How often should I get an eye exam?

Eye Examination Frequency Recommendations

For adults without diabetes or specific risk factors, comprehensive eye examinations should be performed every 5-10 years under age 40, every 2-4 years from ages 40-54, every 1-3 years from ages 55-64, and every 1-2 years at age 65 and older. 1

General Adult Population (No Risk Factors)

The American Academy of Ophthalmology provides clear age-stratified guidelines for asymptomatic adults without ocular risk factors:

• Under 40 years: Every 5-10 years 1
• 40-54 years: Every 2-4 years 1
• 55-64 years: Every 1-3 years 1
• 65 years and older: Every 1-2 years 1

These intervals are based on moderate quality evidence with strong recommendations, recognizing that age-related conditions like cataracts, glaucoma, and macular degeneration increase substantially after age 40. 1

Patients with Diabetes

Diabetes fundamentally changes the screening paradigm and requires much more frequent monitoring:

Type 1 Diabetes

• Initial exam: Within 5 years after diabetes onset 1, 2
• Follow-up: Annually thereafter 1, 2
• Generally not needed before age 10 years 1, 2

Type 2 Diabetes

• Initial exam: Immediately at time of diagnosis 1, 2
• Follow-up: Annually 1, 2

The critical difference in timing reflects that type 2 diabetes patients may have had years of undiagnosed hyperglycemia and prevalent retinopathy at diagnosis, while type 1 patients typically require at least 5 years of hyperglycemia before retinopathy develops. 2

Modified Intervals for Diabetic Patients

If no retinopathy is present after one or more normal annual exams and glycemic control is optimal, examinations every 1-2 years may be considered. 1, 2 However, this less frequent interval should only be applied when:

• Multiple prior exams show no retinopathy 1
• Glycemic indicators are within goal range 2
• Blood pressure and lipids are well-controlled 1

Once any level of diabetic retinopathy is detected, annual or more frequent examinations are mandatory. 1, 2 The specific frequency escalates based on severity:

• Mild nonproliferative retinopathy: Annually 1
• Moderate nonproliferative retinopathy: Every 3-6 months 1
• Severe nonproliferative retinopathy: Every 3 months 1

High-Risk Populations Requiring More Frequent Screening

Glaucoma Risk Factors

African Americans and Hispanics require more frequent examinations across all age groups: 1

• Under 40 years: Every 1-2 years 1
• 40-54 years: Every 1-3 years 1
• 55 years and older: Every 1-2 years 1

Pregnancy with Preexisting Diabetes

Women with type 1 or type 2 diabetes planning pregnancy require comprehensive examination before conception and in the first trimester, then monitoring every trimester and for 1 year postpartum. 1, 2 This intensive monitoring is justified by substantial progression risk—52.3% prevalence of any retinopathy and 6.1% prevalence of proliferative retinopathy in early pregnancy among those with preexisting diabetes. 1

Important caveat: Women who develop gestational diabetes do NOT require eye examinations during pregnancy, as they are not at increased risk for diabetic retinopathy. 1

Critical Referral Triggers

Immediate ophthalmology referral is required for: 1, 2

• Any level of diabetic macular edema
• Severe nonproliferative diabetic retinopathy
• Any proliferative diabetic retinopathy

Do not delay referral until proliferative disease develops—early referral for severe nonproliferative retinopathy reduces risk of severe visual loss by 50%. 1

Alternative Screening Modalities

Retinal photography with remote reading or FDA-approved artificial intelligence algorithms are acceptable screening strategies for diabetic retinopathy, but must include pathways for timely comprehensive examination when abnormalities are detected. 1, 2 These are screening tools, not substitutes for comprehensive eye examinations. 1

Special Considerations

Rapid Glycemic Improvement

Assess retinopathy status before intensifying glucose-lowering therapy with GLP-1 receptor agonists, as rapid A1C reductions can cause initial worsening of retinopathy. 2 This is particularly relevant when implementing intensive glycemic management in patients with existing retinopathy. 1

Smoking

Smoking is a documented risk factor for multiple ocular diseases and should prompt consideration of more frequent screening. 1