II. Epidemiology
- Occurs in 20% of patients with Diabetes Mellitus
- Occurs equally in Type I and Type II Diabetes Mellitus
III. Risk Factors
- Longer duration of Diabetes Mellitus (>72 months)
- Poor Blood Glucose control (Hgb A1C > 8.0)
- Increased Microalbuminuria levels (>9.5)
- Saum (2002) Br J Gen Pract 52:214-6 [PubMed]
IV. Types
- Nonproliferative Retinopathy
- Retinal veins dilated
- Cotton Wool exudates or spots
- Hard exudates
- Macular edema
- Intraretinal Hemorrhages
- Microaneurysms
- Proliferative Retinopathy
- Neovascularization
- Preretinal Hemorrhages
- Vitreous Hemorrhages
- Vascular fibrosis
V. Symptoms
- Vision Loss, fluctuating Visual Acuity or Visual Field Defects
- Floater or flashes of light (photopsia)
VI. Protocol: Ophthalmology Exam Intervals with no Retinal Disease
- Children with Diabetes
- Initial Exam: Age 10 years (or after 3-5 years of Diabetes Mellitus)
- Subsequent Exams: Annually
- Adults with Type 2 Diabetes
- Initial Exam: At diagnosis
- Subsequent Exams: Annually
VII. Protocol: Ophthalmology Exam Intervals for those with Retinal Disease
- Mild to moderate nonproliferative Diabetic Retinopathy
- No Macular edema
- Exams every 6-12 months
- Macular edema present
- Consider laser photocoagulation
- Intravitreal injection of Vascular Endothelial Growth Factors (e.g. Bevacizumab, aflibercept, ranibizumab)
- Intravitreal Corticosteroid Injection or implant (Cataract risk)
- No Macular edema
- Severe nonproliferative Diabetic Retinopathy
- Eye Examinations every 2-4 months
- Consider laser photocoagulation
- See Macular edema management as above
- Proliferative Diabetic Retinopathy
- Consider laser photocoagulation
-
Vitreous Hemorrhage (or refractory course)
- Intravitreal injection of Vascular Endothelial Growth Factors (e.g. Bevacizumab, aflibercept, ranibizumab)
VIII. Prevention: Slowing Diabetic Retinopathy progression
- Fenofibrate
- Tighter glycemic control reduces progression risk
- However, diabetes goals have loosened to prevent Hypoglycemia (A1C 8.5% in older adults)
- Stratton (2001) Diabetologia 44(2): 156-63 [PubMed]
-
Blood Pressure Control
- Optimal Blood Pressure control does decrease Diabetic Retinopathy Incidence
- However, optimal Blood Pressure control does NOT slow Diabetic Retinopathy progression after onset
- Do (2023) Cochrane Database Syst Rev 3(3):CD006127 +PMID: 36975019 [PubMed]
IX. References
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSHCZE) | postižení oční sítnice při diabetes mellitus, forma mikroangiopatie. Postižen je parenchym sítnice i cévy. Bývají mikroaneurysmata cév, tvrdé exsudáty, krvácení, edém, vatovitá ložiska. Závažná je forma proliferativní s novotvorbou cév, sklivcovou hemoragií, rizikem odchlípení sítnice a poruchou zraku. Léčebně se uplatňuje fotokoagulace laserem, kryokoagulace, popř. vitrektomie. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (NCI) | A chronic, pathological complication associated with diabetes mellitus, where retinal damages are incurred due to microaneurysms in the vasculature of the retina, progressively leading to abnormal blood vessel growth, and swelling and leaking of fluid from blood vessels, resulting in vision loss or blindness. |
| Definition (MSH) | Disease of the RETINA as a complication of DIABETES MELLITUS. It is characterized by the progressive microvascular complications, such as ANEURYSM, interretinal EDEMA, and intraocular PATHOLOGIC NEOVASCULARIZATION. |
| Definition (CSP) | retinal changes occurring in diabetes mellitus, marked by microaneurysms, exudates, and hemorrhages, and sometimes by neovascularization. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D003930 |
| ICD9 | 362.0 |
| ICD10 | H36.0 |
| SnomedCT | 4855003, 267471001, 154678005, 163997001, 141196007, 193353002, 309595004, 155107006 |
| LNC | MTHU020818 |
| English | Diabetic Retinopathies, Retinopathies, Diabetic, DIABETIC RETINOPATHY, Retinopathy, Diabetic, DR - Diabetic retinopathy, DR, diabetic retinopathy (diagnosis), diabetic retinopathy, Retina abnormal - diabet-relat, Retinopathy diabetic, Diabetic Retinopathy [Disease/Finding], Retinopathy;diabetic, Retinopathy - diabetic, Retinal abnormality - diabetes-related (disorder), Diabetic retinopathy NOS (disorder), Diabetic retinopathy, Retinal abnormality - diabetes-related, Diabetic retinopathy (disorder), Diabetic Retinopathy, Diabetic retinopathy, NOS, Diabetic retinopathy NOS |
| Dutch | retinopathie diabetisch, diabetische retinopathie, Diabetische retinopathie, Retinopathie, diabetische |
| German | Retinopathie diabetisch, Retinopathia diabetica, diabetische Retinopathia, Diabetische Retinopathie |
| Swedish | Diabetisk näthinnesjukdom |
| Czech | diabetická retinopatie, Diabetická retinopatie, retinopathia diabetica |
| Finnish | Diabeettinen retinopatia |
| Russian | DIABETICHESKAIA RETINOPATIIA, ДИАБЕТИЧЕСКАЯ РЕТИНОПАТИЯ |
| Korean | 당뇨 망막병증 |
| Croatian | DIJABETIČNA RETINOPATIJA |
| Polish | Retinopatia cukrzycowa |
| Japanese | 糖尿病網膜症, ﾄｳﾆｮｳﾋﾞｮｳﾓｳﾏｸｼｮｳ |
| Hungarian | Diabeteses retinopathia |
| Norwegian | Diabetesretinopati, Netthinnesykdom ved diabetes, Diabetisk retinopati, Diabetisk netthinnesykdom |
| Spanish | retinopatía diabética, SAI, retinopatía diabética, SAI (trastorno), anomalía retiniana relacionada con diabetes (trastorno), anomalía retiniana relacionada con diabetes, retinopatía diabética (trastorno), retinopatía diabética, Retinopatía diabética, Retinopatía Diabética |
| Portuguese | Retinopatia diabética, Retinopatia Diabética |
| French | Rétinopathie diabétique |
| Italian | Retinopatia diabetica |
Ontology: Diabetic macular edema (C0730285)
| Concepts | Disease or Syndrome (T047) |
| ICD9 | 362.07 |
| SnomedCT | 312912001 |
| Dutch | diabetisch macula-oedeem |
| French | Oedème maculaire diabétique |
| German | diabetisches Makulaoedem |
| Italian | Edema maculare diabetico |
| Portuguese | Edema macular diabético |
| Spanish | Edema macular diabético, edema macular diabético (trastorno), edema macular diabético |
| Japanese | 糖尿病性黄斑浮腫, ﾄｳﾆｮｳﾋﾞｮｳｾｲｵｳﾊﾝﾌｼｭ |
| English | diabetic macular edema (diagnosis), diabetic macular edema, edema diabetic macular, diabetic macular oedema, Diabetic macular edema, Diabetic macular oedema, Diabetic macular edema (disorder) |
| Czech | Diabetický makulární edém |
| Hungarian | Diabeteses macula oedema |
