Eye Care Of The Patient With Diabetes Mellitus
Publication Date: October 1, 2019
Last Updated: March 14, 2022
ACTION STATEMENTS
Individuals should be made aware of the effectiveness of diet and physical activity programs in delaying the onset or preventing type 2 diabetes. (A, Strong Recommendation)
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Individuals with diabetes should be educated about the long-term benefits of glucose control in reducing the risk of onset and progression of diabetic retinopathy. (A, Strong Recommendation)
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Persons with diabetes should be educated about the potential benefits of blood pressure control in reducing the risk for development or progression of diabetic retinopathy. (B, Strong Recommendation)
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Individuals with diabetes should be educated about the long-term benefits of optimizing lipid control in reducing the risk for progression of diabetic retinopathy. (B, Strong Recommendation)
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Patients should be counseled about the benefits of physical exercise in delaying or reducing the ocular effects of diabetes. (B, Strong Recommendation)
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The ocular examination of an individual suspected of having undiagnosed diabetes should include all aspects of a comprehensive eye and vision examination, with ancillary testing, as needed. (, Consensus Statement)
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Persons without a diagnosis of diabetes who present with signs or symptoms suggestive of diabetes during an eye examination should have appropriate follow-up. This may include a fingerstick A1C test, random plasma glucose or fasting blood glucose analysis, or referral to their primary care physician for evaluation. (, Consensus Statement)
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Retinal examinations for diabetic retinopathy should be performed through a dilated pupil. (, Consensus Statement)
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The initial ocular examination of a person with diabetes should include all aspects of a comprehensive eye and vision examination, with ancillary testing, as indicated to diagnose and thoroughly evaluate ocular complications of diabetes. (, Consensus Statement)
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Fundus photography or retinal imaging should be considered to identify diabetic retinopathy lesions and document retinal status. (B, Recommendation)
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Optical coherence tomography (OCT) should be considered in the assessment of patients with diabetic macular edema (DME). (B, Recommendation)
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If ophthalmoscopy and/or optical coherence tomography (OCT) is used, fluorescein angiography (FA) is not needed to confirm a diagnosis of proliferative diabetic retinopathy (PDR) or to assess diabetic macular edema (DME). (B, Recommendation)
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The patient’s primary care physician should be informed of eye examination results following each examination, even when retinopathy is minimal or not present. (B, Strong Recommendation)
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A baseline comprehensive eye and vision examination should be performed on children and adults with type 1 diabetes mellitus, with follow-up examination as directed by their eye doctor. (B, Strong Recommendation)
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Since diabetes may go undetected for many years, any individual with type 2 diabetes mellitus should have a comprehensive eye and vision examination soon after the diagnosis of the condition, with follow-up examination as directed by their eye doctor. (B, Strong Recommendation)
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Women with diabetes should have a comprehensive eye and vision examination prior to a planned pregnancy. Women with diabetes who become pregnant should have a comprehensive eye and vision examination during every trimester of pregnancy, with follow-up at 6 to 12 months postpartum. (B, Strong Recommendation)
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Examination of persons with nonretinal ocular complications of diabetes should be consistent with current recommendations of care for each condition. (, Consensus Statement)
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Individuals with diabetes should receive at least annual dilated eye examinations. More frequent examination may be needed depending on the presence of comorbidities, changes in vision, and/or the severity, progression, or treatment of diabetic retinopathy. (, Consensus Statement)
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Electronic Health Records (EHRs) can be used to support clinical decision-making and improve preventive care and intervention in persons with diabetes. (B, Recommendation)
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Treatment protocols for persons with nonretinal ocular and visual complications of diabetes should follow current recommendations for care and include education on the condition(s) and recommendations for follow-up visits. (, Consensus Statement)
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Patients with severe or very severe nonproliferative diabetic retinopathy, early proliferative diabetic retinopathy with risk of progression, or high-risk proliferative diabetic retinopathy should be referred to an ophthalmologist experienced in the management of diabetic retinal disease for possible panretinal photocoagulation (PRP)44 or intravitreous anti-VEGF treatment. (A, Strong Recommendation)
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Anti-vascular endothelial growth factor (anti-VEGF) agents should be considered as a treatment alternative or adjunct to panretinal photocoagulation (PRP) in the management of proliferative diabetic retinopathy (PDR), with or without diabetic macular edema (DME). (A, Strong Recommendation)
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Patients with central-involved diabetic macular edema (DME) should be referred to an ophthalmologist experienced in the management of diabetic retinal disease for treatment with anti-VEGF agents and/or subsequent or deferred focal/grid macular laser therapy. (A, Strong Recommendation)
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Persons who experience persistent diabetic macular edema (DME) following laser and/or anti-vascular endothelial growth factor therapy for DME should be referred to an ophthalmologist experienced in the management of diabetic retinal disease for possible treatment with intraocular steroids. (A, Strong Recommendation)
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Persons with vitreous hemorrhage, traction retinal detachment, macular traction, or an epiretinal membrane should be referred to an ophthalmologist experienced in the management of diabetic retinal disease for possible vitrectomy. (B, Recommendation)
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Ocular telehealth programs for diabetic retinopathy can be used to increase access to evaluation, educate patients, and promote appropriate follow-up and treatment, but they are not a replacement for a comprehensive eye examination. (B, Strong Recommendation)
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Persons with diabetes should be educated about the ocular signs and symptoms of diabetic retinopathy and other nonretinal ocular complications of diabetes, and encouraged to comply with recommendations for followup eye examinations and care. (, Consensus Statement)
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Patients with diabetes should be encouraged to participate in lifestyle education and diabetes self-management programs. (B, Recommendation)
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Individuals should be advised by their health care providers of the risks of smoking and encouraged to quit smoking and/or seek smoking cessation assistance. (A, Strong Recommendation)
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Persons who experience vision loss from diabetes should be counseled on the availability and scope of vision rehabilitation care and provided, or referred for, a comprehensive examination of their visual impairment by a practitioner trained or experienced in vision rehabilitation. (, Consensus Statement)
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Referral for counseling is indicated for any individual experiencing difficulty dealing with vision and/or health issues associated with diabetes or diabetic retinopathy. Educational literature and a list of support agencies and other resources should be made available to these individuals. (, Consensus Statement)
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Recommendation Grading
Overview
Title
Eye Care Of The Patient With Diabetes Mellitus
Authoring Organization
American Optometric Association
Publication Month/Year
October 1, 2019
Last Updated Month/Year
January 31, 2024
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
Identify patients at risk for diabetes and visual changes associated with diabetes.
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Optometrist, optician, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Prevention, Management
Diseases/Conditions (MeSH)
D003920 - Diabetes Mellitus, D003930 - Diabetic Retinopathy
Keywords
diabetes, diabetes mellitus, prediabetes, diabetic complications, visual changes
Methodology
Number of Source Documents
402
Literature Search Start Date
January 1, 1976
Literature Search End Date
January 1, 2019