriber what you take, and contact your prescriber promptly about vision changes; sudden vision loss or rapidly worsening eyesight needs urgent evaluation. If you have diabetic retinopathy, your eye doctor may want to see you more closely while your blood sugar is coming down.
Does Medicare cover a yearly diabetic eye exam? Yes. Medicare Part B covers an eye exam for diabetic retinopathy once a year for people with diabetes, with 20% coinsurance after the Part B deductible. Routine exams for glasses or contacts are not covered by Original Medicare.
Schedule Your Comprehensive Eye Exam in Summerville
Your eyes are one of the clearest windows into how diabetes is affecting your body, and a yearly exam is one of the simplest ways to protect your sight. If it has been more than a year since your last dilated eye exam, or you were recently diagnosed, now is a good time to come in. If you are starting a GLP-1-based medicine, remember the AOA's recommendation: a comprehensive dilated exam within the 12 months before you start, or a baseline exam within one month after. Talk with your prescriber and your eye doctor about any other medication changes.
Jackson Davenport Vision Center has cared for Lowcountry families for more than 50 years. Our office is at 218 Old Trolley Road in Summerville, and our optometrists are Dr. Christopher Holstead, O.D., and Dr. Alyssa Davenport, O.D. At your exam, the doctor will review your history and medications, examine your eyes, and tell you how often you should be seen. If your exam shows something that needs a specialist, they can talk with you about next steps.
Call (843) 871-9750 or use our contact page to schedule a comprehensive eye exam. When you call, ask whether to bring a list of your medications or recent lab results.
This article is general information, not medical advice, and is not a substitute for an exam by a licensed eye doctor. Your eyes and your situation are unique — if you have a vision or eye-health concern, please schedule a comprehensive eye exam.