Summary
Definition
History and exam
Key diagnostic factors
- diabetes
Other diagnostic factors
- microaneurismas
- manchas brancas do tipo "bolas de algodão"
- hemorragia intrarretiniana
- exsudatos lipídicos
- edema macular
- beading venoso
- anormalidades microvasculares intrarretinianas
- neovascularização do disco óptico
- neovascularização retiniana
- hemorragia pré-retiniana ou vítrea
- descolamento de retina
Risk factors
- diabetes de duração prolongada
- controle glicêmico inadequado
- dislipidemia
- hipertensão
- doença renal
- etnia
- gestação
- cirurgia de catarata
- melhora rápida no controle glicêmico
Diagnostic investigations
1st investigations to order
- tomografia de coerência óptica
- fotografia de fundo do olho/fotografia de fundo do olho de campo amplo
Investigations to consider
- angiografia fluoresceínica/angiografia fluoresceínica de campo amplo
- angiotomografia de coerência óptica
- ultrassonografia modo B
- gonioscopia
Emerging tests
- eletrorretinografia
- testes de campo visual e perimetria cromática adaptada ao escuro
- análise de imagens de angiografia por tomografia de coerência óptica assistida por inteligência artificial (IA)
Treatment algorithm
retinopatia diabética não proliferativa (RDNP): leve
retinopatia diabética não proliferativa (RDNP): moderada
retinopatia diabética não proliferativa (RDNP): grave
retinopatia diabética proliferativa (RDP): de não alto risco
retinopatia diabética proliferativa (RDP): alto risco
retinopatia diabética proliferativa (RDP): avançada
neovascularização da íris
edema macular diabético sem resposta clínica a injeções intravítreas de inibidor do fator de crescimento endotelial vascular (VEGF)
edema macular com tração vítreo-macular anteroposterior
edema macular crônico, isquemia macular, descolamento macular crônico, atrofia óptica secundária a glaucoma neovascular
Contributors
Authors
Corrina P. Azarcon, MD
Assistant Professor/Clinical
Department of Ophthalmology
The University of Texas at San Antonio Health Science Center
San Antonio, TX
Disclosures
CA declares that she is a faculty member (Retina Specialist) of the University of Texas at San Antonio Health Science Center.
Acknowledgements
Dr Corrina P. Azarcon would like to gratefully acknowledge Dr Johnathan Dowler and Dr Robin Hamilton, previous contributors 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. Diabetic retinopathy PPP 2024. Feb 2025 [internet publication].Full text
American Diabetes Association. Standards of care in diabetes - 2025. Diabetes Care 2025 Jan 1;48(suppl 1):S1-343.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
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Síndrome isquêmica ocular
- Retinopatia por radiação
- Oclusão venosa retiniana
More DifferentialsGuidelines
- Type 2 diabetes in adults: management
- Retina summary benchmarks - 2025
More GuidelinesPatient information
Diabetes: o que posso fazer para me manter saudável?
Diabetes: o que é?
More Patient informationLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer