Diabetic retinopathy: The FP’s role in preserving vision
Evaluation and Tx of this debilitating complication falls to the eye specialist, but you play a central role in assessing risk and optimizing prevention strategies.
PRACTICE RECOMMENDATIONS
› Refer patients with type 1 diabetes mellitus (DM) to an ophthalmologist or optometrist for a dilated and comprehensive eye examination within 5 years of disease onset. B
› Refer patients with type 2 DM to an ophthalmologist or optometrist for an initial dilated and comprehensive eye examination at time of diagnosis. B
› Control blood pressure—ideally, < 140/90 mm Hg—in patients with DM to reduce the risk of diabetic retinopathy. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Despite limited data on the impact of lipid-lowering agents on patients with diabetic retinopathy, those with type 2 DM (especially) and those who have, or are at risk of, atherosclerotic cardiovascular disease should receive statin therapy.18
Aspirin therapy. Aspirin has not been found to be beneficial for slowing progression of diabetic retinopathy. However, aspirin did not cause further deterioration of disease, specifically in patients with vitreous hemorrhages4; patients with diabetic retinopathy who require aspirin therapy for other medical reasons can therefore continue to take it without increasing the risk of damage to the retina.4,18
When should you refer patients for screening?
Screening for diabetic retinopathy is important because affected patients can be asymptomatic but have significant disease. Early detection also helps determine which patients need treatment when it is most beneficial: early in its course.4
Type 1 DM. Retinopathy can become apparent as early as 6 or 7 years after the onset of disease, and is rare in children prior to puberty.4,11 As a result, patients with type 1 DM should first be screened with a comprehensive eye examination by an ophthalmologist or optometrist within 5 years of DM onset.4,18
Type 2 DM. Because of the insidious onset of type 2 DM, patients who are given a diagnosis of DM after 30 years of age might already have high-risk features of retinopathy.9 In patients with type 2 DM, therefore, initial screening for diabetic retinopathy should begin at the time of diagnosis and include a comprehensive eye examination by an ophthalmologist or optometrist.4,18,23
Continue to: Components of the exam
