Nonproliferative Diabetic Retinopathy |
21 |
Table 4
Recommended Scheduling of Examinations Based on the Timing of Diabetes Mellitus Onset
Time of onset |
Recommended time for |
Routine minimum follow-up |
|
first examination |
|
|
|
|
Age less than 30 years |
5 years after onset |
Yearly |
Age 30 and older |
At time of diagnosis |
Yearly |
Before pregnancy |
Before or soon after conception |
At least every 3 months |
|
|
|
|
Table 5 |
|
Recommended Follow-up Based on the Status of the Retinopathy |
||
|
|
|
Status |
|
Follow-up (months) |
|
|
|
No retinopathy or microaneurysms only |
12 |
|
Mild/moderate NPDR without macular edema |
6–12 |
|
Mild/moderate NPDR with macular edema that is not |
4–6 |
|
clinically significant |
|
|
Mild/moderate NPDR with clinically significant macular edema |
3–4 |
|
Severe/very severe NPDR |
|
3–4 |
NPDR nonproliferative diabetic retinopathy
The lifestyle intervention reduced the incidence by 58% (95% confidence interval, 48–66%) and metformin by 31% (95% confidence interval, 17–43%), compared with placebo. Therefore, a healthy lifestyle is a cost-saving, effective method to prevent the development of diabetic complications.
SUMMARY
On the basis of the results of controlled clinical trials that have accumulated over the past several decades, we now have beneficial methods for the treatment of diabetic retinopathy. However, diabetic retinopathy remains a leading cause of visual loss in the United States among working-age Americans. This is unfortunate, because when properly treated, the 5-year risk of blindness for patients with PDR is reduced by 90% and the risk of visual loss from macular edema is reduced by 50%. (80) Appropriate fol- low-up (Tables 4 and 5) and timely intervention are essential and may help prevent blinding complications of diabetic retinopathy. With the advent of emerging therapies, prevention strategies, and heightened awareness of the extensive microvascular complications in diabetes, the future for effective clinical management of diabetic retinopathy is optimistic.
ACKNOWLEDGMENT
This chapter was based on, and reprinted from, Retina, 4th Edition, Vol. 2 (eds Ryan SJ, Schachat AP), Drs. E.Y. Chew and F.L. Ferris III, “Nonproliferative Diabetic Retinopathy”, pp. 1271–1284, 2006, with permission from Elsevier.
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