21
Retinopathy
Î Optimize blood pressure and glycemic control to reduce the risk or
slow the progression of retinopathy. (A)
Screening
Î Adults with type 1 diabetes should have an initial dilated
comprehensive eye examination by an ophthalmologist or optometrist
within 5 years after the onset of diabetes. (B)
Î Patients with type 2 diabetes should have an initial dilated and
comprehensive eye examination by an ophthalmologist or optometrist
shortly after the diagnosis of diabetes. (B)
Î If there is no evidence of retinopathy for ≥1 more eye exams, then
exams every 2 years may be considered. If diabetic retinopathy is
present, subsequent examinations for type 1 and type 2 diabetic
patients should be repeated annually by an ophthalmologist or
optometrist. If retinopathy is progressing or sight threatening, then
examinations will be required more frequently. (B)
Î High-quality fundus photographs can detect most clinically significant
diabetic retinopathy. Interpretation of the images should be performed
by a trained eye care provider. (E)
Note: While retinal photography may serve as a screening tool for retinopathy, it is not a
substitute for a comprehensive eye exam, which should be performed at least initially and
at intervals thereafter as recommended by an eye care professional.
Î Women with pre-existing diabetes who are planning a pregnancy or
who have become pregnant should have a comprehensive eye
examination and should be counseled on the risk of development
and/or progression of diabetic retinopathy. Eye examination should
occur in the first trimester with close follow-up throughout pregnancy
and for 1 year postpartum. (B)
Treatment
ÎPromptly refer patients with any level of macular edema, severe
nonproliferative diabetic retinopathy (NPDR), or any proliferative diabetic
retinopathy (PDR) to an ophthalmologist who is knowledgeable and
experienced in the management and treatment of diabetic retinopathy. (A)
Î Laser photocoagulation therapy is indicated to reduce the risk of
vision loss in patients with high-risk PDR, clinically significant
macular edema, and in some cases of severe NPDR. (A)
Î Anti-vascular endothelial growth factor (VEGF) therapy is indicated for
diabetic macular edema. (A)
Î The presence of retinopathy is not a contraindication to aspirin
therapy for cardioprotection, since this therapy does not increase the
risk of retinal hemorrhage. (A)
