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Î The prevalence of diabetes, both worldwide and in the United States, is
increasing; as such, the prevalence of diabetic retinopathy and vision-
threatening diabetic retinopathy (VTDR) is also expected to increase
dramatically.
Î Currently, only about 60% of people with diabetes have yearly
screenings for diabetic retinopathy.
Î People with Type 1 diabetes should have annual screenings for diabetic
retinopathy beginning 5 years after the onset of their disease, whereas
those with Type 2 diabetes should have a prompt examination at the
time of diagnosis and at least yearly examinations thereafter.
Î Maintaining near-normal glucose levels and near-normal blood pressure
lowers the risk of retinopathy developing and/or progressing, so
patients should be informed of the importance of maintaining good
glycosylated hemoglobin levels, serum lipids, and blood pressure.
Î Patients with diabetes may use aspirin for other medical indications
without an adverse effect on their risk of diabetic retinopathy.
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,
patients with diabetes who become pregnant should be examined early
in the course of the pregnancy.
Î Referral to an ophthalmologist is required when there is any
nonproliferative diabetic retinopathy, proliferative retinopathy, or
macular edema.
Î Ophthalmologists should communicate both ophthalmologic findings
and level of retinopathy to the primary care physician. They should
emphasize to the patient the need to adhere to the primary care
physician's guidance to optimize metabolic control.
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.
Î At this time, laser photocoagulation remains the preferred treatment for
non-center-involving diabetic macular edema.
