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Treatment
Diabetic retinopathy progresses in an orderly fashion from mild to more severe
stages when there is not appropriate intervention. It is important to recognize
the stages when treatment may be most beneficial.
Laser Photocoagulation
Î The Early Treatment Diabetic Retinopathy Study (ETDRS) demonstrated
a benefit of laser photocoagulation in both center-involving clinically
significant macular edema (ci-CSME) and non-center-involving clinically
significant macular edema (nci-CSME). (I++, G, S)
Quality Assurance Measures
Î Although the ophthalmologist will perform most of the examination
and all surgery, certain aspects of data collection may be performed
by trained individuals under the ophthalmologist's supervision and
review. (III, G, S)
Î Because of the complexities of the diagnosis and treatment for
diabetic retinopathy, the ophthalmologist caring for patients with this
condition should be familiar with the specific recommendations of
relevant clinical trials. (III, G, S)
Î The ophthalmologist should refer patients with diabetes to a primary
care physician for appropriate management of their systemic
condition, and should communicate examination results to the
physician managing the patient's ongoing diabetes care. (III, G, S)
Î Those whose conditions fail to respond to surgery and those for whom
further treatment is unavailable should be provided with proper
professional support and offered referral for counseling, vision
rehabilitation, or social services as appropriate. (III, G, S)
Î Patients with functionally limiting postoperative visual impairment
should be referred for vision rehabilitation and social services. (III, G, S)
Î Frequent ophthalmologic monitoring is important when patients are
being brought under better control. (III, G, S)
Î Diabetes mellitus education and regular reinforcement should be
provided by diabetes nurses and dietitian educators and may help
minimize the risk of hypoglycemia. (III, G, S)
