From the Guidelines
For patients with diabetes who require complex management, annual comprehensive dilated retinal examinations are recommended, as stated in the most recent guidelines 1. This yearly screening is essential for early detection of diabetic retinopathy, a common complication that can lead to vision loss if left untreated. However, if the patient already has established retinopathy, more frequent examinations may be necessary, potentially every 3-6 months depending on the severity and progression of retinal changes. The frequency might be adjusted based on individual risk factors such as poor glycemic control (HbA1c > 9%), hypertension, longer duration of diabetes (>10 years), or previous evidence of retinopathy. These regular eye exams are crucial because diabetic retinopathy often develops silently without symptoms until significant damage has occurred. Early detection through regular screening allows for timely intervention with treatments such as laser photocoagulation, anti-VEGF injections, or vitrectomy when necessary, which can prevent or delay vision loss. Maintaining good glycemic control, blood pressure management, and lipid control are also important complementary strategies to reduce the risk of developing or worsening retinopathy, as supported by previous studies 1. Some key points to consider include:
- The presence of retinopathy is not a contraindication to aspirin therapy for cardioprotection, as aspirin does not increase the risk of retinal hemorrhage 1.
- Telemedicine programs that use validated retinal photography with remote reading by an ophthalmologist or optometrist and timely referral for a comprehensive eye examination when indicated can be an appropriate screening strategy for diabetic retinopathy 1.
- Women with preexisting type 1 or type 2 diabetes who are planning pregnancy or who are pregnant should be counseled on the risk of development and/or progression of diabetic retinopathy, and eye examinations should occur before pregnancy or in the first trimester, with close follow-up throughout pregnancy and for 1 year postpartum 1. The most recent guidelines from 2023 1 provide the strongest evidence for the recommended frequency of retinal exams in patients with diabetes, and should be prioritized in clinical decision-making.
From the Research
Recommended Frequency for Retinal Exams
The recommended frequency for retinal exams in patients with diabetes varies depending on the presence and severity of diabetic retinopathy.
- For patients with no diabetic retinopathy at diagnosis, a screening interval of 1-2 years is recommended 2.
- For patients with pre-existing diabetic retinopathy, a shorter interval of ≤1 year is warranted 2.
Screening Options
Different methods can be used for screening diabetic retinopathy, including nonmydriatic cameras and comprehensive ocular examinations 3.
- Nonmydriatic cameras can be useful in identifying lesions of diabetic retinopathy requiring treatment, but have limitations such as lack of dilation and cataract formation.
- Comprehensive ocular examinations are essential for accurate diagnosis and management of diabetic retinopathy.
Management of Diabetic Retinopathy
The management of diabetic retinopathy involves strict metabolic control, tight blood pressure control, laser photocoagulation, and vitrectomy 4.
- Laser photocoagulation and vitrectomy are effective in preventing severe visual loss from sight-threatening diabetic retinopathy and its complications.
- Intravitreous ranibizumab may be a reasonable treatment alternative to panretinal photocoagulation for patients with proliferative diabetic retinopathy 5.
Functional Diabetic Retinopathy
Functional diabetic retinopathy is a new concept that emphasizes the importance of multifocal functional tests in the management of diabetic retinal diseases 6.
- Multifocal functional tests can objectively characterize both foveal and extrafoveal, localized and global, function.
- Early detection of functional diabetic retinopathy using multifocal functional tests could bring diabetic retinopathy management strategies forward, enabling prevention of later stage vision-threatening complications.