Diabetic Retinopathy Recommendations

	2016 ADA Guideline Recommendations
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Older Adults with Diabetes
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Management of Diabetes in Pregnancy
Diabetes Care in the Hospital Setting

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Tarek Nafee, M.D. [3]

2016 ADA Standards of Medical Care in Diabetes Guidelines^[1]

"1. Optimize glycemic control to reduce the risk or slow the progression of diabetic retinopathy. (Level of Evidence: A)"
"2. Optimize blood pressure and serum lipid control to reduce the risk or slow the progression of diabetic retinopathy. (Level of Evidence: A)"

"1. Adults with type 1 diabetes should have an initial dilated and compre- hensive eye examination by an oph- thalmologist or optometrist within 5 years after the onset of diabetes. '(Level of Evidence: B)"
"2. Patients with type 2 diabetes should have an initial dilated and compre- hensive eye examination by an oph- thalmologist or optometrist at the time of the diabetes diagnosis. (Level of Evidence: B)"
"3. If there is no evidence of retinop- athy for one or more annual eye exams, then exams every 2 years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal exami- nations for patients with type 1 or type 2 diabetes should be re- peated at least annually by an ophthalmologist or optometrist. If retinopathy is progressing or sight-threatening, then examinations will be required more frequently. (Level of Evidence: B)"
"4. While retinal photography may serve as a screening tool for reti- nopathy, it is not a substitute for a comprehensive eye exam, which should be performed at least ini- tially and at intervals thereafter as recommended by an eye care professional. (Level of Evidence: E)"
"5. Eye examinations should occur be- fore pregnancy or in the first tri- mester, and then patients should be monitored every trimester and for 1 year postpartum as indicated by the degree of retinopathy. (Level of Evidence: B)"

"1. Promptly refer patients with any level of macular edema, severe nonproliferative diabetic retinopathy (a precursor of proliferative diabetic retinopathy), or any pro- liferative diabetic retinopathy to an ophthalmologist who is knowledgeable and experienced in the management and treatment of diabetic retinopathy. (Level of Evidence: A)"
"2. Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with high-risk proliferative diabetic retinopathy and, in some cases, severe nonproliferative diabetic retinopathy (Level of Evidence: A)"
"3. Intravitreal injections of antivas- cular endothelial growth factor are indicated for center-involved diabetic macular edema, which occurs beneath the foveal center and may threaten reading vision (Level of Evidence: A)"
"4. The presence of retinopathy is not a contraindication to aspirin therapy for cardioprotection, as aspirin does not increase the risk of retinal hemorrhage (Level of Evidence: A)"