Management of diabetic retinopathy

General practitioners have a pivotal role in ensuring that all patients with diabetes have their eyes regularly and comprehensively examined. This can be by referral to an optometrist or ophthalmologist, or in a community setting by someone experienced in using a fundus camera and interpreting the images.

Patients with evidence of macular oedema, proliferative retinopathy or moderate to severe nonproliferative diabetic retinopathy should be promptly referred to an ophthalmologist for management. Evolving therapies include panretinal laser photocoagulation, and intravitreal injections of antivascular endothelial growth factor. Patients with mild nonproliferative retinopathy and lesions near the macula or disc should also be referred to an ophthalmologist, because these lesions can be vision threatening.

Patients with known retinopathy and acute visual symptoms must be assessed urgently by an ophthalmologist.

To reduce the risk or slow the progression of retinopathy, optimise the glycaemic profile, blood lipid levels and blood pressure, and encourage smoking cessation if applicable.

Addition of fenofibrate to statin treatment should be considered to slow progression of retinopathy in patients with type 2 diabetes, irrespective of blood lipid levels. A suitable regimen of fenofibrate is:

An improvement in the glycaemic profile can be associated with temporary deterioration of existing retinopathy, which should be closely monitored and managed by an ophthalmologist. Pregnancy in women with diabetes is also associated with potential progression of diabetic retinopathy; see Management of complications of diabetes before conception.