Chapter 21. Treatment of Retinopathy

  1. R. Williams3,
  2. W. Herman4,
  3. A.-L. Kinmonth6 and
  4. N. J. Wareham5
  1. T. Mark Johnson1 and
  2. Ron M. Kurtz2

Published Online: 9 APR 2003

DOI: 10.1002/0470846585.ch21

The Evidence Base for Diabetes Care

The Evidence Base for Diabetes Care

How to Cite

Johnson, T. M. and Kurtz, R. M. (2002) Treatment of Retinopathy, in The Evidence Base for Diabetes Care (eds R. Williams, W. Herman, A.-L. Kinmonth and N. J. Wareham), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/0470846585.ch21

Editor Information

  1. 3

    Nuffield Institute for Health, University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK

  2. 4

    Department of Internal Medicine and Epidemiology, 1500 East Medical Center Drive, 3920 Taubman Center, Box 0345, Ann Arbor, MI 48109, USA

  3. 5

    Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

  4. 6

    General Practice and Primary Care Research Unit, Dept. of Public Health & Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

Author Information

  1. 1

    Bert M. Glaser National Retina Institute, 901 Dulaney Valley Road, Suite 200 Baltimore, MD 21204, USA

  2. 2

    Department of Ophthalmolgy, University of California, Irvine Dept. of Ophthalmology, 118 Med Surge I, Irvine, CA 92697-4375, USA

Publication History

  1. Published Online: 9 APR 2003
  2. Published Print: 27 AUG 2002

ISBN Information

Print ISBN: 9780471988762

Online ISBN: 9780470846582

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Keywords:

  • proliferative diabetic retinopathy;
  • macular edema;
  • retinal screening;
  • risk factor;
  • pregnancy;
  • photocoagulation;
  • vitrectomy;
  • laser therapy;
  • cataract

Summary

Diabetic retinopathy was one of the first conditions studied extensively using clinical trials. These studies defined indications, safety and the efficacy of various therapeutic interventions, while also detailing the natural history and epidemiology of the disease. Classification schemes recognize two distinct entities: proliferative diabetic retinopathy and diabetic macular edema. An individual's risk of developing either depends on the duration and type of diabetes, existing level of retinopathy and glycemic control. Even with excellent glycemic control, most diabetics eventually develop retinopathy. No randomized trial has ever demonstrated that a particular screening protocol reduces the rate of visual loss in diabetics. Referral guidelines are based on natural history findings from several clinical trials. The current gold standard fro retinopathy screening is a series of seven high-quality fundus photographs graded by an experienced observer. The management of proliferative diabetic retinopathy involves a progression from laser to surgical treatment, based on the severity of disease. For diabetic macular edema, laser photocoagulation in the central macula reduces exudation and swelling, stabilizing visual acuity.