8
Management
Summary of Management Recommendations
Î Screening programs should follow established guidelines. (III, G, S)
Î Physicians who care for patients with diabetes, and patients
themselves, need to be educated about indications for ophthalmologic
referral. (III, G, S)
Î Close partnership with the primary care physician is important to
make sure that patient care is optimized. (III, G, S)
Î People with Type 1 diabetes should have annual screenings for
diabetic retinopathy beginning 5 years after the onset of their disease,
while those with Type 2 diabetes should have yearly screening for
diabetic retinopathy beginning immediately following their diagnosis.
(II+, G, S)
Î The patient with a normal retinal exam or minimal nonproliferative
diabetic retinopathy (NPDR) should be re-examined annually. (III, G, S)
Î Referral to an ophthalmologist is required when there is any non-
proliferative diabetic retinopathy, proliferative retinopathy, or macular
edema. (III, G, S)
Î An ophthalmologist who treats patients for macular edema should be
familiar with relevant studies and techniques as described in the Early
Treatment Diabetic Retinopathy Study Research Group (ETDRS).
(III, G, S)
Î Patients with retinal microaneurysms and occasional blot
hemorrhages or hard exudates should be re-examined within 6–12
months. (III, G, S)
Î Patients with mild or moderate NPDR and non-clinically significant
macular edema should be re-examined within 3–4 months. (III, G, S)
Î Patients with very severe NPDR should be re-examined within 2–4
months. (III, G, S)
Î Ophthalmologists should communicate to the primary care physician
the ophthalmologic findings and level of retinopathy as well as the
need for optimizing metabolic control. (III, G, S)
ÎPatients with diabetes may use aspirin for other medical indications
without an adverse effect on their risk of diabetic retinopathy. (I++, G, D)
