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Table 6. Key Elements of Evaluation and Follow-up
Initial Exam History
• Duration of diabetes
• Past glycemic control (HbA
1c
)
• Medications
• Medical history (e.g., obesity, renal disease, systemic hypertension, serum lipid levels,
pregnancy, neuropathy)
• Ocular history (e.g., trauma, eye disease, ocular injections, surgery, including retinal
laser treatment and refractive surgery)
Initial Physical Exam
• Visual acuity
• Slit-lamp biomicroscopy
• Measurement of intraocular pressure (IOP)
• Gonioscopy before dilation when indicated (for neovascularization of the iris or
increased IOP)
• Pupillary assessment for optic nerve dysfunction
• Thorough funduscopy including stereoscopic examination of the posterior pole
• Examination of the peripheral retina and vitreous, best performed with indirect
ophthalmoscopy or with slit-lamp biomicroscopy
Diagnosis
• Classify both eyes as to category and severity of diabetic retinopathy and macular
edema. Each category has an inherent risk for progression and is dependent on
adherence to overall diabetes control
Î Women who develop gestational diabetes do not require an eye
examination during pregnancy and do not appear to be at increased
risk of developing diabetic retinopathy during pregnancy. However,
diabetics who become pregnant should be examined early in the
course of the pregnancy. (II+, G, S)
Î Intravitreal injections of anti-vascular endothelial growth factor
(VEGF) agents have been shown to be an effective treatment for
center-involving diabetic macular edema. (I++, G, S)
Î At this time, laser photocoagulation remains the preferred treatment
for non-center-involving diabetic macular edema. (I++, G, S)
