From One Medical Student to Another
A proper diabetic eye exam should always begin by gathering a thorough history from the patient. Ask about any visual symptoms and systemic issues which may impact their risk for DR such as pregnancy, blood pressure, cholesterol levels, and renal status. Additionally, make sure to check their last hemoglobin A1c to gain an idea how their blood glucose control has been over the past 3 months.
Examination should begin with visual acuity, intraocular pressure measurements, and a slit-lamp exam, including careful inspection of the iris for neovascularization. If neovascularization of the iris is suspected or the patient has elevated intraocular pressures, gonioscopy should be performed to assess the iridocorneal angle. Gonioscopy utilizes a special mirrored lens which allows you to view the angle and trabecular meshwork. This cannot be accomplished using the slit lamp alone. Next, the patient should have his or her pupils dilated for a thorough fundus exam.