Diabetic Retinopathy Recommendations

2016 ADA Guideline Recommendations

Types of Diabetes Mellitus

Main Diabetes Page

Diabetes type I

Diabetes type II

Gestational Diabetes Mellitus

2016 ADA Standard of Medical Care Guideline Recommendations

Strategies for Improving Care

Classification and Diagnosis of Diabetes

Foundations of Care and Comprehensive Medical Evaluation

Diabetes Self-Management, Education, and Support
Nutritional Therapy

Prevention or Delay of Type II Diabetes

Glycemic Targets

Obesity Management for Treatment of Type II Diabetes

Approaches to Glycemic Treatment

Cardiovascular Disease and Risk Management

Hypertension and Blood Pressure Control
Lipid Management
Antiplatelet Agents
Coronary Heart Disease

Microvascular Complications and Foot Care

Diabetic Kidney Disease
Diabetic Retinopathy
Diabetic Neuropathy
Diabetic Footcare

Older Adults with Diabetes

Children and Adolescents with Diabetes

Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes
Microvascular Complications in Children and Adolescents with Diabetes

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]

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"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)"

#### Screening

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"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)"

#### Treatment

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"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)"

## References

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1. ↑ "care.diabetesjournals.org" (PDF).

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