SA JOURNAL OF DIABETES & VASCULAR DISEASE
DRUG TRENDS
VOLUME 7 NUMBER 3 • SEPTEMBER 2010
129
should perform interpretation of the
images. While retinal photography may
serve as a screening tool for retinopathy,
it is not a substitute for a comprehensive
eye examination, which should be per-
formed at least initially and at intervals
thereafter as recommended by an eye-
care professional (E).
• Women with pre-existing diabetes who
are planning pregnancy or who have
become pregnant should have a compre-
hensive eye examination and should be
counselled on the risk of development
and/or progression of diabetic retinopa-
thy. The eye examination should occur in
the first trimester, with close follow up
throughout pregnancy and for one year
postpartum (B).
Treatment
• Promptly refer patients with any level of
macular oedema, severe non-proliferative
diabetic retinopathy (NPDR), or any pro-
liferative diabetic retinopathy (PDR) to an
ophthalmologist who is knowledgeable
and experienced in the management and
treatment of diabetic retinopathy (A).
• Laser photocoagulation therapy is indi-
cated to reduce the risk of vision loss
in patients with high-risk PDR, clinically
significant macular oedema, and in some
cases of severe NPDR (A).
• The presence of retinopathy is not a con-
traindication to aspirin therapy for car-
dioprotection, as this therapy does not
increase the risk of retinal haemorrhage
(A).
Source: Executive summary: Standards of medical care in
diabetes – 2010.
Diabetes Care
2010;
33
: S4–9
Compiled by J Aalbers, Special Assignments
Editor
1. World Health Organisation. The World Health Report 2002. htpp://www.who.int.
2. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence,
numerical estimates, and projections. Diabetes Care 1998;
21
: 1414–1431.
3. The prevalence of the metabolic syndrome did not increase in Mexico City between
1990–1992 and 1997–1999 despite more central obesity. Diabetes Care 2005;
28
: 2480–2485.
4. Office of Population Censuses and Surveys. Causes of blindness and partial sight in
England and Wales 1990–1991. London: HMSO, 1995.
5. Grading diabetic retinopathy from stereoscopic colour fundus photographs – An ex-
tension of the Airlie House classification. ETDRS report number 10. Ophthalmology
1991;
98
(Suppl): 786–806.
6. Four risk factors for severe visual loss in diabetic retinopathy. The third report from
the Diabetic Retinopathy Study. The Diabetic Retinopathy Study Research Group.
Arch Ophthalmol 1979;
97
(4): 654–655.
7. Preliminary report on effects of photocoagulation therapy. The Diabetic Retinopathy
Study Research Group. Am J Ophthalmol 1976;
81
(4 Group): 383–396.
8. Photocoagulation treatment of proliferative diabetic retinopathy. The second report
of the Diabetic Retinopathy Study Research Group. The Diabetic Retinopathy Study
Research. Ophthalmology 1978;
85
(1): 82–106.
9. Indication for photocoagulation treatment of diabetic retinopathy. The Diabetic Retin-
opathy Study Research. Int Ophthalmol Clin 1987;
27
(4): 239–253.
10. Group photocoagualation treatment of proliferative diabetic retinopathy: clinical
application of Diabetic Retinopathy Study (DRS) findings. The Diabetic Retinopathy
Study Research. DRS report number 8. Ophthalmology 1981;
88
(7): 583–600.
R
eferences
11. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treat-
ment Diabetic Retinopathy Study research group. Ophthalmology 1991;
98
(5 Suppl):
766–785.
12. Diabetes Control and Complications Trial research group. The effect of intensive
treatment of diabetes on the development and progression of long-term complica-
tions in insulin-dependant diabetes mellitus. N Engl J Med 1993;
329
(14): 977–986.
13. UK Prospective Diabetes Study (UKPDS) group. Intensive blood glucose control
with sulphonylureas and insulin compared with conventional treatment and the
risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;
352
(9131): 837–853.
14. Sui SC, Ko TC Wong KW, Chan WN. Effectiveness of non-mydriatic retinal photogra-
phy and direct ophthalmoscopy in detecting diabetic retinopathy. Hong Kong Med J
1998;
4
(4): 367–370.
15. Lin DY, Blumenkranz MS, Brothers RJ, Grosvenor DM. The sensitivity and specificity
of single-field nonmydriatic monochromatic digital fundus photography with remote
image interpretation for diabetic retinopathy screening: a comparison with ophthal-
moscopy and standardized mydriatic colour photography. Am J Ophthalmol 2002;
134
(2): 204–213
16. Cuadros J, Bresnick G. Eyepacs: An adaptable telemedicine system for diabetic
retinopathy screening. J Diabetes Sci Technol 2009;
3
(3): 509–516.
17. Freudenstein U, Verne J. A national screening programme for diabetic retinopathy.
Needs to learn the lessons of existing screening programmes. Br Med J 2001;
323
(7303): 4–5.
18. Mukamel DB, Bresnick GH, Wang Q, Dickey CF. Barriers to compliance with screen-
ing guidelines for diabetic retinopathy. Ophthalmic Epidemiol 1999;
6
(1): 61–72.
19. Moss SE, Klein R, Klein BE. Factors associated with having eye examinations in
persons with diabetes. Arch Fam Med 1995;
4
(6): 529–534.
… continued from page 121
