Diabetic Retinopathy Screening and Management

Screening Frequency

Diabetic patients without retinopathy should have comprehensive eye examinations every 1-2 years, while those with any level of retinopathy require at least annual examinations, with more frequent monitoring needed as retinopathy severity increases 1, 2
The American Diabetes Association recommends initial comprehensive dilated eye examination within 5 years after diagnosis for Type 1 diabetes patients and at the time of diagnosis for Type 2 diabetes patients 1, 2
Children with diabetes generally do not require eye examinations before 10 years of age, though clinical judgment should be used 3
Annual examinations are recommended for all patients with diabetes, according to the American Diabetes Association, but if retinopathy is absent and glycemic control is good, examinations every 1-2 years may be considered 1, 4

Patients with no retinopathy detected should have eye examinations every 1-2 years if glycemic control is good, and annually if glycemic control is suboptimal 1, 2, 5
Patients with mild retinopathy should have eye examinations at least annually 1, 5
Patients with moderate retinopathy should have eye examinations every 3-6 months 5
Patients with severe retinopathy should have eye examinations every 3 months 5
If retinopathy is progressing or sight-threatening, more frequent examinations are required, according to the American Diabetes Association 6, 7

Pregnant women with pre-existing diabetes should have eye examinations before pregnancy or in the first trimester, and monitored every trimester during pregnancy, with continued monitoring for 1 year postpartum 1, 2
Pregnant patients with diabetes should have a comprehensive eye examination in the first trimester and close follow-up throughout pregnancy, as recommended by the American Diabetes Association 3, 8

Prompt referral to an ophthalmologist experienced in diabetic retinopathy is required for any level of macular edema, severe nonproliferative diabetic retinopathy, or any proliferative diabetic retinopathy 1
Any level of macular edema requires prompt referral to an ophthalmologist, as recommended by the American Diabetes Association 1, 4
Severe nonproliferative diabetic retinopathy (NPDR) or any proliferative diabetic retinopathy (PDR) requires immediate ophthalmology referral, according to the American Diabetes Association 6, 7
Patients with sudden vision loss, eye pain with blurry vision, signs of retinal artery occlusion, or suspected proliferative diabetic retinopathy (PDR) should be referred to an ophthalmologist for a comprehensive dilated eye examination, as recommended by the American Academy of Ophthalmology 3, 9
Patients with unexplained visual acuity loss should always be referred to an ophthalmologist, even if retinal examination appears normal, as stated by the American Academy of Ophthalmology 9

Diabetic retinopathy is a highly specific vascular complication of both type 1 and type 2 diabetes, as stated by the American Diabetes Association 6, 7
Diabetic retinopathy is the most frequent cause of new cases of blindness among adults aged 20-74 years, according to the American Diabetes Association 7
Early detection and treatment can prevent vision loss, as recommended by the American Diabetes Association 7
Early referral to an ophthalmologist at the severe NPDR stage can reduce the risk of severe visual loss by 50%, as reported by the American Academy of Ophthalmology 3, 9

Patients who experience vision loss should be referred for vision rehabilitation with specialists trained in low-vision care, as recommended by the American Academy of Ophthalmology 3, 8, 10
In low-resource settings, screening schedules can be adjusted, but referral criteria for severe conditions remain the same, as stated by the American Academy of Ophthalmology 9
The ophthalmologist is best qualified to perform, oversee, and interpret results of a comprehensive medical eye evaluation, as stated by the American Academy of Ophthalmology 11