Diabetic retinopathy: management and monitoring

Context

This is a new guideline on diagnosing and managing diabetic retinopathy. It includes information on monitoring and treatment for people in hospital eye services with:

Diabetic retinopathy is one of the leading causes of visual impairment and blindness in the UK. Retinopathy is a direct consequence of raised glucose levels so, within 20 years of being diagnosed with diabetes, most people with type 1 or type 2 diabetes will have some degree of retinopathy.

Diabetic retinopathy is an umbrella term that covers all complications of diabetes that affect the retina. This includes non-proliferative diabetic retinopathy, proliferative diabetic retinopathy and maculopathy. Maculopathy affects the centre part of the retina, called the macula. There are 2 forms of diabetic maculopathy: diabetic macular oedema and diabetic macular ischaemia.

Non-proliferative diabetic retinopathy is an early stage of the disease with fewer symptoms. Some people with non-proliferative diabetic retinopathy progress to having proliferative diabetic retinopathy. Proliferative diabetic retinopathy refers to abnormal blood vessels that grow in the optic nerve, in the retina, or both, which can lead to vitreous haemorrhage. It can also cause scarring that can, in turn, lead to tractional retinal detachment and central and peripheral vision loss.

At any stage of retinopathy, people may also develop diabetic macular oedema. It causes fluid to gather in the macula and can lead to loss of central vision.

Without the correct monitoring and treatment, proliferative diabetic retinopathy and macular oedema can both lead to permanent vision loss.

The eyes of people with diabetes are monitored as part of the NHS diabetic eye screening programme (DESP). Once they show signs of sight-threatening diabetic retinopathy, they are referred to hospital eye services for further tests and treatment. This guideline covers people who have been referred to hospital eye services, or are already under their care.