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Diabetic retinopathy

Last reviewed: 5 Oct 2024
Last updated: 13 Feb 2024

Summary

Definition

History and exam

Key diagnostic factors

  • diabetes
Full details

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
Full details

Risk factors

  • longer duration of diabetes
  • poor glycemic control
  • elevated lipid levels
  • hypertension
  • renal disease
  • ethnicity
  • pregnancy
  • cataract surgery
Full details

Diagnostic tests

1st tests to order

  • optical coherence tomography
  • fundus photography/wide-field fundus photography
Full details

Tests to consider

  • fluorescein angiography/wide-field fluorescein angiography
  • optical coherence tomography angiography
  • B-scan ultrasonography
Full details

Treatment algorithm

ACUTE

nonproliferative diabetic retinopathy

proliferative diabetic retinopathy

iris neovascularization

advanced proliferative diabetic retinopathy

ONGOING

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
Jonathan Dowler

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. 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.

  • Diabetic retinopathy images
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  • Guidelines

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  • Patient information

    Diabetes type 2: should I take insulin?

    Diabetes type 2: what treatments work?

    More Patient information
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