Diabetic retinopathy - Tips From Other Journals

Date: March, 1991

In a recent review article of ophthalmology, Bienfang and colleagues summarize topics which are of importance for the family physician, including the management of glaucoma, cataracts and macular degeneration, and the ophthalmologic manifestations of diabetes mellitus, human immunodeficiency virus infection and other systemic illnesses.

One of the more common problems in ophthalmology is retinopathy associated with diabetes. Diabetic retinopathy occurs in two forms: proliferative and non-profilerative. Each form affects vision in a different manner, and both forms can appear together.

The hallmark of nonproliferative diabetic retinopathy is the microaneurysm. Capillary leakage near microaneurysms results in retinal edema with characteristic hard exudates. Proliferative retinopathy occurs when new vessels form and extend across the anterior surface of the retina or optic disc and proliferate between the retina and vitreous cavity. Both forms of retinopathy may result in blindness. However, both forms are treatable by laser therapy if identified early.

Because diabetic retinopathy may be asymptomatic in the early stages, careful and regular examination by an ophthalmologist must be part of the primary care of all patients with diabetes. The National Diabetes Advisory Board recommends referral to an ophthalmologist for all patients with the type II (noninsulin-dependent) diabetes mellitus and for patients with type I (insulin-dependent) diabetes mellitus who have had diabetes for more than five years. In addition, proliferative diabetic retinopathy may appear suddenly and may progress rapidly in patients with type I diabetes who are between the ages of 17 and 25 years, who are in the last trimester of pregnancy or who have clinically evident diabetic nephropathy. The patients in these categories should be immediately referred to an ophthalmologist. (New England Journal of Medicine, October 4, 1990, vol. 323, p. 956.)

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