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Diabetic Retinopathy Guidelines 2017

Update On Diagnosis And Treatment Of Diabetic Retinopathy: A Consensus Guideline Of The Working Group Of Ocular Health (spanish Society Of Diabetes And Spanish Vitreous And Retina Society)

Update On Diagnosis And Treatment Of Diabetic Retinopathy: A Consensus Guideline Of The Working Group Of Ocular Health (spanish Society Of Diabetes And Spanish Vitreous And Retina Society)

Update on Diagnosis and Treatment of Diabetic Retinopathy: A Consensus Guideline of the Working Group of Ocular Health (Spanish Society of Diabetes and Spanish Vitreous and Retina Society) 1Spanish Retina and Vitreous Society (SERV), IMO (Institut Microcirurgia Ocular), Barcelona, Spain 2Spanish Society of Diabetes (SED), Endocrinology Department, Valme University Hospital and RAMSE Foundation, Sevilla, Spain 3Spanish Society of Diabetes (SED), Endocrinology and Nutrition Department, Hospital General Universitario Gregorio Maran, Madrid, Spain 4Spanish Society of Diabetes (SED), Diabetes and Metabolism Research Unit and CIBERDEM (ISCIII), Vall dHebron Reseach Institute (VHIR), Barcelona, Spain 5Spanish Retina and Vitreous Society (SERV), Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain 6University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain 7Spanish Society of Diabetes (SED), Department of Endocrinology and Nutrition, University Clinic of Navarra, Pamplona, Spain 8Spanish Retina and Vitreous Society (SERV), Department of Ophthalmology, Nuevo Hospital Univeristario y Politcnico La Fe, Valencia, Spain Correspondence should be addressed to Rafael Sim Received 30 December 2016; Revised 20 April 2017; Accepted 23 May 2017; Published 14 June 2017 Copyright 2017 Borja Corcstegui et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A group of members of the Spanish Retina and Vitreous Society (SERV) and of the Working Group of Ocular Health of the Spanish Society of Diabetes (SED) updated knowledge regarding the diagnosis and treatment of diabetic retinopathy (DR) based on r Continue reading >>

2017 Ada Position Statement On Diabetic Retinopathy

2017 Ada Position Statement On Diabetic Retinopathy

Home / Specialties / Ophthalmology / 2017 ADA Position Statement on Diabetic Retinopathy 2017 ADA Position Statement on Diabetic Retinopathy This represents the first such update by the American Diabetes Association since 2002, and is notable for inclusion of the latest evidence and recommendations with respect to appropriate eye examination intervals, referral criteria, prevention of incidence and progression of diabetic retinopathy (DR), and treatment strategies with respect to preventing vision loss from vision-threatening diabetes-related retinal disease proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME). Diabetes remains the leading cause of severe vision loss and blindness in Americans of working age, and though improved metabolic control of diabetes and advances in therapy have significantly diminished the probability of poor vision outcomes for individual patients, the increased prevalence of diabetes (despite plateauing incidence) combined with improved longevity of patients serve to sustain the impact of DR on a population level. [1] With respect to prevention of DR and vision loss, the Statement continues to emphasize the importance of good diabetes control (blood glucose, blood pressure and lipids), including the benefits of good, early glycemic control (protective metabolic memory) even in patients with T2DM (based on findings from ACCORD-Eye). It also emphasizes the emerging benefit of fenofibrate therapy to prevent progression of mild to moderate non-proliferative diabetic retinopathy (NPDR) in patients with T2DM (based on findings from two RCTs, FIELD and ACCORD-Eye). In fact, fenofibrate is approved as first-line therapy for adults with T2DM and NPDR in Australia; the number needed to treat to prevent one patient from requiring l Continue reading >>

