Diabetic Retinopathy
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
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
Overview
Title
Diabetic Retinopathy
Authoring Organization
American Academy of Ophthalmology
Publication Month/Year
January 1, 2020
Last Updated Month/Year
February 2, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
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
Scope
Diagnosis, Management, Treatment
Diseases/Conditions (MeSH)
D003920 - Diabetes Mellitus, D003930 - Diabetic Retinopathy, D048909 - Diabetes Complications
Keywords
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