Clinical Review

Managing diabetic retinopathy

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c5400 (Published 25 October 2010) Cite this as: BMJ 2010;341:c5400
  1. Zoe Ockrim, medical retina fellow1,
  2. David Yorston, consultant ophthalmologist2
  1. 1Moorfields Eye Hospital, London EC1V 2PD, UK
  2. 2Tennent Institute of Ophthalmology, Glasgow, UK
  1. Correspondence to: Z Ockrim zoe_ockrim{at}hotmail.com
  • Accepted 8 September 2010

Summary points

  • Prevalence of blindness caused by diabetic retinopathy is rising, despite effective treatments

  • Duration of diabetes is the most important risk factor; hypertension and hyperglycaemia are other risk factors

  • Fundus photography is the best way to detect retinopathy early—when still treatable and before vision is irreversibly lost

  • Annual retinal examination is recommended for patients with diabetes, although compliance is low

  • Laser photocoagulation and intravitreal injection of anti-vascular endothelial growth factor agents are effective treatments for diabetic macular oedema

  • Laser photocoagulation and vitrectomy are effective treatments for proliferative retinopathy

Diabetic retinopathy is the most common cause of blindness in working age people in England, Wales, and Scotland. Despite the availability of effective treatment, the prevalence of blindness as a result of diabetic retinopathy is increasing. Between February 1999 and March 2000, the number of patients on the blind register as a result of diabetic retinopathy in this age group was 2.05 per 100 000 population compared with 1.26 per 100 000 population in 1990-1.1

The global prevalence of diabetes in adults will rise from 171 million in 2000 to 366 million in 2030.2 Increased visual impairment as a result of diabetic retinopathy will impose a human and economic cost on entire communities, particularly in middle income countries.

Diabetic retinopathy is a chronic yet treatable condition. Primary prevention by improved medical management of diabetes, early detection, and timely treatment all reduce the risk of visual loss. In addition, the emergence of new treatments will change the management of retinopathy.

Sources and selection criteria

We searched Medline and Embase with the keywords “diabetic macular oedema”, “diabetic maculopathy”, “diabetic retinopathy”, and “controlled clinical trials”. We used evidence from published abstracts from major international scientific meetings and from the UK National Institute for Health and Clinical Excellence. We gave priority to evidence from well conducted systematic reviews and large well …

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