Home

Loading...

Table of contents

Diabetic retinopathy

What's new

Updated 2024 ADA guidelines for the diagnosis and management of diabetic retinopathy.

Background

Overview

Definition
DR is a chronic microvascular complication of diabetes characterized by visual impairment in one or both the eyes.
Pathophysiology
DR is caused due to uncontrolled longstanding hyperglycemia.
1
2
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.
1
2
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].
3

Guidelines

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). ...
Show more

Screening and diagnosis

Indications for screening: as per ADA 2024 guidelines, 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.
B
Show 2 more
Create free account

Medical management

Glycemic control: as per ADA 2024 guidelines, implement strategies to help reach glycemic goals to slow the progression of DR.
A

More topics in this section

  • BP and lipid control

  • Management of antiplatelet agents

Therapeutic procedures

Intravitreous anti-VEGF injections
As per ADA 2024 guidelines:
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.
B
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.
A

More topics in this section

  • Intravitreous corticosteroid injections

  • Laser photocoagulation

Specific circumstances

Pediatric patients: as per ADA 2024 guidelines, obtain screening for retinopathy by dilated fundoscopy at or soon after diagnosis and annually thereafter.
B
Show 3 more

More topics in this section

  • Pregnant patients

Preventative measures

Primary prevention, glycemic control: as per ADA 2024 guidelines, implement strategies to help reach glycemic goals to reduce the risk of DR in patients with diabetes.
A

More topics in this section

  • Primary prevention (BP and lipid control)

Follow-up and surveillance

Indications for referral: as per ADA 2024 guidelines, 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.
A

More topics in this section

  • Serial eye examinations (patients without retinopathy)

  • Serial eye examinations (patients with retinopathy)

  • Vision rehabilitation