Diabetic Retinopathy

Publication Date: January 1, 2020
Last Updated: March 14, 2022


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).

Recommendation Grading



Diabetic Retinopathy

Authoring Organization

Publication Month/Year

January 1, 2020

Last Updated Month/Year

February 2, 2024

Document Type


External Publication Status


Country of Publication


Document Objectives

Identify patients at risk of developing diabetic retinopathy. Encourage a collaborative approach between the patient, the primary care physician, and subspecialists in the management of the patient's systemic disorder, with specific attention to control of blood sugar, blood pressure, serum lipids, body weight, and the management of renal disease, coronary artery disease, and neuropathy. Encourage and provide lifelong monitoring of retinopathy progression. Treat patients with visual loss or those at risk for visual loss from diabetic retinopathy. Minimize the side effects of treatment that might adversely affect the patient's vision and/or vision-related quality of life. Provide or refer for visual rehabilitation services when a patient has visual impairment from the disease. Refer for ophthalmological follow-up for potentially reversable vision loss such as cataracts, glaucoma, or refractive changes. Develop new technologies for telemedicine improvement.

Target Patient Population

All patients with diabetes mellitus

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Emergency care, Outpatient

Intended Users

Optometrist, nurse, nurse practitioner, physician, physician assistant


Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D003920 - Diabetes Mellitus, D003930 - Diabetic Retinopathy, D048909 - Diabetes Complications


diabetes mellitus, diabetic retinopathy, diabetic macular edema

Source Citation

Flaxel, C. J., Adelman, R. A., Bailey, S. T., Fawzi, A., Lim, J. I., Vemulakonda, G. A., & Ying, G. (2019). Diabetic Retinopathy Preferred Practice Pattern®. Ophthalmology. doi:10.1016/j.ophtha.2019.09.025

Supplemental Methodology Resources

Data Supplement


Number of Source Documents
Literature Search Start Date
April 1, 2018
Literature Search End Date
June 1, 2019