Diabetic Retinopathy Ppp - Updated 2017

Diabetic Retinopathy Ppp - Updated 2017

HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE The prevalence of diabetes, both worldwide and in the United States, is increasing; as such, the prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy (VTDR) is also expected to increase dramatically. Currently, only about 60% of people with diabetes have yearly screenings for diabetic retinopathy. People with Type 1 diabetes should have annual screenings for diabetic retinopathy beginning 5 years after the onset of their disease, whereas those with Type 2 diabetes should have a prompt examination at the time of diagnosis and at least yearly examinations thereafter. Maintaining near-normal glucose levels and near-normal blood pressure lowers the risk of retinopathy developing and/or progressing, so patients should be informed of the importance of maintaining good glycosylated hemoglobin levels, serum lipids, and blood pressure. Patients with diabetes may use aspirin for other medical indications without an adverse effect on their risk of diabetic retinopathy. Women who develop gestational diabetes do not require an eye examination during pregnancy and do not appear to be at increased risk of developing diabetic retinopathy during pregnancy. However, patients with diabetes who become pregnant should be examined early in the course of the pregnancy. Referral to an ophthalmologist is required when there is any nonproliferative diabetic retinopathy, proliferative retinopathy, or macular edema. Ophthalmologists should communicate both ophthalmologic findings and level of retinopathy to the primary care physician. They should emphasize to the patient the need to adhere to the primary care physicians guidance to optimize metabolic control. Intravitreal injections of anti-vascular endothelial growth fac Continue reading >>

2017 Ada Position Statement: Diabetic Retinopathy

2017 Ada Position Statement: Diabetic Retinopathy

American Diabetes Association released a position statement on diabetic retinopathy in March 2017. Please find below recommendations, published in Diabetes Care journal. Optimize glycemic control to reduce the risk or slow the progression of diabetic retinopathy. Optimize blood pressure and serum lipid control to reduce the risk or slow the progression of diabetic retinopathy. Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of DM diagnosis. If there is no evidence of retinopathy for one or more annual eye exams, then exams may be considered every 2 years. If any level of diabetic retinopathy is present, subsequent dilated retinal examinations for patients with type 1 or type 2 diabetes should be repeated at least annually by an ophthalmologist or optometrist. If retinopathy is progressing or sight-threatening, then examinations will be required more frequently. Women with preexisting type 1 or type 2 diabetes who are planning pregnancy or who have become pregnant should be counseled on the risk of development and/or progression of diabetic retinopathy. Eye examinations should occur before pregnancy or in the first trimester in patients with preexisting type 1 or type 2 diabetes, and then these patients should be monitored every trimester and for 1 year postpartum as indicated by the degree of retinopathy. While retinal photography may serve as a screening tool for retinopathy, it is not a substitute for a comprehensive eye exam, which should be performed at least initially and at intervals thereafter as Continue reading >>

Ijerph | Free Full-text | Diabetic Retinopathy Screening: A Systematic Review On Patients Non-attendance | Html

Ijerph | Free Full-text | Diabetic Retinopathy Screening: A Systematic Review On Patients Non-attendance | Html

Int. J. Environ. Res. Public Health 2018, 15(1), 157; doi: 10.3390/ijerph15010157 Diabetic Retinopathy Screening: A Systematic Review on Patients Non-Attendance Rahima Muhammad Kashim *, Paul Newton Department of Adult Nursing and Paramedic Sciences, Faculty of Education and Health, University of Greenwich, Avery Hill Campus, Southwood Site, London SE9 2UG, UK Received: 22 November 2017 / Accepted: 15 January 2018 / Published: 19 January 2018 Diabetic Retinopathy is a microvascular complication of diabetes, that can go undetected and unnoticed until irreversible damage and even blindness has occurred. Effective screening for diabetic retinopathy has been proven to reduce the risk of sight loss. The National Health Service (NHS) which provides healthcare for all UK citizens, implemented systematic retinal screening for diabetic retinopathy in England in 2003, with the aim of identifying and treating all patients with sight threatening retinopathy. Crucial to this is patients partaking in the programme. Therefore, increasing screening uptake has been a major focus of the programme. This review explores the views of people living with diabetes who do not attend retinal screening, their characteristics, concerns, experiences of retinal screening and their understanding of the risks of diabetic retinopathy. All studies that satisfied the study inclusion criteria on patients non-attendance at retinal screening, between 2003 to 2017 were included after extensive database search. A total of 16 studies were included in the review. Findings showed that socio-economic deprivation was a major risk factor for non-attendance, about 11.513.4% of the screened population had sight threatening retinopathy (STDR), repeated nonattendance was linked to sight threatening diabetic retinopath Continue reading >>

