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High Risk Diabetic Retinopathy

Prevalence And Risk Factors For Diabetic Retinopathy In A High-risk Chinese Population

Prevalence And Risk Factors For Diabetic Retinopathy In A High-risk Chinese Population

Prevalence and risk factors for diabetic retinopathy in a high-risk Chinese population Wang et al.; licensee BioMed Central Ltd.2013 Lifestyle plays an important role in the development of diabetic retinopathy. The lifestyle in Guangzhou is different from other cities in China as the Cantonese prefer eating rice porridge, but not spicy foods. The objectives of this study were to investigate the prevalence and determinants of diabetic retinopathy in a high-risk population of Guangzhou. Subjects (619 totals) aged over 45 years old, without known diabetes were recruited from five randomly selected Guangzhou communities in 20092010. All participants were invited to complete the Finnish Diabetes Risk Score (FINDRISC) questionnaire. Subjects with FINDRISC score 9 were included in the study, and underwent an investigation of demographic data, a standardized physical examination, ocular fundus examination, and laboratory analyses. The minimum criterion for diagnosis of diabetic retinopathy was the presence of at least one microaneurysm. Of 619 subjects, 208 eligible subjects (122 women) with FINDRISC score 9 were included in the study. The mean age was 69.2 8.5 years. Diabetic retinopathy was detected in 31 subjects, and the prevalence of diabetic retinopathy in subjects with high risk for diabetes was 14.9%. In binary logistic regression analysis, risk factors associated with diabetic retinopathy were history of impaired glucose regulation [odds ratio (OR), 7.194; 95% confidence interval (CI): 1.083, 47.810], higher hemoglobin A1c (HbA1c; OR, 2.912; 95% CI: 1.009, 8.402), higher two-hour postprandial plasma glucose level (OR, 1.014; 95% CI: 1.003, 1.025), and presence of microalbuminuria (OR, 5.387; 95% CI: 1.255, 23.129). Diabetic retinopathy was prevalent in a high-risk Chi Continue reading >>

How To Diagnose And Manage Diabetic Retinopathy

How To Diagnose And Manage Diabetic Retinopathy

How to diagnose and manage diabetic retinopathy Diabetic retinopathy is a huge disease, and is one of the two bread and butter diseases in retina, the other being macular degeneration. This is a long framework, but we promise you its all high-yield.Heres the core information you need to know to get you started towards optimally treating your diabetic patients! Diabetic micro-angiopathy affects the capillaries in the eye just like it does elsewhere in the body leading to neuropathy and nephropathy. At first, the ischemia causes non-proliferative retinopathy. When the peripheral retina (where its more vulnerable) gets too ischemic, it releases VEGF and other angiogenic factors leading to neovascularization and proliferative diabetic retinopathy. Non-Proliferative Diabetic Retinopathy (NPDR) Non-proliferative diabetic retinopathy is caused by diabetic microvascular abnormalities causing focal ischemia. Its hard to find good photos online of these important diabetic retinopathy features. Here, we have assembled photos from the ETDRS study (Early Treatment of Diabetic Retinopathy Study), one of the landmark trials in diabetes. Weve sized the photos to approximatelymatch what youd see using theindirect, and circled the relevant findings on each image so you know what you are looking for. These are the first sign of diabetic retinopathy. Weakening of capillary walls results in small vessel aneurysms with distinct margins (no larger than largest retinal vessel). They may be hard to find clinically but they really light up onFA. When MAs rupture, they can create medium sized round hemorrhages that are dot, blot, or flame shaped. These are larger than MAs with indistinct margins. These are blocking on FA (appear as dark splotches).A clear sign of moderate DR. Active or resolvedm Continue reading >>

