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Diabetic retinopathy

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.
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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.
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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].
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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).
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Guidelines

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.
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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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More topics in this section

  • Serial eye examinations (patients without retinopathy)

  • Serial eye examinations (patients with retinopathy)

  • Vision rehabilitation