10
Management
Table 6. Key Elements of Evaluation and Follow-up (cont'd)
Follow-up History (Recommended intervals for follow-up in Table 8)
• Changes in visual symptoms
• Systemic status (pregnancy, blood pressure, serum cholesterol, renal status)
• Glycemic status (HbA
1c
)
Follow-up Physical Exam (Recommended intervals for follow-up in Table 8)
• Visual acuity
• Measurement of IOP
• Slit-lamp biomicroscopy with iris examination
• Gonioscopy (preferably before dilation when iris neovascularization is suspected or if
IOP is elevated)
• Stereoscopic examination of the posterior pole after dilation of the pupils
• Examination of the peripheral retina and vitreous when indicated
• Optical coherence tomography (OCT) imaging when appropriate
Ancillary Tests
• OCT can be used to quantify retinal thickness, monitor macular edema, identify
vitreomacular traction, and detect other forms of macular disease in patients with
diabetic macular edema (DME). Decisions to repeat anti-VEGF injections, change
therapeutic agents (e.g., use of intraocular corticosteroids), initiate laser treatment, or
even consider vitrectomy surgery are often based in part on OCT findings
• Fundus photography may be useful for documenting the presence of new vessels
elsewhere in the retina (NVE) and new vessels at the optic disc (NVD), the response
to treatment, and the need for additional treatment at future visits
• Fluorescein angiography is used as a guide for laser treatment of CSME and as a
means of evaluating the cause(s) of unexplained decreased visual acuity
• Fluorescein angiography can identify macular capillary nonperfusion or sources of
capillary leakage resulting in macular edema as possible explanations for visual loss
• Fluorescein angiography is not routinely indicated as a part of the examination of
patients with diabetes
• Ultrasonography enables assessment of the status of the retina in the presence of a
vitreous hemorrhage or other media opacity, and may be helpful to define the extent
and severity of vitreoretinal traction, especially on the macula of diabetic eyes