Treatment For Diabetic Retinopathy

Treatment For Diabetic Retinopathy

Authors: Authors: Dal W. Chun, MD; Jeffrey S. Heier, MD This activity is intended for ophthalmologists, endocrinologists, diabetologists, and other healthcare professionals who treat patients with diabetic retinopathy. The goal of this activity is to elucidate the current and future treatment options for diabetic retinopathy. Upon completion of this activity, participants will be able to: Evaluate the risk for retinopathy in patients with diabetes. Describe how to classify a patient's level of retinopathy. Discuss current treatment options for proliferative and nonproliferative diabetes. Evaluate future treatment options for proliferative and nonproliferative diabetes. As an organization accredited by the ACCME, Medscape requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Disclosure: Dal W. Chun, MD, has disclosed no relevant financial relationships. Tufts University School of Medicine, Assistant Professor; Harvard Medical School, Clinical Instructor; Opthalmic Consultants of Boston, Vitreoretinal Specialist Disclosure: Jeffrey S. Heier, MD, has disclosed that he has received grants for clinical research from Allergan, Bausch & Lomb, Carl Zeiss Meditec, Eyetech, Genentech, OXiGENE, Pfizer, Theragenics, and VisionCare. Dr. Heier Continue reading >>

Anti-vegf Induces Regression Of Diabetic Retinopathy In High-risk Populace

Anti-vegf Induces Regression Of Diabetic Retinopathy In High-risk Populace

Anti-VEGF induces regression of diabetic retinopathy in high-risk populace Modern Medicine Feature Articles , Modern Medicine Feature Articles , Ophthalmology , Modern Retina , Retina Reviewed by Charles C. Wykoff, MD HoustonInvestigators in a follow-up RISE/RIDE analysis of patients who had the highest risk of progression to proliferative diabetic retinopathy saw robust regression of diabetic retinopathy in high percentages of patients treated with ranibizumab (Lucentis, Genentech) independent of their baseline characteristics, including macular non-perfusion. Recent: Academy brings innovation theme to Chicago in October Diabetic retinopathy is a global problem and the most common complication of diabetes that affects vision and causes blindness in working-age individuals. Its incidence rate is expected to nearly double from 2010 to 2050, making identification of effective treatments paramount, according to Charles C. Wykoff, MD. The Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale quantifies retinopathy severity and population-based studies, including the Los Angeles Latino Eye Study, have demonstrated decrease in patients health-related quality of life when the severity of diabetic retinopathy worsens beyond the 43 level. At that level, patients have moderate non-proliferative diabetic retinopathy. Related: Aflibercept DME superiority diminishes in second year It is at this level that difficulty in driving begins to increase and quality of life on the National Eye Institute Visual Function Questionnaire begins to drop, said Dr. Wykoff, who is in private practice in Houston. In the RIDE/RISE phase III trials in which patients with diabetic retinopathy and diabetic macular edema were randomly assigned sham injections or treatment Continue reading >>

When Should Eyes With Proliferative Diabetic Retinopathy Receive Panretinal Laser Photocoagulation?

When Should Eyes With Proliferative Diabetic Retinopathy Receive Panretinal Laser Photocoagulation?

When Should Eyes With Proliferative Diabetic Retinopathy Receive Panretinal Laser Photocoagulation? Ivan J. Suer, MD Diabetic retinopathy is the leading cause of blindness in patients 20 to 64 years old in developed countries. In eyes with proliferative diabetic retinopathy (PDR), fibrovascular proliferation results from ischemia and release of vasoproliferative factors. Proliferation extends beyond the internal limiting membrane (ILM) and results in vitreous hemorrhage (VH) and vitreoretinal traction, which can lead to severe vision loss (SVL). Panretinal photocoagulation (PRP) is effective in stabilizing PDR and reducing the risk of severe visual loss. The goal of PRP is to induce regression of existing neovascular tissue and to prevent progressive neovascularization. The Diabetic Retinopathy Study (DRS) was a randomized, controlled, prospective clinical trial evaluating PRP in eyes with clear media and high-risk PDR. High-risk PDR was defined as neovascularization of the disc (NVD) involving 25% to 33% of a disc area with VH, moderate to severe NVD with or without VH, or neovascularization elsewhere (NVE) on the retina with VH.1 The DRS demonstrated a 50% reduction in the risk of severe visual loss, defined as visual acuity of less than 5/200 on 2 consecutive follow-up examinations 4 months apart.2 If there is concurrent clinically significant macular edema (CSME), this should be treated either before or at the same time as the first session of PRP. When discussing the procedure with the patient, I emphasize that we are trying to prevent SVL and other neovascular complications. I also discuss the potential secondary effects such as decrease in peripheral vision, night vision, color vision, as well as possible temporary loss of accommodation. I also discuss the poten Continue reading >>

