-
Diabetes is associated with the development of:
-
Non-proliferative retinopathy
-
Proliferative retinopathy – vision threatening
-
Macular oedema – may be vision threatening
-
Cataracts – may become vision threatening
-
All patients should then have retinal photoscreening at least every 2 years
-
All pregnant women with known diabetes before pregnancy should also have retinal photoscreening in the first trimester
-
The frequency of retinal photoscreening in both pregnant and non-pregnant adults with diabetes may be increased if any abnormality is found
-
All patients with moderate or vision-threatening retinopathy or macular oedema should be seen by ophthalmology
-
Management of diabetic retinopathy in primary care includes:
-
Optimisation of glycaemic control
-
Rapid improvements in glycaemic control in those with severe hyperglycaemia may aggravate the retinopathy
-
Tight blood pressure control
-
Control of dyslipidaemia
-
Smoking cessation
-
Cessation of pioglitazone if macular oedema
-
Consider fibrates (e.g. bezafibrate) if macular oedema
-
Urgent referral to ophthalmology if any sudden deterioration in vision