II. Epidemiology

  1. Occurs in 20% of patients with Diabetes Mellitus
  2. Occurs equally in Type I and Type II Diabetes Mellitus

III. Risk Factors

  1. Longer duration of Diabetes Mellitus (>72 months)
  2. Poor Blood Glucose control (Hgb A1C > 8.0)
  3. Increased Microalbuminuria levels (>9.5)
  4. Saum (2002) Br J Gen Pract 52:214-6 [PubMed]

IV. Types

  1. Nonproliferative Retinopathy
    1. Retinal veins dilated
    2. Cotton Wool exudates or spots
    3. Hard exudates
    4. Macular edema
    5. Intraretinal Hemorrhages
    6. Microaneurysms
  2. Proliferative Retinopathy
    1. Neovascularization
    2. Preretinal Hemorrhages
    3. Vitreous Hemorrhages
    4. Vascular fibrosis

V. Symptoms

  1. Vision Loss, fluctuating Visual Acuity or Visual Field defects
  2. Floater or flashes of light (photopsia)

VI. Protocol: Ophthalmology Exam Intervals with no Retinal Disease

  1. Children with Diabetes
    1. Initial Exam: Age 10 years (or after 3-5 years of Diabetes Mellitus)
    2. Subsequent Exams: Annually
  2. Adults with Type 2 Diabetes
    1. Initial Exam: At diagnosis
    2. Subsequent Exams: Annually

VII. Protocol: Ophthalmology Exam Intervals for those with Retinal Disease

  1. Mild to moderate nonproliferative Diabetic Retinopathy
    1. No Macular edema
      1. Exams every 6-12 months
    2. Macular edema present
      1. Consider laser photocoagulation
      2. Intravitreal injection of Vascular Endothelial Growth Factors (e.g. Bevacizumab, aflibercept, ranibizumab)
        1. Wells (2015) N Engl J Med 372(13): 1193-203 +PMID:25692915 [PubMed]
      3. Intravitreal Corticosteroid Injection or implant (Cataract risk)
        1. Grover (2008) Cochrane Database Syst Rev (1):CD005656 +PMID:18254088 [PubMed]
  2. Severe nonproliferative Diabetic Retinopathy
    1. Eye Examinations every 2-4 months
    2. Consider laser photocoagulation
    3. See Macular edema management as above
  3. Proliferative Diabetic Retinopathy
    1. Consider laser photocoagulation
  4. Vitreous Hemorrhage (or refractory course)
    1. Intravitreal injection of Vascular Endothelial Growth Factors (e.g. Bevacizumab, aflibercept, ranibizumab)
      1. Osaadon (2014) Eye 28(5): 510-20 [PubMed]

VIII. Prevention: Slowing Diabetic Retinopathy progression

  1. Fenofibrate
    1. Wong (2012) Am J Ophthalmol 154(1): 6-12 [PubMed]
  2. Tighter glycemic control reduces progression risk
    1. However, diabetes goals have loosened to prevent Hypoglycemia (A1C 8.5% in older adults)
    2. Stratton (2001) Diabetologia 44(2): 156-63 [PubMed]

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Related Studies

Ontology: Diabetic Retinopathy (C0011884)

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
Korean 당뇨 망막병증
Polish Retinopatia cukrzycowa
Japanese 糖尿病網膜症, トウニョウビ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, トウニョウビ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