ADA position statement updates recommendations for diabetic retinopathy

The position statement, an update of one from 2002, outlines the stages of diabetic retinopathy and highlights recommendations on optimal blood glycemic control and lowering blood pressure.


An updated position statement outlines guidelines on prevention, assessment, and treatment of diabetic retinopathy, including new technologies and procedures for the condition.

The position statement, which updates the American Diabetes Association's previous one from 2002, includes diagnostic developments such as optical coherence tomography, intraretinal pathology, and wide-field fundus photography, as well as treatments such as intravitreous injection of anti-vascular endothelial growth factor (VEGF) agents. The position statement appeared online Feb. 21 and in the March issue of Diabetes Care.

The position statement outlines the stages of diabetic retinopathy and highlights recommendations on optimal blood glycemic control and lowering blood pressure. Optimized glycemic control can reduce the risk or slow the progression of diabetic retinopathy, and optimized blood pressure and serum lipid control reduce the risk or slow the progression of diabetic retinopathy, the statement said. It cites studies that have shown the positive effects tight glycemic control can have on diabetic retinopathy risks and progression in patients with diabetes and how those benefits can last for years.

Screening recommendations suggest that adults with type 1 diabetes should have a comprehensive eye exam within five years of disease onset and that those with type 2 diabetes should have an exam at the time of diagnosis. If there is no evidence of retinopathy at one or more annual eye exams, then exams every two years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal examination should be repeated at least annually by an ophthalmologist or optometrist, the position statement said. If retinopathy is progressing or sight-threatening, then examinations will be required more frequently.

While retinal photography may serve as a screening tool for retinopathy, it is not a substitute for a comprehensive eye exam, which should be performed at least initially and at intervals thereafter as recommended by an eye care professional, according to the position statement.

Women with preexisting diabetes who are pregnant or planning to become pregnant should be educated on the risks of developing diabetic retinopathy, the statement said. Eye examinations should occur before pregnancy or in the first trimester in patients with preexisting type 1 or type 2 diabetes, and then these patients should be monitored every trimester and for a year postpartum as indicated by the degree of retinopathy. The position statement also outlines specific diabetic retinopathy treatment and management recommendations.