ACTION STATEMENTS

Document Overview

Design and created by Guideline Central in participation with the American Optometric Association.

Eye Care Of The Patient With Diabetes Mellitus

American Optometric Association

Publication Date: Oct 1, 2019

Page Last Updated: May 5, 2026

American Optometric Association Grading System

Quality of Evidence Levels
Grade	Study Type
A	Meta-Analysis
	Systematic Review
	Randomized Clinical Trial
	Diagnostic Studies (Grade A)
	Do not have a narrow population
	Do not use a poor reference standard
	No case control studies of diseases or conditions
B	Randomized Clinical Trial (weaker design)
	Cohort Studies
	Retrospective
	Prospective
	Diagnostic Studies (Grade B - only one of the following)
	Narrow population
	Sample used does not reflect the population to whom the test would apply
	Uses a poor reference standard
	Comparison between the test and reference standard is not blinded
	Case control studies of diseases or conditions
C	Case Control Studies
	Study of sensitivity and specificity of a diagnostic test, population-based descriptive study of diseases or conditions
	Retrospective or prospective
	Diagnostic Studies (Grade C — at least two or more of the following)
	Narrow population
	Sample used does not reflect the population to whom the test would apply
	Uses a poor reference standard
	Comparison between the test and reference standard is not blinded
	Studies of Strong Design
	With substantial uncertainty about conclusions or serious doubts about generalizations, bias, research design, or sample size
	Nonrandomized Trials
D	Cross Sectional Studies
	Case Reports/Series
	Reviews
	Position Papers
	Expert Opinion
	Reasoning from Principle

Level	Clinical Recommendation
Strong Recommendation	The benefits of the recommendation clearly exceed the harms (or the harms clearly exceed the benefits in the case of a negative recommendation) and the quality of evidence is excellent (Grade A or B). In some clearly identified circumstances, a strong recommendation may be made on lesser evidence when high-quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms.
Strong Recommendation	This recommendation should be followed unless clear and compelling rationale for an alternative approach is present.
Recommendation	The benefits of the recommendation exceed the harms (or the harms exceed the benefits in the case of a negative recommendation) but the quality of evidence is not as strong (Grade B or C). In some clearly identified circumstances, a recommendation may be made on lesser evidence when high-quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms.
Recommendation	This recommendation should generally be followed, but remain alert for new information.
Discretional	The current evidence is insufficient to assess the balance of benefits and harms of the recommendation. Evidence may be lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
Discretional	There should be an awareness of this recommendation, but a flexibility in clinical decision-making, as well as remaining alert for new information.
Consensus Statement

Document Overview

Document Title: Eye Care Of The Patient With Diabetes Mellitus

Authoring Society: American Optometric Association

Document Publication Date: Oct 1, 2019

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: aoa.uberflip.com/i/1183026-evidence-based-clinical-practice-guideline-eye-care-of-the-patient-with-diabetes-mellitus-second-edition/0?m4=

Document Scope, Criteria, and Use Cases

Document Objectives: Identify patients at risk for diabetes and visual changes associated with diabetes.

Scope: Assessment and Screening, Diagnosis, Management, Prevention

Diseases/Conditions (MeSH)

D003930 - Diabetic Retinopathy

D003920 - Diabetes Mellitus

D003930 - Diabetic Retinopathy

Keywords: diabetes, diabetes mellitus, diabetic complications, prediabetes, visual changes

Inclusion Criteria: Female, Male, Adult, Older Adult

Health Care Settings: Ambulatory, Outpatient

Intended Users: Nurse, Nurse Practitioner, Optician, Optometrist, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents: 402

Literature Search Start Date: Wednesday, December 31, 1975

Literature Search End Date: Monday, December 31, 2018

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes