Diabetic Retinopathy Management Guidelines

Rahul Chakrabarti; C Alex Harper; Jill Elizabeth Keeffe


Expert Rev Ophthalmol. 2012;7(5):417-439. 

In This Article

Criteria for Urgent Referral to an Ophthalmologist

The necessity to expedite ophthalmic review for patients with vision-threatening retinopathy was consistently established across the guidelines reviewed. Fundamentally, 'vision-threatening' retinopathy was uniformly accepted and defined as encompassing the presence of severe retinopathy (severe NPDR and proliferative DR) and DME. Further consensus was achieved across guidelines that any sudden severe vision loss, or symptoms of retinal detachment, required same-day referral to an ophthalmologist. Overall, all guidelines based their recommendations based on observations from the sentinel studies, the DRS[89] and ETDRS[90] in which photocoagulation was referred as soon as high-risk PDR was detected. These studies demonstrated significant reduction in the risk of severe vision loss among patients with advanced retinopathy with timely retinal photocoagulation. The NICE defined three levels of 'urgency': emergency (same day); within 1 week and within 4 weeks. Patients with any form of maculopathy or severe NPDR required review within 4 weeks. The presence of proliferative retinopathy (anywhere), preretinal or vitreous hemorrhage required review within 1 week. This model was incorporated into both the Australian and Malaysian guidelines. Similarly, the AAO, SIGN, WHO and South African guidelines all recommended ophthalmic review and treatment to be performed expeditiously for patients with PDR and macular edema. However, they failed to clearly define an 'urgent' time frame.