Diabetic Retinopathy: A Team Approach
In many cases, the complications of diabetes that cause blindness can be mitigated with treatments that are highly effective in preventing severe vision loss. Despite the availability of these treatments, many fewer patients with diabetes are referred by primary care physicians than expected according to guidelines from the American Diabetes Association and the American Academy of Ophthalmology. The Los Angeles Latino Eye Study found that 65% of patients with type 2 diabetes had not received a dilated eye examination in the previous year. The Table summarizes the recommended timing of comprehensive eye evaluations, including dilated fundus examinations, for patients with diabetes.
Table. Recommended Eye Examination Schedule for Patients With Diabetes
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Numerous ancillary tests can be performed to define the extent of diabetic retinopathy, to direct management, and to optimize outcomes:
Figure 1. Fundus photographs of the right and left eyes of a patient with bilateral nonproliferative diabetic retinopathy. Scattered intraretinal hemorrhages and hard exudates are visible.
Figure 2. Fundus photograph of proliferative diabetic retinopathy, demonstrating a large preretinal hemorrhage involving the macula.
Figure 3. Fluorescein angiogram of proliferative diabetic retinopathy, demonstrating extensive retinal capillary nonperfusion (ischemia), leaking neovascular vessels, and blockage of underlying fluorescence due to the preretinal hemorrhage shown in Figure 2.
Screening and Referring Patients With Diabetes
In many cases, the complications of diabetes that cause blindness can be mitigated with treatments that are highly effective in preventing severe vision loss. Despite the availability of these treatments, many fewer patients with diabetes are referred by primary care physicians than expected according to guidelines from the American Diabetes Association and the American Academy of Ophthalmology. The Los Angeles Latino Eye Study found that 65% of patients with type 2 diabetes had not received a dilated eye examination in the previous year. The Table summarizes the recommended timing of comprehensive eye evaluations, including dilated fundus examinations, for patients with diabetes.
Table. Recommended Eye Examination Schedule for Patients With Diabetes
| Diabetes Type | Recommended Time of First Examination | Recommended Follow-up |
|---|---|---|
| Type 1 | 3-5 years after diagnosis | Yearly (abnormal findings may necessitate more frequent examinations) |
| Type 2 | At time of diagnosis with diabetes | Yearly (abnormal findings may necessitate more frequent examinations) |
| Before pregnancy for type 1 or type 2 | Before conception and early in first trimester | At direction of eye doctor |
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Numerous ancillary tests can be performed to define the extent of diabetic retinopathy, to direct management, and to optimize outcomes:
Fundus photography: documents extent and severity of diabetic retinopathy (Figures 1 and 2);
Fluorescein angiography: a physiologic study that defines the retinal vasculature, identifying areas of poor perfusion (ischemia), macular edema or neovascularization (Figure 3); and
Ocular coherence tomography: a high-resolution anatomical study invaluable in clinical practice for quantifying macular edema and after response to treatments.
Figure 1. Fundus photographs of the right and left eyes of a patient with bilateral nonproliferative diabetic retinopathy. Scattered intraretinal hemorrhages and hard exudates are visible.
Figure 2. Fundus photograph of proliferative diabetic retinopathy, demonstrating a large preretinal hemorrhage involving the macula.
Figure 3. Fluorescein angiogram of proliferative diabetic retinopathy, demonstrating extensive retinal capillary nonperfusion (ischemia), leaking neovascular vessels, and blockage of underlying fluorescence due to the preretinal hemorrhage shown in Figure 2.
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