Retinopathy

• After 15 years, approx. 80% of patients with type 1 diabetes will develop retinopathy.

• Among patients > 30 years old with type 2 diabetes:

  • Patients not requiring insulin

    • Approx. 25% will develop retinopathy within 5 years of diagnosis.

    • Approx. 50% will develop retinopathy within 19 years.

  • Patients requiring insulin

    • Approx. 40% will develop retinopathy within 5 years of diagnosis.

    • Approx. 85% will develop retinopathy within 19 years.

• Diabetic retinopathy is the most common cause of visual impairment and blindness in patients aged 20–74 years.

Development and progression of diabetic retinopathy is associated with:

• Diabetes-related factors

  • Poor glycemic control

  • Increased duration of diabetes

  • Presence of diabetic nephropathy

• Other cardiovascular risk factors

  • Hypertension

  • Dyslipidemia

• Puberty

• Pregnancy

• History of cataract surgery

• Early stages: usually asymptomatic

• Patients may experience symptoms of associated complications, e.g., macular edema, vitreous hemorrhage, and retinal detachment.

  • Blurred vision

  • Floaters

  • Photopsia

  • Scotoma

  • Sudden, painless vision loss

• Later stages: significant visual impairment progressing to blindness

• Modalities

  • Dilated comprehensive eye examination performed by an ophthalmologist/optometrist

  • Retinal photography

• Onset

  • Type 1 DM: within 5 years of the onset of disease

  • Type 2 DM: at the time of diagnosis

• Interval: every year

Less frequent retinopathy screening (e.g., every 2 years) may be considered in consultation with an ophthalmologist or optometrist for patients with diabetes who have a normal initial eye exam and good glycemic control.

• Optimize management of diabetes to ensure patients meet glycemic targets for DM.

• Manage ASCVD risk factors.

• Educate patients on the importance of screening for complications of diabetes.

  • Ensure patients are aware that they may not experience symptoms until the disease is advanced.

  • Address risk factors for poor adherence (see “Managing chronic conditions”).

• Advise patients to seek immediate medical attention if they notice any changes in their vision.

Advise patients to attend regular screenings as microvascular complications are usually asymptomatic until significant damage has occurred.