Summary
Definition
History and exam
Key diagnostic factors
- diabetes
Other diagnostic factors
- microaneurysms
- cotton wool spots
- intraretinal haemorrhage
- lipid exudates
- floaters
- macular thickening
- vision loss
- venous beading
- intraretinal microvascular abnormalities
- optic disc neovascularisation
- retinal neovascularisation
- pre-retinal or vitreous haemorrhage
- retinal detachment
Risk factors
- young-onset diabetes
- longer duration of diabetes
- poor glycaemic control
- hypertension
- renal disease
- Pima Indians
- pregnancy
- cataract surgery
- elevated lipid levels
Diagnostic investigations
1st investigations to order
- photographs of the fundus
- optical coherence tomography scanning
- fluorescein angiography
- B scan ultrasonography
Treatment algorithm
NPDR: non-severe
NPDR:severe/PDR: non-high-risk
PDR: high-risk/iris neovascularisation
PDR: severe
refractory disease
Contributors
Authors
Jonathan Dowler, MD, FRCS, FRCOphth

Consultant Ophthalmic Surgeon
The London Clinic
London
UK
Disclosures
JD declares that he has no competing interests.
Acknowledgements
Dr Jonathan Dowler would like to gratefully acknowledge Dr Robin Hamilton, a previous contributor to this monograph. RH declares that he has no competing interests.
Peer reviewers
Zachary Bloomgarden, MD
Clinical Professor
Medicine/Endocrinology
Diabetes and Bone Disease
Mount Sinai School of Medicine
New York
NY
Disclosures
ZB declares that he has no competing interests.
Tien Y. Wong, MD, MPH, PhD
Head of Department of Ophthalmology
University of Melbourne
Victoria
Australia
Disclosures
TYW declares that he has no competing interests.
Stephen Schwartz, MD
Medical Director
Bascom Palmer Eye Institute
Miami
FL
Disclosures
Within the last 5 years, SS has received funding for organizing continuing medical education conferences from Alcon, Genentech, and Novartis; has owned shares in Pfizer; has received research funding from Genentech; and is co-holder of a patent pending on "Molecular targets for modulating intraocular pressure and differentiation of steroid responders versus nonresponders."
Differentials
- Ocular ischaemic syndrome
- Radiation retinopathy
- Retinal venous occlusion
More DifferentialsGuidelines
- Type 2 diabetes in adults: management
- Standards of medical care in diabetes - 2022
More GuidelinesPatient leaflets
Diabetes type 2: should I take insulin?
Diabetes type 2: what treatments work?
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