The American Diabetic Association in the March 2017 has released a position statement on Diabetic Retinopathy. This is update on the 2002 recommendations by the ADA. The following is the summary of the recommendations.

A full PDF version can be accessed here: https://dhmbxeygs57ff.cloudfront.net/uploads/ea7f7bfc884444d6a4c3a24450cfef89.pdf

Summary of the 2017, ADA recommendations on diabetic retinopathy

1.Optimize the following to reduce the risk or slow the progression of diabetic retinopathy

  • Glycemic control
  • Blood pressure
  • Serum lipid control

Screening

  1. Adults with type 1 diabetes
  • 5 years after the onset of diabetes
  • Comprehensive eye examination by an ophthalmologist or optometrist

2.Type 2 diabetes

  • At the time of diagnosis of type 2 DM
  • Comprehensive eye examination by an ophthalmologist or optometrist

Frequency of Screening

  1. If there is no evidence of retinopathy for one or more annual eye exams
  • examination every 2 years may be considered

2.If any level of diabetic retinopathy is present

  • At Least annual screening by an ophthalmologist

3. If retinopathy is progressing or sight-threatening

  • More frequent screening

Pregnancy

  1. Women with preexisting type 1 or 2 diabetes planning a pregnancy should be counseled on the risk of development and/or progression of diabetic retinopathy.
  2. Eye examinations should occur before pregnancy or in the first trimester in patients with preexisting type 1 or type 2 diabetes
  • then monitored every trimester
  • and for 1 year postpartum as indicated by the degree of retinopathy

Retinal photography

  1. May serve as a screening tool
  2. NOT a substitute for a comprehensive eye exam

Treatment

  1. Promptly refer all patient with the following to an ophthalmologist who is knowledgeable and experienced in the management and treatment of diabetic retinopathy.
  • any level of macular edema
  • severe nonproliferative diabetic retinopathy (a precursor of proliferative diabetic retinopathy)
  • or any proliferative diabetic retinopathy

2. Laser photocoagulation therapy reduces the risk of vision loss in patients with

  • high-risk proliferative diabetic retinopathy
  • in some cases, severe nonproliferative diabetic retinopathy

3. Intravitreous injections of anti–vascular endothelial growth factor are indicated for central-involved diabetic macular edema, which

  • occurs beneath the foveal center
  • and may threaten reading vision

4. Aspirin does not increase the risk of retinal hemorrhage

  • presence of retinopathy is not a contraindication to aspirin therapy for cardioprotection
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