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Screening Guidelines for DED’s

Screening Guidelines for Diabetes-Related Eye Diseases

A number of countries have published their own clinical guideline recommendations relating to screening and management of Diabetes-related Retinopathy in people with diabetes (Table 1). Specific recommendations vary between countries, often reflecting differences between healthcare system structure (e.g. private vs public) and levels of health care resources available (e.g. health care personnel, access to diagnostic equipment and treatments).

The two largest global ophthalmology and diabetes societies (the International Council of Ophthalmology [ICO] and the International Diabetes Federation [IDF]) have also published international guidelines for eyes affected by diabetes, which include specific recommendations for screening, diagnosis and treatment of DR (Table 2).

 

Table 2: International guidelines for screening, treatment and management of diabetic eye disease

 

A short summary of the ICO and IDF global recommendations relating to screening and referral is provided below: Algorithms detailing the screening recommendations from the ICO and IDF guidelines are shown below (Figures 1 and 2).

Figure 1: Flowchart showing screening for Diabetes-related Retinopathy (ICO Guidelines[46])
Figure 2: Screening recommendations (IDF/The Fred Hollows Foundation guidelines[47])

Recommended Initial Eye Examinations

Your PCP (primary care provider) should inform you that initial eye examinations and follow up schedule for diabetes patients as recommended by the American Academy of Ophthalmology-Preferred Practice Patterns are as follows:

 

  • Patients with T1D (Type 1 Diabetes) should have an initial dilated eye examination with 3–5 years after the onset of diabetes, after the age of 10, and annual retinal follow-up examination.
  • Patients with T2D (Type 2 Diabetes) should have an initial dilated eye examination shortly after the diagnosis of diabetes and yearly follow-up examinations.
  • Subsequent eye examination for both T1D and T2D should be should be done annually. Examinations will be required more frequently if there is any abnormal findings and retinopathy is progressing.
  • Women with pre-existing diabetes who are planning for pregnancy:
  • Patients with T2D (Type 2 Diabetes) should have an initial dilated eye examination shortly after the diagnosis of diabetes and yearly follow-up examinations. 
  • Subsequent eye examination for both T1D and T2D should be should be done annually. Examinations will be required more frequently if there is any abnormal findings and retinopathy is progressing. 
  • Women with pre-existing diabetes who are planning for pregnancy:

 

    1. Should have a comprehensive eye examination before conception and early in the first trimester of pregnancy.
    2. Have subsequent eye examination in every 3–12 months for no retinopathy to mild-moderate NPDR (Non-Proliferative Diabetes-related Retinopathy), and every 1–3 months for patients with severe NPDR or worse category.
    3. Should be counselled on risk of development and progression of DR.
    4. Be encouraged to make every attempt to lower their blood glucose levels to normal or near normal.

 

Women who develop gestational diabetes do not require eye examination during their pregnancy.

Please click on the link below for a short video on when diabetes patients should have eye exams.

https://www.sharecare.com/health/eye-care/when-diabetes-patient-see-ophthalmologist

 

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