- •Regular screening is important for early detection of treatable diabetic retinopathy. Screening intervals for diabetic retinopathy vary according to the individual's age and type of diabetes.
- •Optimal glycemic control reduces the onset and progression of sight-threatening diabetic retinopathy.
- •Local intraocular pharmacological therapies have the potential to improve vision and reduce the level of retinopathy.
- •Diabetic retinopathy involves changes to retinal blood vessels that can cause them to bleed or leak fluid, distorting vision.
- •With good glycemic control, regular eye exams and early treatment, the risk of vision loss is reduced.
- •Diabetic retinopathy often goes unnoticed until vision loss occurs; therefore, people with diabetes should get a comprehensive dilated eye exam regularly. Discuss the recommended frequency with your diabetes healthcare team and experienced vision care professionals (optometrists or ophthalmologists).
- •Diabetic retinopathy can be treated with several therapies used alone or in combination.
Definition and Pathogenesis
|When to initiate screening|
|If retinopathy is present|
|If retinopathy is not present|
Delay of Onset and Progression
- Nathan D.M.
- Genuth S.
- et al.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The diabetes control and complications trial research group.
Local (intraocular) pharmacological intervention
- 1.In individuals ≥15 years of age with type 1 diabetes, screening and evaluation for retinopathy should be performed annually by an experienced vision care professional (optometrist or ophthalmologist) starting 5 years after the onset of diabetes [Grade A, Level 1 (16,18)] (for screening recommendation for children and adolescents <15 years with type 1 diabetes, see Type 1 Diabetes in Children and Adolescents chapter, p. S234; for screening recommendations for pregnant women, see Diabetes and Pregnancy chapter, p. S255).
- 2.In individuals with type 2 diabetes, screening and evaluation for diabetic retinopathy should be performed by an experienced vision care professional (optometrist or ophthalmologist) at the time of diagnosis of diabetes [Grade A, Level 1 (17,20)]. The interval for follow-up assessments should be tailored to the severity of the retinopathy [Grade D, Consensus]. In those with no or minimal retinopathy, the recommended interval is 1–2 years [Grade A, Level 1 (17,20)] (for screening recommendations for children and adolescents with type 2 diabetes, see Type 2 Diabetes in Children and Adolescents chapter, p. S247).
- 3.Screening for diabetic retinopathy should be performed by an experienced vision care professional (optometrist or ophthalmologist), either in person or through interpretation of retinal photographs taken through dilated pupils [Grade A, Level 1 (13)] or undilated pupils with high-resolution ultra-wide field imaging [Grade D, Consensus].
- 4.Results of eye examinations and the follow-up interval and plan should be clearly communicated to all members of the diabetes health-care team to promote optimal care [Grade D, Consensus].
- 5.To prevent the onset and delay the progression of diabetic retinopathy, people with diabetes should be treated to achieve optimal control of BG [Grade A, Level 1A (35,
Diabetes Control and Complications Trial Research Group
- Nathan D.M.
- Genuth S.
- et al.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The diabetes control and complications trial research group.N Engl J Med. 1993; 329: 977-98638) for type 1 diabetes; Grade A, Level 1A (36,40,41) for type 2 diabetes] and BP [Grade A, Level 1A (36,44) for type 2 diabetes; Grade D, Consensus for type 1 diabetes].
- 6.Although not recommended for CVD prevention or treatment, fenofibrate, in addition to statin therapy, may be used in people with type 2 diabetes to slow the progression of established retinopathy [Grade A, Level 1A (40,41,53)].
- 7.Individuals with sight-threatening diabetic retinopathy should be assessed by a qualified ophthalmologist and/or retina specialist [Grade D, Consensus]. Pharmacological intervention [Grade A, Level 1A (9,11,73,74)], laser therapy and/or vitrectomy [Grade A, Level 1A (58,60,68,69)] may be used to manage the diabetic retinopathy.
- 8.Visually disabled people should be referred for low-vision evaluation and rehabilitation [Grade D, Consensus].
Other Relevant Guidelines
- Targets for Glycemic Control, p. S42
- Dyslipidemia, p. S178
- Treatment of Hypertension, p. S186
- Type 1 Diabetes in Children and Adolescents, p. S234
- Type 2 Diabetes in Children and Adolescents, p. S247
- Diabetes and Pregnancy, p. S255
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The Canadian Diabetes Association is the registered owner of the name Diabetes Canada.
Conflict of interest statements can be found on page S214.