Highlights & Basics
- Diabetic retinopathy is a chronic, progressive disease resulting from hyperglycemia-induced vascular and neurodegenerative changes in the retina.
- The duration and control of diabetes, as well as systemic comorbidities, influences disease severity and progression.
- Diagnosis is clinical, typically made through dilated fundus exam, optical coherence tomography, and fluorescein angiography.
- Sight-threatening features include diabetic macular edema, retinal ischemia, neovascularization of the retina or optic disc, neovascular glaucoma, vitreous hemorrhage, and tractional retinal detachment.
- Treatment of vision-threatening disease includes intravitreal vascular endothelial growth factor inhibitor injections, panretinal photocoagulation, macular laser therapy, and pars plana vitrectomy for advanced complications.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Nonproliferative diabetic retinopathy: intraretinal microvascular abnormality (IRMA; green arrow), venous beading and segmentation (blue arrow), cluster hemorrhage (red circle), featureless retina suggestive of capillary nonperfusion (white ellipse)
Nonproliferative diabetic retinopathy with macular edema: exudate (yellow arrow)
Nonproliferative diabetic retinopathy with macular edema: thickened retina (white ellipse), exudate (yellow arrow)
Nonproliferative diabetic retinopathy with macular edema: cotton wool spot (white arrow), thickened retina (white circle)
Proliferative diabetic retinopathy: optic disk new vessels (red arrow), intraretinal microvascular abnormality (IRMA; green arrow), cotton wool spot (white arrow), venous beading and segmentation (red rectangle), featureless retina suggestive of capillary nonperfusion (white ellipse)
Nonproliferative diabetic retinopathy with macular edema: nerve fiber layer hemorrhage (blue arrow), exudate (yellow arrow)
Proliferative diabetic retinopathy: new vessels on the optic disk (red circle)
Proliferative diabetic retinopathy: extensive vitreous hemorrhage obscuring most of fundus (white circle)
Proliferative diabetic retinopathy: traction toward optic disk and consequent total retinal detachment (white block arrow)
Fluorescein angiogram of nonproliferative diabetic retinopathy: microaneurysms (red arrow), intraretinal microvascular abnormalities (blue arrow)
Nonproliferative diabetic retinopathy: cluster hemorrhages (red circle), cotton wool spot (white arrow)
Proliferative diabetic retinopathy: cotton wool spot (white arrow)
Nonproliferative diabetic retinopathy: flame hemorrhage (red arrow), venous beading (white rectangle)
Nonproliferative diabetic retinopathy with macular edema: exudate plaque (yellow arrow), cluster hemorrhage (green arrow), venous beading (blue arrow)
Nonproliferative diabetic retinopathy: blot hemorrhage (white circle)
Nonproliferative diabetic retinopathy with macular edema: exudate (yellow arrow), microaneurysms (red arrow), venous dilatation (blue arrow), cotton wool spot (white arrow)
Proliferative diabetic retinopathy: retrohyaloid hemorrhage (red arrow)
Proliferative diabetic retinopathy: new vessels on the optic disk (red circle), retrohyaloid hemorrhage (red arrow), new vessels elsewhere with fibrosis (white arrow), dot and blot hemorrhage (green arrow)
Proliferative diabetic retinopathy: macular laser burns (black arrow), misty vitreous hemorrhage (blue arrow), clot within vitreous hemorrhage (red arrow)
Proliferative diabetic retinopathy: retrohyaloid hemorrhage (red arrow), venous beading (blue arrow), cluster hemorrhage (white circle), panretinal laser burns (black arrow)
Proliferative diabetic retinopathy: new vessels elsewhere (red arrow), venous beading (blue arrow), intraretinal microvascular abnormality (green arrow)
Proliferative diabetic retinopathy: nerve fiber layer hemorrhage (yellow arrow)
Proliferative diabetic retinopathy: venous beading (blue arrow)
