Description

• Most patients with diabetes mellitus (DM) will develop diabetic retinopathy (DR). It is the leading cause of new cases of legal blindness among residents in the United States between the ages of 20 and 64 years.
• DR can be divided into three stages:
  • Nonproliferative diabetic retinopathy (NPDR) (background)
  • Severe NPDR (preproliferative)
  • Proliferative diabetic retinopathy [PDR]

Pregnancy Considerations
Pregnancy can exacerbate condition.

Epidemiology

Incidence

• Peak incidence of type 1, juvenile-onset DM is between the ages of 12 and 15 years.
• Peak incidence of type 2, adult-onset DM is between the ages of 50 and 70 years.

Prevalence

• Worldwide, DR affects 1 out of 3 persons with DM.
• 2/3 of type 1 DM (T1DM) patients who have had DM for at least 35 years will develop PDR, and 1/3 will develop diabetic macular edema (DME). Proportions are reversed for type 2 DM (T2DM).

Etiology and Pathophysiology

• Related to development of diabetic microaneurysms and microvascular abnormalities
• Vascular endothelial growth factor (VEGF) is elevated in patients with hypoxic retina. Intraocular levels of VEGF are elevated in patients with retinal or iris NV. Retinal hypoxia also contributes to DME, and VEGF is a major contributor to DME.

Risk Factors

• Renal disease
• Systemic hypertension (HTN)
• Smoking
• Elevated lipid levels

General Prevention

• Monitor and control of blood glucose.
• Schedule yearly ophthalmologic eye exams.

Commonly Associated Conditions

• Glaucoma; cataracts
• Retinal detachment; vitreous hemorrhage (VH)
• Disc edema (diabetic papillopathy)