Eye
Diabetic Retinopathy
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Diabetic Retinopathy
, Diabetic Macular Edema
See Also
Diabetes Complications
Epidemiology
Occurs in 20% of patients with
Diabetes Mellitus
Occurs equally in Type I and
Type II Diabetes Mellitus
Risk Factors
Longer duration of
Diabetes Mellitus
(>72 months)
Poor
Blood Glucose
control (Hgb A1C > 8.0)
Increased
Microalbuminuria
levels (>9.5)
Saum (2002) Br J Gen Pract 52:214-6 [PubMed]
Types
Nonproliferative
Retinopathy
Retina
l veins dilated
Cotton Wool exudates or spots
Hard exudates
Macula
r edema
Intraretinal
Hemorrhage
s
Microaneurysms
Proliferative
Retinopathy
Neovascularization
Preretinal
Hemorrhage
s
Vitreous Hemorrhage
s
Vascular fibrosis
Symptoms
Vision Loss
, fluctuating
Visual Acuity
or
Visual Field Defect
s
Floater or flashes of light (photopsia)
Protocol
Ophthalmology Exam Intervals with no
Retinal Disease
Children with Diabetes
Initial Exam: Age 10 years (or after 3-5 years of
Diabetes Mellitus
)
Subsequent Exams: Annually
Adults with Type 2 Diabetes
Initial Exam: At diagnosis
Subsequent Exams: Annually
Protocol
Ophthalmology Exam Intervals for those with
Retinal Disease
Mild to moderate nonproliferative Diabetic Retinopathy
No
Macula
r edema
Exams every 6-12 months
Macula
r edema present
Consider laser photocoagulation
Intravitreal injection of
Vascular Endothelial Growth Factor
s (e.g.
Bevacizumab
, aflibercept, ranibizumab)
Wells (2015) N Engl J Med 372(13): 1193-203 +PMID:25692915 [PubMed]
Intravitreal
Corticosteroid Injection
or implant (
Cataract
risk)
Grover (2008) Cochrane Database Syst Rev (1):CD005656 +PMID:18254088 [PubMed]
Severe nonproliferative Diabetic Retinopathy
Eye Examination
s every 2-4 months
Consider laser photocoagulation
See
Macula
r edema management as above
Proliferative Diabetic Retinopathy
Consider laser photocoagulation
Vitreous Hemorrhage
(or refractory course)
Intravitreal injection of
Vascular Endothelial Growth Factor
s (e.g.
Bevacizumab
, aflibercept, ranibizumab)
Osaadon (2014) Eye 28(5): 510-20 [PubMed]
Prevention
Slowing Diabetic Retinopathy progression
Fenofibrate
Wong (2012) Am J Ophthalmol 154(1): 6-12 [PubMed]
Tighter glycemic control reduces progression risk
However, diabetes goals have loosened to prevent
Hypoglycemia
(A1C 8.5% in older adults)
Stratton (2001) Diabetologia 44(2): 156-63 [PubMed]
References
Pelletier (2016) Am Fam Physician 94(3):219-26 [PubMed]
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