By the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee: Christina J. Flaxel, MD,1 Steven T. Bailey, MD,2 Amani Fawzi, MD,3 Jennifer I. Lim, MD,4 Ron A. Adelman, MD, MPH, MBA, FACS,5 G. Atma Vemulakonda, MD,6 Gui-shuang Ying, MD, PhD7
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1Casey Eye Institute, Oregon Health & Science University, Portland, OR
2Casey Eye Institute, Oregon Health & Science University, Portland, OR
3Feinberg School of Medicine, Northwestern University, Chicago, IL
4University of Illinois at Chicago, Chicago, IL
5Yale University Eye Center, New Haven, CT
6Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
7Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Highlighted Findings and Recommendations for Care
The prevalence of diabetes is increasing with increasing industrialization and globalization. Consequently, the prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy is also expected to increase. Only about 60% of people with diabetes have recommended yearly screenings for diabetic retinopathy. Referral to an ophthalmologist is required when there is any evidence of diabetic retinopathy.
People with type 1 diabetes should have annual screenings for diabetic retinopathy beginning 5 years after the onset of their disease, whereas those with type 2 diabetes should have a prompt screening at the time of diagnosis and at least yearly screenings thereafter.
Maintaining control of glucose and blood pressure lowers the risk of retinopathy developing and/or progressing, so patients should be informed of the importance of maintaining good levels of glycosylated hemoglobin, and blood pressure.
Patients with diabetes may use aspirin for other medical indications (as antiplatelet therapy) without an adverse effect on their risk of diabetic retinopathy.
Women with diabetes who become pregnant should be examined early and closely in the course of the pregnancy because the disease can progress rapidly. However, an eye examination is not required when gestational diabetes occurs during pregnancy. Patients with diabetes have an accelerated rate of diabetic retinopathy progression during puberty and should be followed more closely.
Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents are effective in the treatment of center-involved diabetic macular edema with vision loss. At this time, laser photocoagulation surgery remains the preferred treatment for non-center-involved diabetic macular edema and pan-retinal photocoagulation (PRP) surgery remains the mainstay treatment for proliferative diabetic retinopathy (PDR).