Diabetic Retinopathy

1. See Also
   1. Diabetes Complications
2. Epidemiology
   1. Occurs in 20% of patients with Diabetes Mellitus
   2. Occurs equally in Type I and Type II Diabetes Mellitus
3. Risk Factors
   1. Longer duration of Diabetes Mellitus (>72 months)
   2. Poor Blood Glucose control (Hgb A1C > 8.0)
   3. Increased microalbuminuria levels (>9.5)
   4. Saum (2002) Br J Gen Pract 52:214-6
4. Types
   1. Nonproliferative Retinopathy
      1. Retinal veins dilated
      2. Cotton Wool exudates or spots
      3. Hard exudates
      4. Macular edema
      5. Intraretinal hemorrhages
      6. Microaneurysms
   2. Proliferative Retinopathy
      1. Neovascularization
      2. Preretinal hemorrhages
      3. Vitreous Hemorrhages
      4. Vascular fibrosis
5. Protocol: Ophthalmology Exam Intervals with no Retinal disease
   1. Children with Diabetes
      1. Initial Exam: Age 10 years (or after 3-5 years of Diabetes Mellitus)
      2. Subsequent Exams: Annually
   2. Adults with Type 2 Diabetes
      1. Initial Exam: At diagnosis
      2. Subsequent Exams: Annually
6. Protocol: Ophthalmology Exam Intervals for those with Retinal disease
   1. Mild to moderate nonproliferative Diabetic Retinopathy
      1. No macular edema: Exams every 6-12 months
      2. Macular edema present: Consider laser photocoagulation
   2. Severe nonproliferative Diabetic Retinopathy
      1. Eye examinations every 2-4 months
      2. Consider laser photocoagulation
   3. Proliferative Diabetic Retinopathy
      1. Consider laser photocoagulation
7. Resources
   1. AAO Practice Guideline
      1. http://www.aao.org/education/guidelines/ppp/dr_new.cfm