Diabetic Retinopathy

Diabetic Retinopathy

Diabetic retinopathy refers to retinal changes that occur in patients with diabetes mellitus. These changes affect the small blood vessels of the retina and can lead to vision loss through several different pathways. Visit EyeSmart from the American Academy of Ophthalmology for a brief, patient-friendly summary of diabetic retinopathy. Retinal disease that occurs in patients with diabetes mellitus. Diabetes Uncontrolled glucose or blood pressure levels are associated with increased risk (see NHANES, UKDPS, WESDR references below) The main types of diabetic retinopathy are non-proliferative and proliferative diabetic retinopathy. The main distinguishing feature between these two categories is the presence (proliferative) or absence (non-proliferative) of abnormal new (neovascular) blood vessels (retinal neovascularization). Vascular endothelial growth factor (VEGF) is secreted by ischemic retina. VEGF leads to a) increased vascular permeability resulting in retinal swelling/edema and b) angiogenesis- new blood vessel formation Control of glucose and blood pressure. Each 1% reduction in updated mean HbA(1c) was associated with reductions in risk of 21% for any end point related to diabetes(95% confidence interval 17% to 24%, P<0.0001), 21% for deaths related to diabetes (15% to 27%, P<0.0001), 14% for myocardial infarction (8% to 21%, P<0.0001), and 37% for microvascular complications (33% to 41%, P<0.0001). (UKDPS report 35). Ask for symptoms of decreased vision or fluctuating vision, presence of floaters, flashes of light (photopsias) or defects in the field of vision. It is important to know the hemoglobin A1c and whether the patient’s blood pressure is under control. Slit lamp examination and dilated fundus examination should be performed. One should look carefully Continue reading >>

Risk Factors For High-risk Proliferative Diabetic Retinopathy And Severe Visual Loss: Early Treatment Diabetic Retinopathy Study Report #18. | Iovs | Arvo Journals

Risk Factors For High-risk Proliferative Diabetic Retinopathy And Severe Visual Loss: Early Treatment Diabetic Retinopathy Study Report #18. | Iovs | Arvo Journals

Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: Early Treatment Diabetic Retinopathy Study Report #18. Investigative Ophthalmology & Visual Science February 1998, Vol.39, 233-252. doi: Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: Early Treatment Diabetic Retinopathy Study Report #18. You will receive an email whenever this article is corrected, updated, or cited in the literature. You can manage this and all other alerts in My Account M D Davis, M R Fisher, R E Gangnon, F Barton, L M Aiello, E Y Chew, F L Ferris, G L Knatterud; Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: Early Treatment Diabetic Retinopathy Study Report #18.. Invest. Ophthalmol. Vis. Sci. 1998;39(2):233-252. ARVO (1962-2015); The Authors (2016-present) PURPOSE: To identify risk factors for the development of high-risk proliferative diabetic retinopathy (PDR) and for the development of severe visual loss or vitrectomy (SVLV) in eyes assigned to deferral of photocoagulation in the Early Treatment Diabetic Retinopathy Study (ETDRS). METHODS: Multivariable Cox models were constructed to evaluate the strength and statistical significance of baseline risk factors for development of high-risk PDR and of SVLV. RESULTS: The baseline characteristics identified as risk factors for high-risk PDR were increased severity of retinopathy, decreased visual acuity (or increased extent of macular edema), higher glycosylated hemoglobin, history of diabetic neuropathy, lower hematocrit, elevated triglycerides, lower serum albumin, and persons with mild to moderate nonproliferative retinopathy, younger age (or type 1 diabetes). The predominant risk factor for development of SVLV was the prior development Continue reading >>