Guidelines For Diabetic Eye Care 2017

Guidelines For Diabetic Eye Care 2017

The International Council of Ophthalmology (ICO) has released the 2017 Guidelines for Diabetic Eye Care . The guidelines include guidance on intravitreal injections, diabetes in pregnancy and more extensive recommendations for treatment. They serve a supportive and educational role for eye care providers, and are intended to improve the quality of eye care for patients around the world. The Guidelines inform ophthalmologists about the requirements for the screening, detection, and the appropriate assessment and management of patients with diabetic retinopathy . Diabetes and diabetic retinopathy are a rapidly increasing problem worldwide . Hence it is vital to ensure that eye care providers are adequately prepared. The updated Guidelines were introduced at the 10th General Assembly of the International Agency for the Prevention of Blindness (IAPB) in South Africa. Currently the 2017 version is available in English but will be translated into the main languages as the previous version. Avoidable Blindness Set To Increase In Future On World Sight Day, eye care organisations around the world take note of new data that shows that gl... IAPB Vision Atlas: Key Messages The IAPB Vision Atlas will be revised with the latest data and projections on World Sight Day th... New Data: FAQs Here are some FAQs about the new Vision Loss Expert Group (VLEG) data (our VLEG FAQs!). Do leave you... Latest Global Blindness & VI prevalence figur... New paper notes that there were 253 million people with visual impairmentand a staggering 1.1 billi... Continue reading >>

Diabetic Retinopathy: Updated Guidelines Reflect Improved Assessment And Treatment

Diabetic Retinopathy: Updated Guidelines Reflect Improved Assessment And Treatment

Diabetic Retinopathy: Updated Guidelines Reflect Improved Assessment and Treatment The American Diabetes Association (ADA) released their first position statement in 15 years regarding diabetic retinopathy. The updated statement reflects the significant advancements made in both assessment and treatment of the condition since ADAs last guidance in 2002. The report notes the recent improvements made in evaluating the diabetes complication, such as the implementation of optical coherence tomography for assessing retinal thickness and intraretinal pathology, and wide-field fundus photography to detect clinically silent microvascular lesions. Therapies have also made advancements, with treatment now given by intravitreous injection of anti-vascular endothelial growth factor (VEGF) agents. Treatment recommendations from the ADA include: Promptly refer patients with any level of macular edema, severe nonproliferative diabetic retinopathy, or any proliferative diabetic retinopathy to an ophthalmologist. Laser photocoagulation therapy reduces risk of vision loss in patients with high-risk proliferative diabetic retinopathy and, in some cases, severe nonproliferative diabetic retinopathy. Intravitreous injections of anti-vascular endothelial growth factor are indicated for central-involved diabetic macular edema. The presence of retinopathy is not a contraindication to aspirin therapy for cardioprotection, as aspirin does not increase the risk of retinal hemorrhage. The ADA recommends optimization of glycemic control, as well as blood pressure and serum lipids, to reduce or slow the progression of diabetic retinopathy. The report also advises screening via dilated and comprehensive eye exam by an eye specialist within 5 years after the onset of type 1 diabetes and immediately a Continue reading >>

Ada Position Statement Updates Recommendations For Diabetic Retinopathy

Ada Position Statement Updates Recommendations For Diabetic Retinopathy

An updated position statement outlines guidelines on prevention, assessment, and treatment of diabetic retinopathy, including new technologies and procedures for the condition. The position statement, which updates the American Diabetes Association's previous one from 2002, includes diagnostic developments such as optical coherence tomography, intraretinal pathology, and wide-field fundus photography, as well as treatments such as intravitreous injection of anti-vascular endothelial growth factor (VEGF) agents. The position statement appeared online Feb. 21 and in the March issue of Diabetes Care. The position statement outlines the stages of diabetic retinopathy and highlights recommendations on optimal blood glycemic control and lowering blood pressure. Optimized glycemic control can reduce the risk or slow the progression of diabetic retinopathy, and optimized blood pressure and serum lipid control reduce the risk or slow the progression of diabetic retinopathy, the statement said. It cites studies that have shown the positive effects tight glycemic control can have on diabetic retinopathy risks and progression in patients with diabetes and how those benefits can last for years. Screening recommendations suggest that adults with type 1 diabetes should have a comprehensive eye exam within five years of disease onset and that those with type 2 diabetes should have an exam at the time of diagnosis. If there is no evidence of retinopathy at one or more annual eye exams, then exams every two years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal examination should be repeated at least annually by an ophthalmologist or optometrist, the position statement said. If retinopathy is progressing or sight-threatening, then examination Continue reading >>

Adherence To Diabetic Eye Examination Guidelines In Australia: The National Eye Health Survey

Adherence To Diabetic Eye Examination Guidelines In Australia: The National Eye Health Survey

Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey Joshua Foreman, Stuart Keel, Jing Xie, Peter Van Wijngaarden, Hugh R Taylor and Mohamed Dirani Med J Aust 2017; 206 (9): 402-406. || doi: 10.5694/mja16.00989 Objective: To determine adherence to NHMRC eye examination guidelines for Indigenous and non-Indigenous Australian people with diabetes. Design: Cross-sectional survey using multistage, random cluster sampling. Setting: Thirty randomly selected geographic sites in the five mainland Australian states and the Northern Territory, stratified by remoteness. Participants: 1738 Indigenous Australians aged 4092 years and 3098 non-Indigenous Australians aged 5098 years were recruited and examined between March 2015 and April 2016 according to a standardised protocol that included a questionnaire (administered by an interviewer) and a series of standard eye tests. Main outcome measures: Adherence rates to NHMRC eye examination guidelines; factors influencing adherence. Results: Adherence to screening recommendations was significantly greater among non-Indigenous Australians (biennial screening; 77.5%) than Indigenous Australians (annual screening; 52.7%; P <0.001). Greater adherence by non-Indigenous Australians was associated with longer duration of diabetes (adjusted odds ratio [aOR], 1.19 per 5 years; P = 0.018), while increasing age was associated with poorer adherence in non-Indigenous Australians (aOR, 0.70 per decade; P = 0.011). For Indigenous Australians, residing in inner regional areas (aOR, 1.66; P = 0.007) and being male (aOR, 1.46; P = 0.018) were significant factors positively associated with adherence. Conclusions: More than three-quarters of non-Indigenous Australians with diabetes and more than half of Indigenous Continue reading >>

Keep Your Eye On The New Diabetic Retinopathy Guidelines

Keep Your Eye On The New Diabetic Retinopathy Guidelines

Keep your Eye on the new Diabetic Retinopathy Guidelines Daisy, a 67-year-old woman with Type 2 diabetes, presents to your clinic with her daughter Skye (age 23) and her grandson Forrest, 9, who both have Type 1 diabetes. All three of them received a diagnosis of diabetes on November 1, the day after Halloween. At what age do you recommend screening for diabetic retinopathy, and how often do you recommend screening, for Skye is planning to begin conception of a second child. What do you recommend regarding diabetic retinopathy screening? Daisy read on her local seniors' Facebook group about the importance of antioxidants and asks if these are recommended for diabetic retinopathy. What do you reply? The Canadian Ophthalmological Society has released 2017 guidelines for primary care providers regarding screening for diabetic retinopathy. Here are some highlights: TYPE 1 - START at puberty. If diagnosed after puberty, start 5 years after diagnosis. 1) If considering pregnancy, get ophthalmic evaluation before attempting to conceive 2) Recommend Teleophthalmology for rural and remote patients (if available) 3) High-dose Antioxidant use is NOT helpful at preventing retinopathy Finally,KNOW and TREAT Risk factorsfor diabetic retinopathy: *Interestingly the evidence shows that every 2 years is OK - however the recommendation remains to screen every 1-2 years for fear of poor adherence. **Treatment has not convincingly been shown to reduce retinopathy, but consider treating to reduce cardiovascular risk if they meet lipid guideline recommendations - see the summary table from the 2016 Canadian guidelines here Excerpt from the Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy. Can J Ophthalmol. 52(S1), 2017. Continue reading >>

Ada: Diabetic Retinopathy Management Guidelines Issued

Ada: Diabetic Retinopathy Management Guidelines Issued

ADA: Diabetic Retinopathy Management Guidelines Issued ADA releases updated diabetic retinopathy guidelines The American Diabetes Association (ADA) has issued updated guidelines on the prevention, assessment, and treatment of diabetic retinopathy. The recommendations, an update to the 2002 ADA position statement, will be published in the March 2017 issue of Diabetes Care. "Over the past decade, new research and significant improvements in technology have aided our ability to diagnose and treat diabetic retinopathy, and advances in medications are giving people with diabetes the opportunity to improve glucose management and potentially avoid or delay the progression of complications such as retinopathy," said Thomas W. Gardner, MD, MS, corresponding author of the article and professor of ophthalmology and visual sciences at the Kellogg Eye Center at the University of Michigan. To reduce the risk or slow the progression of of diabetic retinopathy, the guidelines recommend optimizing glycemic control, as well as lowering blood pressure and serum lipids. For adults with type 1 diabetes, a comprehensive eye exam should be conducted within five years of the onset of diabetes; for patients with type 2 diabetes, the exam should be done at the time of diagnosis. With regards to treatment, the ADA recommends the following: Patients with macular edema, severe nonproliferative diabetic retinopathy or any proliferative diabetic retinopathy should be promptly referred to an ophthalmologist with experience in managing diabetic retinopathy (Grade A) In patients with high-risk proliferative diabetic retinopathy (and sometimes in severe nonproliferative diabetic retinopathy), laser photocoagulation therapy can reduce the risk of vision loss (Grade A) For central-involved diabetic macula Continue reading >>

Diabetic Retinopathy: Current Understanding, Mechanisms, And Treatment Strategies

Diabetic Retinopathy: Current Understanding, Mechanisms, And Treatment Strategies

Diabetic retinopathy: current understanding, mechanisms, and treatment strategies We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Diabetic retinopathy: current understanding, mechanisms, and treatment strategies Elia J. Duh, Jennifer K. Sun, and Alan W. Stitt Diabetic retinopathy (DR) causes significant visual loss on a global scale. Treatments for the vision-threatening complications of diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) have greatly improved over the past decade. However, additional therapeutic options are needed that take into account pathology associated with vascular, glial, and neuronal components of the diabetic retina. Recent work indicates that diabetes markedly impacts the retinal neurovascular unit and its interdependent vascular, neuronal, glial, and immune cells. This knowledge is leading to identification of new targets and therapeutic strategies for preventing or reversing retinal neuronal dysfunction, vascular leakage, ischemia, and pathologic angiogenesis. These advances, together with approaches embracing the potential of preventative or regenerative medicine, could provide the means to better manage DR, including treatment at earlier stages and more precise tailoring of treatments based on individual patient variations. The clinical challenge of diabetic retinopathy The global prevalence of diabetes mellitus is predicted to increase dramatically in the coming decades, fro Continue reading >>

