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Diabetic Retinopathy

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4 Diagnosis Î The care process for diabetic retinopathy includes a medical history, a regular ophthalmologic examination or screening of high quality retinal photographs of patients who have not had previous treatment for diabetic retinopathy or other eye disease and regular follow-up. (III, G, S) Î Patients must be informed that they may have good vision and no ocular symptoms, yet may still have significant disease that needs treatment. They should be educated that early treatment works best and is why they need to return for an annual eye examination, even when their vision is good. (III, G, S) Î Individuals with Type 2 diabetes mellitus without diabetic retinopathy should be encouraged to have an annual dilated eye exam or screenings using fundus photography to detect the onset of diabetic retinopathy. (II++, G, S) Î Those with Type 1 diabetes mellitus without diabetic retinopathy should have annual dilated eye examinations or screenings beginning 5 years after the onset of diabetes. (II++, G, S) Table 2. International Clinical Diabetic Macular Edema Disease Severity Scale Proposed Disease Severity Level Findings Observable Upon Dilated Ophthalmoscopy Diabetic macular edema apparently absent No apparent retinal thickening or hard exudates in posterior pole Diabetic macular edema apparently present Some apparent retinal thickening or hard exudates in posterior pole If diabetic macular edema is present, it can be categorized as follows: Proposed Disease Severity Level Findings Observable Upon Dilated Ophthalmoscopy a Diabetic macular edema present • Mild diabetic macular edema: some retinal thickening or hard exudates in posterior pole but distant from the center of the macula • Moderate diabetic macular edema: retinal thickening or hard exudates approaching the center of the macula but not involving the center • Severe diabetic macular edema: retinal thickening or hard exudates involving the center of the macula a Hard exudates are a sign of current or previous macular edema. Diabetic macular edema is defined as retinal thickening ; this requires a three-dimensional assessment that is best performed by dilated examination using slit-lamp biomicroscopy and/or stereoscopic fundus photography. Optical coherence tomography may supplement the fundus evaluation for determining the presence of diabetic macular edema. Reproduced with permission from Wilkinson CP, Ferris FL III, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmolog y 2003;110:1680.

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