Last Updated: January 2023

Author: Diabetes Program, Vermont Department of Health

Dilating the pupil in the eye allows an eye care professional to examine the retina, lens, cornea and other areas inside the eye. Annual dilated eye exams are important for people with diabetes because they are at higher risk for diabetic eye disease, which includes retinopathy (damage to blood vessels in the retina), glaucoma (increase in fluid pressure that damages the optic nerve), and cataracts (clouding of the lens of the eye). Read more in this diabetic eye disease education program module.These conditions lead to vision loss and blindness if not treated early.

This indicator has not changed significantly over time.

Diabetic retinopathy is the leading cause of blindness in the United States. All forms of diabetic eye disease have the potential to cause severe vision loss and blindness. As the prevalence of diabetes rises, diabetic eye disease is expected to follow a similar increase.

Read more about the importance of dilated eye exams from the National Eye Institute. 

• Vermont Blueprint for Health 
• Community Health Improvement, UVMMC
• Vermont Optometric Association

Controlling blood glucose (good management of diabetes) is the key strategy for preventing the progression of diabetic retinopathy. Controlling blood pressure in people with diabetes may slow the progression of retinopathy.

Vermonters are instructed that self-care to prevent or delay eye disease includes controlling blood sugar and blood pressure, not smoking, and visiting an eye care professional regularly.

At the Vermont Department of Health, staff in Health Promotion and Disease Prevention use Centers for Disease Control and Prevention (CDC) funds to collaborate with primary care and community partners to offer evidence-based programs to prevent and control diabetes (Diabetes Prevention Program and the Healthier Living Workshop for Diabetes). Other strategies include the development and distribution of treatment guidelines and consumer resources for clinical management and self-management of blood sugar and blood pressure. The Health Department has developed educational booklets for the DASH diet (Dietary Approaches to Stop Hypertension) and for managing diabetes – Learning to Live Well with Diabetes.

Dilated eye exams usually take place in the offices of an eye care profession, therefore, findings from the exam do not always get shared with other members of the health care team, including the primary care provider and the endocrinology specialist, if one is involved. This has been an ongoing challenge when working across health systems, especially when the eye care professional is not part of the referring health care system. Over the years there have been repeated unsuccessful attempts to improve communication among health care providers. This remains a topic for quality improvement.

The Behavioral Risk Factor Surveillance System question asks people with diabetes if they had an annual eye exam. Answers to the question indicated a low of 51% in 2010 (Healthy Vermonters 2020 baseline) and a high of 72% in 2005. 

Vermont tracks risk behaviors and chronic disease using a telephone survey of adults called the Behavioral Risk Factor Surveillance Survey (BRFSS). Since 1990, Vermont, along with the 49 other states, Washington D.C. and U.S. territories, has participated in the BRFSS with the Centers for Disease Control and Prevention. The CDC provides the Vermont Department of Health with funding each year to carry out the survey. Several thousand Vermonters are randomly and anonymously selected and called annually, on both landlines and cell phones. An adult (18 or older) is asked a uniform set of questions. The results are weighted to represent the adult population of the state.

Note that beginning in 2011 the CDC implemented changes to the BRFSS weighting methodology in order to more accurately represent the adult population. While this makes calculations more representative of the population, the changes in methodology also limit the ability to compare results from 2011 forward with those from previous years. The Vermont Department of Health recommends that comparisons between BRFSS data from 2011 forward and earlier years be made with caution.