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Table 6. Key Elements of Evaluation and Follow-up (cont'd)
Patient Education
• Discuss results of exam and implications
• Encourage patients with diabetes but without diabetic retinopathy to have annual
dilated eye exams
• Inform patients that effective treatment for diabetic retinopathy depends on timely
intervention, despite good vision and no ocular symptoms
• Educate patients about the importance of maintaining near-normal glucose levels and
near-normal blood pressure and lowering serum lipid levels
• Communicate with the attending physician, e.g., family physician, internist, or
endocrinologist, regarding eye findings
• Provide patients whose conditions fail to respond to surgery and for whom further
treatment is unavailable with proper professional support and offer referral for
counseling, rehabilitative, or social services as appropriate
• Refer patients with functionally limiting postoperative visual impairment for vision
rehabilitation (see www.aao.org/smartsight) and social services
Comorbidity Management
Î Patients should be informed of the importance of maintaining good
glycosylated hemoglobin levels, serum lipids, and blood pressure.
(III, G, S)
Î Intensive management of hypertension may slow retinopathy progress,
but the data are inconclusive. (II++, M, D)
Î Management of serum lipids may reduce retinopathy progression and
the need for treatment. (II+, M, D)
Î It is reasonable to encourage patients with diabetes to be as compliant
as possible with therapy of all medical aspects of their disease.
(II++, G, S)
Diabetes Management
Î The patient with Type 2 diabetes should be referred for ophthalmologic
evaluation at the time of diagnosis. (II+, G, S)
Î The initial examination for a patient with diabetes mellitus includes
all features of the comprehensive adult medical eye evaluation, with
particular attention to those aspects relevant to diabetic retinopathy.
(II++, G, S)
