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Diabetic retinopathy

DR is a chronic microvascular complication of diabetes characterized by visual impairment in one or both the eyes.
DR is caused due to uncontrolled longstanding hyperglycemia.
Disease course
Clinical manifestations of DR include microaneurysms, dot and blot hemorrhages, hard exudates, cotton wool spots, intraretinal microvascular abnormalities, and retinal edema in non-proliferative DR. Severe non-proliferative DR progresses to proliferative DR characterized by neovascularization. Progressive DR results in diabetic macular edema and permanent visual loss.
Prognosis and risk of recurrence
DR is associated with increased all-cause mortality and cardiovascular events risk with an odds ratio of 2.34 (95% CI 1.96-2.80].
Key sources
The following summarized guidelines for the evaluation and management of diabetic retinopathy are prepared by our editorial team based on guidelines from the American Diabetes Association (ADA 2024).


1.Screening and diagnosis

Indications for screening: obtain an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of diagnosis in patients with T2DM and within 5 years after the onset of diabetes in adult patients with T1DM.
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2.Medical management

Glycemic control: implement strategies to help reach glycemic goals to slow the progression of DR.

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  • BP and lipid control

  • Management of antiplatelet agents

3.Therapeutic procedures

Intravitreous anti-vascular endothelial growth factor injections
Consider administering intravitreal injections of anti-VEGF as an alternative to traditional panretinal laser photocoagulation in some patients with proliferative DR and also reduce the risk of vision loss in these patients.
Administer intravitreal injections of anti-VEGF as first-line therapy in most eyes with diabetic macular edema involving the foveal center and impairing vision acuity.

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  • Intravitreous corticosteroid injections

  • Laser photocoagulation

4.Specific circumstances

Pediatric patients: obtain screening for retinopathy by dilated fundoscopy at or soon after diagnosis and annually thereafter.
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  • Pregnant patients

5.Preventative measures

Primary prevention, glycemic control: implement strategies to help reach glycemic goals to reduce the risk of DR in patients with diabetes.

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  • Primary prevention (BP and lipid control)

6.Follow-up and surveillance

Indications for referral: refer patients with any of the following to an ophthalmologist knowledgeable and experienced in the management of DR:
any level of diabetic macular edema
moderate or worse nonproliferative DR (a precursor of proliferative DR)
any proliferative DR

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  • Serial eye examinations (patients without retinopathy)

  • Serial eye examinations (patients with retinopathy)

  • Vision rehabilitation