Diabetic Retinopathy

Diabetic Retinopathy

Diabetic retinopathy is a condition that occurs in people who have diabetes. It causes progressive damage to the retina, the light-sensitive lining at the back of the eye. Diabetic retinopathy is a serious sight-threatening complication of diabetes. Diabetes interferes with the body's ability to use and store sugar (glucose). The disease is characterized by too much sugar in the blood, which can cause damage throughout the body, including the eyes. Over time, diabetes damages the blood vessels in the retina. Diabetic retinopathy occurs when these tiny blood vessels leak blood and other fluids. This causes the retinal tissue to swell, resulting in cloudy or blurred vision. The condition usually affects both eyes. The longer a person has diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness. Symptoms of diabetic retinopathy include: Seeing spots or floaters Blurred vision Having a dark or empty spot in the center of your vision Difficulty seeing well at night When people with diabetes experience long periods of high blood sugar, fluid can accumulate in the lens inside the eye that controls focusing. This changes the curvature of the lens, leading to blurred vision. However, once blood sugar levels are controlled, blurred distance vision will improve. Patients with diabetes who can better control their blood sugar levels will slow the onset and progression of diabetic retinopathy. Often the early stages of diabetic retinopathy have no visual symptoms. That is why the American Optometric Association recommends that everyone with diabetes have a comprehensive dilated eye examination once a year. Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy. T Continue reading >>

Risk Factors For High-risk Proliferative Diabetic Retinopathy And Severe Visual Loss: Early Treatment Diabetic Retinopathy Study Report #18.

Risk Factors For High-risk Proliferative Diabetic Retinopathy And Severe Visual Loss: Early Treatment Diabetic Retinopathy Study Report #18.

Invest Ophthalmol Vis Sci. 1998 Feb;39(2):233-52. Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: Early Treatment Diabetic Retinopathy Study Report #18. To identify risk factors for the development of high-risk proliferative diabetic retinopathy (PDR) and for the development of severe visual loss or vitrectomy (SVLV) in eyes assigned to deferral of photocoagulation in the Early Treatment Diabetic Retinopathy Study (ETDRS). Multivariable Cox models were constructed to evaluate the strength and statistical significance of baseline risk factors for development of high-risk PDR and of SVLV. The baseline characteristics identified as risk factors for high-risk PDR were increased severity of retinopathy, decreased visual acuity (or increased extent of macular edema), higher glycosylated hemoglobin, history of diabetic neuropathy, lower hematocrit, elevated triglycerides, lower serum albumin, and persons with mild to moderate nonproliferative retinopathy, younger age (or type 1 diabetes). The predominant risk factor for development of SVLV was the prior development of high-risk PDR. The only other clearly significant factor was decreased visual acuity at baseline. In the eyes that developed SVLV before high-risk proliferative retinopathy was observed, baseline risk factors were decreased visual acuity (or increased extent of macular edema), older age (or type 2 diabetes), and female gender. These analyses supported the view that the retinopathy-inhibiting effect of better glycemic control extends across all ages, both diabetes types, and all stages of retinopathy up to and including the severe nonproliferative and early proliferative stages and the possibility that reducing elevated blood lipids and treating anemia slow the progression of Continue reading >>

Diabetic Retinopathy Grading And Classification

Diabetic Retinopathy Grading And Classification

Accurately grading diabetic retinopathy can be a significant challenge for beginning ophthalmology residents. After nervously searching Google in the physicians workroom for the diabetic retinopathy grading scale more often than I care to admit, I have decided to summarize the classification criteria for diabetic retinopathy, at least in a way that makes sense to me. I hope you find this summary helpful. No retinopathy and mild NPDR Proposed Diabetic Retinopathy Severity Level Exam Findings No apparent diabetic retinopathy (No DR) No abnormalities (no microaneurysms) Mild nonproliferative diabetic retinopathy (Mild NPDR) Microaneurysms ONLY In reality, there is not much difference in risk between diabetic eyes with no retinopathy and those with mild retinopathy. Both have a very low risk of progressing to PDR; in fact, the Early Treatment Diabetic Retinopathy Study (ETDRS) did not examine those with no retinopathy nor mild NPDR. However, the Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR) did include these individuals in its study, and found that the rate of progression to PDR after four years was less than 1% for both young and older patients with no diabetic retinopathy, compared to 4.1% in younger patients with a rare microaneurysm and hemorrhage and even less in older patients with these findings. In other words, a diabetic patient with no retinopathy has a <1% chance of developing PDR and a diabetic patient with a rare MA/DBH has a <5% chance of progressing to PDR in the next four years. All things considered, this is pretty low risk. These patients can be followed every 12 months. Moderate NPDR Proposed Diabetic Retinopathy Severity Level Exam Findings Moderate nonproliferative diabetic retinopathy (Moderate NPDR) More than just micro aneurysms (wi Continue reading >>

