First ADA Guidance on Diabetic Retinopathy in 15 Years
A new retinopathy position statement from the American Diabetes Association (ADA) reflects the "dramatic" improvements in both assessment and treatment in the 15 years since ADA's last guidance on this diabetes complication.

Published online in Diabetes Care on February 21, the statement covers the natural history of diabetic retinopathy, including risk factors, and reviews the stages from mild nonproliferative to moderate nonproliferative with macular edema, to severe nonproliferative. The document also summarizes recent data on screening and treatment with recommendations given for both and includes a discussion about cost-effectiveness.

Recent improvements in the evaluation include the widespread adoption of optical coherence tomography for assessing retinal thickness and intraretinal pathology and wide-field fundus photography to detect clinically silent microvascular lesions.And advances in treatment include intravitreous injection of anti–vascular endothelial growth factor (VEGF) agents for both diabetic macular edema and proliferative diabetic retinopathy.

The key points from the guideline are:

-Optimize Blood Glucose, Blood Pressure, and Lipids to Slow DR

-Optimization of glycemic control, as well as blood pressure and serum lipids, to reduce or slow the progression of diabetic retinopathy

-Screening via dilated and comprehensive eye exam by an eye specialist should begin within 5 years after onset of type 1 diabetes and at the time of diagnosis of type 2 diabetes

-Women with preexisting diabetes who are planning pregnancy should be screened prior to becoming pregnant, or if that doesn't occur, during the first trimester

-Patients with either type of diabetes, if no evidence of retinopathy is found, follow-up eye exams can be scheduled about every 2 years.But if any retinopathy is identified, subsequent dilated-pupil retina exams are advised at least annually, and more frequently for those in whom the retinopathy is progressing or sight-threatening

-Laser photocoagulation is still the mainstay of treatment for patients with high-risk proliferative diabetic retinopathy and for some cases of severe nonproliferative retinopathy

-Intravitreous injections of anti-VEGF are indicated for central-vision-involved and sight-threatening diabetic macular edema

-Both screening and traditional laser treatment are long-established as cost-effective

-Anti-VEGF injections have been shown in many studies to be more cost-effective than laser monotherapy for diabetic macular edema, but the same calculation has not yet been established for anti-VEGF treatment for proliferative diabetic retinopathy