Management of Non-Proliferative Diabetic Retinopathy

Optimizing Systemic Control

The American Diabetes Association recommends intensive glucose control with a goal of normoglycemia as the most important intervention to prevent and delay the progression of non-proliferative diabetic retinopathy (NPDR) 1, 2
Strict glucose control substantially reduces the risk and progression of diabetic retinopathy, according to the American Diabetes Association 1, 2
Optimal blood pressure control also reduces the risk and delays the progression of retinopathy, as recommended by the American Diabetes Association 1, 2
The American Diabetes Association suggests that lipid control should be optimized, particularly with fenofibrate in patients with mild NPDR, as it may delay progression 1, 3

The American Academy of Ophthalmology recommends classifying NPDR into mild, moderate, and severe categories, each requiring different follow-up intervals 4
Mild NPDR requires re-examination every 6-12 months by an ophthalmologist or optometrist, according to the American Academy of Ophthalmology 4
Moderate NPDR requires re-examination every 3-6 months, as recommended by the American Academy of Ophthalmology 4
Severe NPDR (pre-proliferative) requires re-examination in less than 3 months and immediate referral to an ophthalmologist with experience in managing diabetic retinopathy, according to the American Diabetes Association 1, 5, 2

The American Diabetes Association recommends that panretinal laser photocoagulation is not recommended for mild or moderate NPDR 5, 2
For severe NPDR, laser photocoagulation may be considered in selected patients, especially those with poor adherence to follow-up, imminent cataract surgery, or pregnancy, as suggested by the American Academy of Ophthalmology 5, 2
Laser photocoagulation reduces the risk of severe visual loss by approximately 50% when applied in severe NPDR stages, according to the American Diabetes Association 2

The American Diabetes Association recommends that patients with any level of macular edema require immediate referral, regardless of the degree of NPDR 1, 5, 2
Aspirin does not increase the risk of retinal hemorrhage and is not contraindicated, according to the American Diabetes Association 1, 2

The American Diabetes Association suggests that if there is no evidence of retinopathy by one or more annual exams and glucose control is good, exams can be performed every 1-2 years 1
If any level of diabetic retinopathy exists, dilated exams should be repeated at least annually, as recommended by the American Diabetes Association 1
If retinopathy is progressing or threatening vision, more frequent exams are required, according to the American Diabetes Association 1