Proliferative diabetic retinopathy: new vessels elsewhere (white arrow), vitreous (intra-gel) hemorrhage (green arrow), retrohyaloid hemorrhage (red arrow)
Proliferative diabetic retinopathy: traction tear (white ellipse)
Nonproliferative diabetic retinopathy with macular edema: exudate (yellow arrow), microaneurysms (red arrow), thickened retina (white circle), cystic change at macula (blue arrow)
Optical coherence tomography in macular edema: loss of central foveal depression (yellow arrow), accumulation of fluid within cystoid spaces at fovea (red arrow)
Optical coherence tomogram of normal eye: normal foveal depression at center of macula (yellow arrow), inner retina (toward center of eye; red arrow), outer retina (farther from center of eye; blue arrow)
Optical coherence tomography in vitreomacular traction: loss of foveal depression with traction on fovea (in direction of yellow arrow)
Normal retina left eye: optic disk (white square), macula (white circle), arteriole (red arrow), venule (blue arrow)
Fluorescein angiogram in mid-venous phase in diabetic retinopathy with microaneurysms only: microaneurysm (red arrow), optic disk (yellow arrow), macula (white circle)
Fluorescein angiogram in proliferative diabetic retinopathy with macular ischemia: macular ischemia (green circle), capillary nonperfusion (white arrow), optic disk new vessels (red arrow), venous beading (blue arrow)
Fluorescein angiography in proliferative diabetic retinopathy. Vascular component of fibrovascular proliferation (red arrows), capillary nonperfusion (yellow arrow), laser burns (green circle)
Fluorescein angiogram in proliferative diabetic retinopathy: new vessels on the optic disk (red arrow), capillary nonperfusion (red rectangle), microaneurysms (green circle), venous beading (blue arrow), intraretinal microvascular abnormalities (yellow arrow)
Fluorescein angiogram in proliferative diabetic retinopathy: new vessels elsewhere (red circle), capillary nonperfusion (white arrow), panretinal laser burns (blue arrow)
Fluorescein angiogram of nonproliferative diabetic retinopathy: microaneurysms (red arrow), intraretinal microvascular abnormalities (blue arrow)
Fluorescein angiogram in proliferative diabetic retinopathy with macular ischemia: macular ischemia (green circle), capillary nonperfusion (white arrow), optic disk new vessels (red arrow), venous beading (blue arrow)
Ocular ischemic syndrome: scattered posterior-pole and equatorial cluster hemorrhages (white circle)
Radiation retinopathy: cotton wool spots (white arrow), optic disk edema (white circle), venous beading (blue arrow), nerve fiber layer hemorrhage (red arrow)
Central retinal vein occlusion: optic disk swelling (white circle), macular edema (yellow circle), exudate (yellow arrow), nerve fiber layer hemorrhage (blue arrow), venous engorgement and tortuosity (white arrow)
Branch retinal vein occlusion: site of occlusion (white circle), cotton wool spot (white arrow), nerve fiber layer hemorrhage (red arrow), cluster hemorrhage (green arrow)
Citations
American Academy of Ophthalmology. Diabetic retinopathy PPP 2024. Feb 2025 [internet publication].[Full Text]
American Diabetes Association. Standards of care in diabetes - 2026. Diabetes Care. 2025 Dec;49(suppl 1):S1-362.[Full Text]
Wong TY, Sun J, Kawasaki R, et al. Guidelines on diabetic eye care: The International Council of Ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings. Ophthalmology. 2018 Oct;125(10):1608-22.[Abstract][Full Text]
American Academy of Ophthalmology. Preferred practice patterns: retina summary benchmarks - 2025. Dec 2025 [internet publication].[Full Text]
Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: a position statement by the American Diabetes Association. Diabetes Care. 2017 Mar;40(3):412-8.[Abstract][Full Text]
