Patients with type 1 diabetes do not usually have vision-threatening retinopathy in the first five years of their disease. Over the next 20 years, however, nearly all type 1 diabetics develop some retinopathy. A significant percentage of patients with type 2 diabetes have retinopathy at the time of diagnosis, and many will develop some degree of retinopathy over subsequent years. Retinopathy progresses in a predictable manner, advancing from mild background abnormalities to pre-proliferative retinopathy, and then to proliferative retinopathy. Vision loss occurs when macular edema or capillary non-perfusion cause the loss of central vision, or from proliferative retinopathy, which can lead to retinal detachment and irreversible vision loss. The proliferative vessels may also bleed, leading to pre-retinal or vitreous hemorrhage. Prevention and treatment recommendations for diabetic retinopathy include the following:
• Maximize glycemic control, since this reduces the risk of progression to clinically significant retinopathy.
• Maximize blood pressure control.
• Annual funduscopic eye exam. Screen diabetic patients for retinopathy, since proliferative retinopathy and macular edema may occur in completely asymptomatic patients,
• Monitor pregnant diabetic patients closely, since pregnancy may aggravate retinopathy.
• Continue aspirin therapy. It neither prevents retinopathy nor increases the risk of retinal hemorrhage.
• Refer patients for laser photocoagulation surgery when indicated. Photocoagulation reduces the risk of further vision loss in patients with retinopathy, but does not ordinarily reverse established vision loss.
Dec 152010