Last reviewed: 1 Nov 2023
Last updated: 16 Nov 2023
Summary
Definition
History and exam
Key diagnostic factors
- diabetes
More key diagnostic factors
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
Other diagnostic factors
Risk factors
- longer duration of diabetes
- poor glycemic control
- elevated lipid levels
- hypertension
- renal disease
- ethnicity
- pregnancy
- cataract surgery
More risk factors
Diagnostic investigations
1st investigations to order
- optical coherence tomography
- fundus photography/wide-field fundus photography
More 1st investigations to order
Investigations to consider
- fluorescein angiography/wide-field fluorescein angiography
- optical coherence tomography scanning
- B-scan ultrasonography
More investigations to consider
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
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.
Differentials
- Ocular ischemic syndrome
- Radiation retinopathy
- Retinal venous occlusion
More DifferentialsGuidelines
- Standards of care in diabetes - 2023
- Comprehensive adult medical eye evaluation: preferred practice pattern
More GuidelinesPatient leaflets
Diabetes type 2: should I take insulin?
Diabetes type 2: what treatments work?
More Patient leaflets
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