Diabetic Retinal Screening, Grading, Monitoring And Referral Guidance

Diabetic Retinal Screening, Grading, Monitoring And Referral Guidance

Diabetic Retinal Screening, Grading, Monitoring and Referral Guidance New Zealand already has a variety of local diabetic retinopathy screening services, some of which are very effective. The updated standards for grading, referral and monitoring set out in this guidance document recognise that some established programmes will have to adjust their processes and also that technology is quickly evolving. As a result this guidance aims to promote further convergence of regional services thereby reducing variation and providing a national benchmark. The guidance outlines the key components of an organised diabetic retinal screening service so that high-quality, equitable screening can be provided for all those at risk of diabetic eye disease. It represents a statement of best practice, based on stakeholder consultation, evidence and is intended to guide the delivery of a nationally consistent programme. There are strong links with the New Zealand Primary Care Handbook 2012 (updated 2013), the Quality Standards for Diabetes Care 2014 and Living Well with Diabetes 2015. Although the emphasis is on type 2 diabetes, pregnancy, children and adults with type 1 diabetes are also addressed to ensure they have the support of an organised retinal screening programme. Continue reading >>

Availability And Variability In Guidelines On Diabetic Retinopathy Screening In Asian Countries.

Availability And Variability In Guidelines On Diabetic Retinopathy Screening In Asian Countries.

Availability and variability in guidelines on diabetic retinopathy screening in Asian countries. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong. Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Victoria, Australia. School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK. Duke-NUS Medical School, National University of Singapore, Singapore, Singapore. Br J Ophthalmol. 2017 Oct;101(10):1352-1360. doi: 10.1136/bjophthalmol-2016-310002. Epub 2017 Mar 14. BACKGROUND: Diabetic retinopathy (DR) is a blinding yet treatable complication of diabetes. DR screening is highly cost-effective at reducing blindness. Amidst the rapidly growing diabetic population in Asia, the prevalence of DR in the region is relatively less well known. AIMS: To review existing national DR screening guidelines of 50 countries in Asia, compare them against the International Council of Ophthalmology (ICO) guideline, and summarise the prevalence rates of DR and sight-threatening DR (STDR) in these countries. METHODS: We systematically searched for published guidelines from the National Guideline Clearinghouse and other databases, and contacted local diabetic and ophthalmological associations of all 50 Asian countries. RESULTS: Eleven Asian countries have published relevant guidelines, nine of which pertain to general diabetes care and two are DR-specific, covering less than half of Asia's population. The median DR prevalence among patients with diabetes is 30.5% (IQR: 23.2%-36.8%), similar to the USA and the UK. Howev Continue reading >>

Diabetic Retinopathy Management Guidelines

Diabetic Retinopathy Management Guidelines

Diabetic Retinopathy Management Guidelines Diabetic retinopathy (DR) is an important cause of avoidable blindness worldwide. Seventy percent of diabetes occur in low and lower-middle income countries. Clinical practice guidelines for the management of DR have been implemented throughout the world, but mainly in developed nations. However, there is considerable variation between existing guidelines in the recommended frequency of referral, methods for examination and personnel involved in screening and review. This review compares the differences between current available guidelines in the context of the current medical evidence and also addresses the implications for management of DR in countries with limited resources. Clinical practice guidelines are defined as 'systematically developed statements' that assist practitioners in making appropriate decisions for healthcare for specific clinical circumstances.[ 1 ] Guidelines are now commonly developed and used for a variety of medical specialties including ophthalmology. Traditionally, guidelines were based on consensus among experts. However, this does not necessarily represent current medical knowledge. Therefore, the paradigm for guideline development has shifted towards systematic identification and appraisal of the best available evidence. The main purpose of clinical guidelines is to better health outcomes through improving practice of health professionals. The process of development and implementation of guidelines is a major undertaking, requiring contribution from individuals and groups in a multidisciplinary approach to ensure that consensus is achieved to make the guidelines work effectively. Diabetic retinopathy (DR) is a microvascular complication of diabetes. Research has clearly demonstrated that blindnes Continue reading >>

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