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Diabetic retinopathy remains a significant cause of vision loss among patients with diabetes mellitus. This comprehensive review outlines current guidelines for screening, prevention strategies, and treatment options, emphasizing the importance of a collaborative approach between primary care physicians and ophthalmologists in managing this condition.
Key Points:
- Implement American Diabetes Association screening guidelines: Refer patients with type 1 diabetes for initial eye examination within 5 years of onset and patients with type 2 diabetes at diagnosis.
- Leverage retinal photography with remote interpretation to increase screening rates and accuracy in detecting diabetic retinopathy.
- Prioritize strict glycemic control as the primary measure to prevent diabetic retinopathy development and progression.
- Consider the potential risk of early worsening of diabetic retinopathy with rapid HbA1c reduction when initiating GLP-1 receptor agonists or other intensive diabetes treatments.
- Treat center-involved diabetic macular edema (DME) with anti-VEGF injections as first-line therapy, using treat-and-extend or as-needed approaches to reduce treatment burden.
- Monitor patients with nonproliferative diabetic retinopathy (NPDR) closely, considering anti-VEGF therapy for severe NPDR cases.
- Manage proliferative diabetic retinopathy with anti-VEGF therapy, potentially combined with panretinal photocoagulation based on individual patient factors.
HCN Medical Memo
Effective management of diabetic retinopathy requires a multidisciplinary approach. Primary care physicians play a crucial role in timely screening, glycemic control, and appropriate referrals, while ophthalmologists provide specialized care and treatment. By working together and leveraging new technologies and treatments, we can significantly reduce the burden of vision loss in patients with diabetes.
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