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Diabetic retinopathy: Prevention and treatment

Authors
Claire E Fraser, MD, PhD
Donald J D'Amico, MD
Section Editors
David M Nathan, MD
Jonathan Trobe, MD
Deputy Editor
Jean E Mulder, MD

INTRODUCTION

Diabetic retinopathy is one of the largest causes of visual loss worldwide and is the principal cause of impaired vision in patients between 25 and 74 years of age [1]. The prevalence of diabetic retinopathy increases with duration of diabetes. Additional risk factors include the level of glycemic control, the type of diabetes (historically, type 1 more than type 2), and the presence or absence of associated conditions such as hypertension, smoking, dyslipidemia, nephropathy, and pregnancy.

Several preventive and therapeutic interventions have been evaluated in an attempt to minimize the morbidity associated with diabetic retinopathy. Treatment of diabetic retinopathy is directed both at prevention (primarily by good glycemic control) and at treatment of established disease.

Strict glycemic control early in the course of diabetes and photocoagulation for vision-threatening disease are of primary importance. Vitrectomy can also be used to preserve vision in advanced cases and certain circumstances. Intravitreal pharmacologic therapies are important new modalities for the treatment of diabetic retinopathy.

Prevention and treatment of diabetic retinopathy will be reviewed here. The screening, pathogenesis, and clinical features of diabetic retinopathy are discussed elsewhere. (See "Diabetic retinopathy: Screening" and "Diabetic retinopathy: Classification and clinical features" and "Diabetic retinopathy: Pathogenesis".)

RISK FACTORS

The prevalence of diabetic retinopathy increases with the duration of diabetes (figure 1). Additional risk factors include a lesser degree of glycemic control, the type of diabetes (historically, type 1 more than 2), and the presence of associated conditions such as hypertension, smoking, nephropathy, dyslipidemia, and pregnancy [2,3]. In some populations, such as minority youth with type 2 diabetes, the prevalence of diabetic retinopathy is higher in patients with type 2 than type 1 diabetes [4]. Although these risk factors are strongly predictive of the development and severity of retinopathy in populations, and controlling some of these risk factors is important for the prevention of retinopathy, it is difficult to predict the development of retinopathy in a particular individual. As an example, many patients are under the impression that they will not develop retinopathy if they maintain good glycemic control. While lower glycated hemoglobin (A1C) levels are associated with a decreased risk of retinopathy development and progression, good glycemic control does not guarantee that retinopathy will not develop or preclude regular screening for diabetic retinopathy (table 1). (See "Diabetic retinopathy: Screening".)

                                   

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Literature review current through: Nov 2016. | This topic last updated: Wed Sep 28 00:00:00 GMT+00:00 2016.
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