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.