Diabetic Retinopathy

Diabetic Retinopathy

Print Overview Diabetic retinopathy (die-uh-BET-ik ret-ih-NOP-uh-thee) is a diabetes complication that affects eyes. It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). At first, diabetic retinopathy may cause no symptoms or only mild vision problems. Eventually, it can cause blindness. The condition can develop in anyone who has type 1 or type 2 diabetes. The longer you have diabetes and the less controlled your blood sugar is, the more likely you are to develop this eye complication. Symptoms You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, diabetic retinopathy symptoms may include: Spots or dark strings floating in your vision (floaters) Blurred vision Fluctuating vision Impaired color vision Dark or empty areas in your vision Vision loss Diabetic retinopathy usually affects both eyes. When to see a doctor Careful management of your diabetes is the best way to prevent vision loss. If you have diabetes, see your eye doctor for a yearly eye exam with dilation — even if your vision seems fine. Pregnancy may worsen diabetic retinopathy, so if you're pregnant, your eye doctor may recommend additional eye exams throughout your pregnancy. Contact your eye doctor right away if your vision changes suddenly or becomes blurry, spotty or hazy. Causes Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don't develop properly and can leak easily. There are two types of diabetic retinopathy: Early diabetic retinopathy. In this more common form — called nonproliferative diabetic retinopathy (NPDR) Continue reading >>

High Risk Characteristics (hrc) Associated With Proliferative Diabetic Retinopathy

High Risk Characteristics (hrc) Associated With Proliferative Diabetic Retinopathy

High Risk Characteristics (HRC) Associated with Proliferative Diabetic Retinopathy A diabetic with proliferative retinopathy may be at risk for severe vision loss if certain high risk characteristics (HRC) are left untreated. Patient selection: diabetic with proliferative retinopathy Outcome: severe vision loss (visual acuity < 25/200) (1) NVD (new vessels on the optical disk or within 1 disk diameter) covering > 25% of the optic disk area (2) NVD of any size AND (preretinal hemorrhage OR vitreous hemorrhage) (3) NVE (new vessels elsewhere, i.e. not on the optic disk) occupying a cumulative area >= 50% of the optic disk area AND (preretinal hemorrhage OR vitreous hemorrhage) In Klein et al the area for NVE is based on a single photographic field. A patient with one or more high risk characteristics should undergo photocoagulation therapy if vision is to be preserved. Kaufman FR (editor). Medical Management of Type 1 Diabetes. Fifth Edition. 2008. American Diabetes Association. page 202. Klein R, Klein BEK, et al. The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol. 1984; 102: 520-526. Continue reading >>

Diabetic Retinopathy Study (drs)

Diabetic Retinopathy Study (drs)

Does PRP (argon or xenon arc) prevent severe vision loss in eyes with diabetic retinopathy? Patients were included in the study if they had PDR in at least one eye or severe NPDR in both eyes, and had VA of 20/100 or better in each eye. Severe NPDR was defined as the presence at least 3 of the following: 3. Intraretinal microvascular abnormalities (IRMA) in at least 2 contiguous overlapping photographic fields 4. Moderate-to-severe retinal hemorrhages and/or MAs Patients were excluded if they had undergone previous PRP or had a macula-threatening TRD. This was a randomized, prospective multicenter clinical trial. 1742 study subjects were enrolled. One eye from each subject was randomly assigned to PRP and the other eye assigned to no PRP. The PRP eyes were randomized to either argon blue-green laser (800-1600, 500 micron spots) or xenon arc (200-400, 4.5 degree spots). The primary outcome measure was severe vision loss, defined as VA < 5/200 on two consecutive follow-up exams, 4 months apart. PRP reduced the risk of severe vision loss by at least 50% as compared to untreated control eyes. The greatest benefit was seen in eyes with high-risk PDR. Study follow-up was over 5 years. High-risk PDR was defined as any one of the following: 3. NVE disc area with vitreous hemorrhage High-risk PDR was also defined as three or more of the following high-risk characteristics (HRCs): 1. Presence of vitreous hemorrhage or pre-retinal hemorrhage 2. Presence of any active neovascularization 3. Location of neovascularization on or within one disc diameter of the optic disc 4. NVD > 1/3 disc area or NVE > disc area Eyes with high-risk PDR had significantly greater risk of severe visual loss and demonstrated the greatest benefit from PDR. No clear benefit was demonstrated for PRP in eyes Continue reading >>

