Diabetic Retinopathy

Diabetic Retinopathy is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Classification

  • DR is classified as preproliferative retinopathy (microaneurysms, retinal infarcts, lipid exudates, cotton wool spots, and/or microhemorrhages) with or without macular edema and proliferative retinopathy.
  • Other ocular abnormalities associated with diabetes include cataract formation, dyskinetic pupils, glaucoma, optic neuropathy, extraocular muscle paresis, floaters, and fluctuating visual acuity. The latter may be related to changes in BG levels.
  • The presence of floaters may be indicative of preretinal or vitreous hemorrhage, and immediate referral for ophthalmologic evaluation is warranted.

Epidemiology

The incidence of DR and vision impairment has dropped significantly with improved management of glycemia, blood pressure, and lipids in patients with both T1DM and T2DM. Early identification and treatment of DR have further reduced vision impairment once it is diagnosed. DR is less frequent in T2DM, but maculopathy may be more severe. DR is still the leading cause of vision loss in adults younger than age 65 years.1

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General Principles

Classification

  • DR is classified as preproliferative retinopathy (microaneurysms, retinal infarcts, lipid exudates, cotton wool spots, and/or microhemorrhages) with or without macular edema and proliferative retinopathy.
  • Other ocular abnormalities associated with diabetes include cataract formation, dyskinetic pupils, glaucoma, optic neuropathy, extraocular muscle paresis, floaters, and fluctuating visual acuity. The latter may be related to changes in BG levels.
  • The presence of floaters may be indicative of preretinal or vitreous hemorrhage, and immediate referral for ophthalmologic evaluation is warranted.

Epidemiology

The incidence of DR and vision impairment has dropped significantly with improved management of glycemia, blood pressure, and lipids in patients with both T1DM and T2DM. Early identification and treatment of DR have further reduced vision impairment once it is diagnosed. DR is less frequent in T2DM, but maculopathy may be more severe. DR is still the leading cause of vision loss in adults younger than age 65 years.1

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