Summary
Definition
History and exam
Key diagnostic factors
- diabetes
Other diagnostic factors
- microaneurysms
- cotton wool spots
- intraretinal hemorrhage
- lipid exudates
- macular edema
- venous beading
- intraretinal microvascular abnormalities
- optic disk neovascularization
- retinal neovascularization
- preretinal or vitreous hemorrhage
- retinal detachment
Risk factors
- longer duration of diabetes
- poor glycemic control
- elevated lipid levels
- hypertension
- renal disease
- ethnicity
- pregnancy
- cataract surgery
Diagnostic tests
1st tests to order
- optical coherence tomography
- fundus photography/wide-field fundus photography
Tests to consider
- fluorescein angiography/wide-field fluorescein angiography
- optical coherence tomography angiography
- B-scan ultrasonography
Treatment algorithm
nonproliferative diabetic retinopathy
proliferative diabetic retinopathy
iris neovascularization
advanced proliferative diabetic retinopathy
macular edema unresponsive to intravitreal anti-VEGF therapy
macular edema with anteroposterior vitreomacular traction
chronic macular edema, macular ischemia, chronic macular detachment, optic atrophy secondary to neovascular glaucoma
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 topic.
Disclosures
RH declares that he has no competing interests.
Peer reviewers
Adrienne W Scott, MD
Chief
Wilmer Eye Institute
Bel Air
Associate Professor of Ophthalmology
Johns Hopkins University School of Medicine
Baltimore
MD
Disclosures
AWS has received grant support and consulting honoraria from Genentech/Roche. She has also received consulting honoraria from Allergan/AbbVie Inc., Novartis, Regeneron, Bausch and Lomb, and Alimera Sciences.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American Academy of Ophthalmology. Preferred practice pattern: diabetic retinopathy. Oct 2019 [internet publication].Full text
Wong TY, Sun J, Kawasaki R, et al. Guidelines on diabetic eye care: The International Council of Ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings. Ophthalmology. 2018 Oct;125(10):1608-22.Full text Abstract
Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: a position statement by the American Diabetes Association. Diabetes Care. 2017 Mar;40(3):412-8.Full text Abstract
American Diabetes Association. Standards of care in diabetes - 2024. Diabetes Care. 2024 Jan;47(suppl 1):S1-321.Full text
American Academy of Ophthalmology. Preferred practice patterns: retina summary benchmarks. Dec 2023 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Ocular ischemic syndrome
- Radiation retinopathy
- Retinal venous occlusion
More DifferentialsGuidelines
- Standards of care in diabetes
- Vision rehabilitation: preferred practice pattern
More GuidelinesPatient information
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Diabetes type 2: what are the treatment options?
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