Diabetic retinopathy is damage to the small blood vessels of the retina caused by long-standing high blood sugar, and it is a leading cause of blindness in working-age adults. It is silent early on, so regular eye screening is the key to catching it before vision is lost.
Key symptoms
- Usually no symptoms early
- Blurred or fluctuating vision
- Floaters or dark spots
- Sudden vision loss from bleeding into the eye
- Poor night vision
What you find on exam
- Visual acuity
- Dilated fundus exam: microaneurysms, dot and blot hemorrhages, hard exudates, cotton wool spots
- New fragile vessels on the disc or retina (proliferative disease)
- Retinal thickening near the macula (macular edema)
Tests
- Dilated eye exam or retinal photos at diagnosis of type 2 diabetes (5 years after type 1), then every 1 to 2 years
- Optical coherence tomography (OCT) for macular edema
- Fluorescein angiography in selected cases
- HbA1c, blood pressure, lipids, kidney function
Treatment basics
- Control blood sugar, blood pressure and cholesterol; stop smoking
- Anti-VEGF injections into the eye such as aflibercept, ranibizumab or bevacizumab
- Panretinal laser photocoagulation for proliferative disease
- Vitrectomy for vitreous hemorrhage that does not clear or for retinal detachment
Red flags
- Sudden loss of vision or a shower of new floaters
- Curtain or shadow over part of the vision (retinal detachment)
- Eye pain with redness and high eye pressure (neovascular glaucoma)
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.