1. Wilkinson CP, Ferris FL 3rd, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003 Sep;110(9):1677-82.[Abstract]
2. Gov.UK. NHS diabetic eye screening programme: grading definitions for referable disease. Dec 2025 [internet publication].[Full Text]
3. Lundeen EA, Burke-Conte Z, Rein DB, et al. Prevalence of diabetic retinopathy in the US in 2021. JAMA Ophthalmol. 2023 Aug 1;141(8):747-54.[Abstract][Full Text]
4. Centers for Disease Control and Prevention. Vision and eye health surveillance system (VEHSS): VEHSS modeled estimates [internet publication].[Full Text]
5. Teo ZL, Tham YC, Yu M, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis. Ophthalmology. 2021 Nov;128(11):1580-91.[Abstract]
6. Stathi D, Nirmalakumaran A, Mangelis A, et al. The impact of african caribbean heritage on the development of sight-threatening diabetic retinopathy in a multiethnic cohort of people with type 2 diabetes. Diabetes Care. 2025 Dec 1;48(12):2054-60.[Abstract]
7. Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012 Mar;35(3):556-64.[Abstract][Full Text]
8. World Health Organization. Global report on diabetes. 2016 [internet publication].[Full Text]
9. Klein R, Klein BE, Moss SE, et al. The Wisconsin Epidemiological Study of Diabetic Retinopathy II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol. 1984 Apr;102(4):520-6.[Abstract]
10. Klein R, Klein BE, Moss SE, et al. The Wisconsin Epidemiological Study of Diabetic Retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol. 1984 Apr;102(4):527-32.[Abstract]
11. Wong TY, Mwamburi M, Klein R,et al. Rates of progression in diabetic retinopathy during different time periods: a systematic review and meta-analysis. Diabetes Care. 2009 Dec;32(12):2307-13.[Abstract][Full Text]
12. American Diabetes Association Professional Practice Committee for Diabetes. 14. Children and adolescents: standards of care in diabetes-2026. Diabetes Care. 2026 Jan 1;49(supplement_1):S297-320.[Abstract][Full Text]
13. Bai P, Barkmeier AJ, Hodge DO, et al. Ocular sequelae in a population-based cohort of youth diagnosed with diabetes during a 50-year period. JAMA Ophthalmol. 2022 Jan 1;140(1):51-7.[Abstract][Full Text]
14. Eppens MC, Craig ME, Cusumano J, et al. Prevalence of diabetes complications in adolescents with type 2 compared with type 1 diabetes. Diabetes Care. 2006 Jun;29(6):1300-6.[Abstract]
15. Henricsson M, Nyström L, Blohmé G, et al. The incidence of retinopathy 10 years after diagnosis in young adult people with diabetes: results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS). Diabetes Care. 2003 Feb;26(2):349-54.[Abstract]
16. Dabelea D, Stafford JM, Mayer-Davis EJ, et al. Association of type 1 diabetes vs type 2 diabetes diagnosed during childhood and adolescence with complications during teenage years and young adulthood. JAMA. 2017 Feb 28;317(8):825-35.[Abstract][Full Text]
17. Constantino MI, Molyneaux L, Limacher-Gisler F, et al. Long-term complications and mortality in young-onset diabetes: type 2 diabetes is more hazardous and lethal than type 1 diabetes. Diabetes Care. 2013 Dec;36(12):3863-9.[Abstract][Full Text]
18. Hammes HP. Diabetic retinopathy: hyperglycaemia, oxidative stress and beyond. Diabetologia. 2018 Jan;61(1):29-38.[Abstract][Full Text]
19. Cinar Y, Senyol AM, Duman K. Blood viscosity and blood pressure: role of temperature and hyperglycemia. Am J Hypertens. 2001 May;14(5 Pt 1):433-8.[Abstract]
20. Pecsvarady Z, Fisher TC, Darwin CH, et al. Decreased polymorphonuclear leucocyte deformability in NIDDM. Diabetes Care. 1994 Jan;17(1):57-63.[Abstract]
21. Vaidyula VR, Boden G, Rao AK. Platelet and monocyte activation by hyperglycemia and hyperinsulinemia in healthy subjects. Platelets. 2006 Dec;17(8):577-85.[Abstract]
22. Forrester JV. Mechanisms of new vessel formation in the retina. Diabet Med. 1987 Sep-Oct;4(5):423-30.[Abstract]
23. van Dijk HW, Kok PH, Garvin M, et al. