Recommended Diabetes Mellitus–Related Ophthalmic Examinations

In the first 5 years following diagnosis of type 1 diabetes mellitus, retinopathy is rare. In contrast, at the time of their initial diagnosis of type 2 diabetes mellitus, a larger percentage of patients already have established retinopathy and require concomitant ophthalmic examination. Because pregnancy is associated with diabetic retinopathy progression, women with diabetes mellitus who become pregnant may require more frequent retinal evaluations. An eye examination is recommended in the first trimester and thereafter at the discretion of the ophthalmologist for all pregnant patients with diabetic retinopathy (Table 5-1). Vision loss may occur from DME or from the complications of PDR. Although some regression of retinopathy may occur after delivery, photocoagulation treatment is generally recommended if high-risk PDR develops during or just before pregnancy. The frequency of follow-up visits depends on the severity of the retinopathy, history of blood glucose levels, and blood pressure control, as well as the threat to visual function from potentially missed opportunities to treat (Table 5-2).

Figure 5-1 Optical coherence tomography angiography (OCTA) images demonstrate macular capillary nonperfusion and vascular tortuosity in diabetic eyes. The foveal avascular zone diameters in these images increase with worsening diabetic retinopathy severity level. A, Nondiabetic eye. B, Mild nonproliferative diabetic retinopathy (NPDR). C, Moderate NPDR. D, Proliferative diabetic retinopathy (PDR).

(Courtesy of Jennifer K. Sun, MD, MPH.)

• American Academy of Ophthalmology Retina/Vitreous Panel. Preferred Practice® Pattern Guidelines. Diabetic Retinopathy. San Francisco: American Academy of Ophthalmology; 2016. Available at www.aao.org/ppp.

Table 5-1 Recommended Eye Examination Schedule for Patients With Diabetes Mellitus

Table 5-2 Recommended Eye Examination Schedule Based on Diabetic Retinopathy Severity

Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.