Diabetic Retinopathy

Diabetic Retinopathy

NATURAL HISTORY OF DIABETIC RETINOPATHY Diabetic retinopathy progresses from mild nonproliferative abnormalities, characterized by increased vascular permeability, to moderate and severe nonproliferative diabetic retinopathy (NPDR), characterized by vascular closure, to proliferative diabetic retinopathy (PDR), characterized by the growth of new blood vessels on the retina and posterior surface of the vitreous. Macular edema, characterized by retinal thickening from leaky blood vessels, can develop at all stages of retinopathy. Pregnancy, puberty, blood glucose control, hypertension, and cataract surgery can accelerate these changes. Vision-threatening retinopathy is rare in type 1 diabetic patients in the first 3–5 years of diabetes or before puberty. During the next two decades, nearly all type 1 diabetic patients develop retinopathy. Up to 21% of patients with type 2 diabetes have retinopathy at the time of first diagnosis of diabetes, and most develop some degree of retinopathy over time. Vision loss due to diabetic retinopathy results from several mechanisms. Central vision may be impaired by macular edema or capillary nonperfusion. New blood vessels of PDR and contraction of the accompanying fibrous tissue can distort the retina and lead to tractional retinal detachment, producing severe and often irreversible vision loss. In addition, the new blood vessels may bleed, adding the further complication of preretinal or vitreous hemorrhage. Finally, neovascular glaucoma associated with PDR can be a cause of visual loss. RISK FACTORS AND TREATMENTS Duration of disease The duration of diabetes is probably the strongest predictor for development and progression of retinopathy. Among younger-onset patients with diabetes in the WESDR, the prevalence of any retinopathy wa Continue reading >>

Diabetic Retinopathy By The Numbers

Diabetic Retinopathy By The Numbers

A guide to following and educating patients who face this sight-threatening diagnosis. Today, optometrists play a crucial role in managing diabetes, a leading—and growing—instigator of vision loss. With management of this disease now firmly in optometry’s wheelhouse, the depth of research into its ocular impact has provided the ability to delineate its progression using various categories. In the case of diabetic retinopathy, these are divided, chiefly, into two: proliferative diabetic retinopathy and nonproliferative diabetic retinopathy. These categories are each further split by severity. It may seem like minutiae, but even minor distinctions can be valuable as they inform our treatment protocol and, ultimately, prevent significant visual impairment for our patients. This article explains the care diabetes patients require and details the biological processes that indicate where to classify a patient with diabetic retinopathy, as well as what treatment should follow. Risk Factors Two particular aspects of diabetes can put patients at risk for developing diabetic retinopathy: duration and glycemic control. • Duration. Approximately 25% of Type 1 patients have some retinopathy after five years.7,8 These numbers increase to almost 60% after 10 years and greater than 80% after 15 years.7,8 In Type 2 patients older than age 30 with a known duration of diabetes of less than five years, 40% of patients taking insulin and 24% of those not taking insulin are found to have retinopathy. After 10 years, the numbers increase to 84% and 53%, respectively. Proliferative diabetic retinopathy is found in approximately 2% of type 2 patients who have diabetes for less than five years, and 25% who have had diabetes for 25 years or more.9 • Glycemic control. Multiple clinical s Continue reading >>

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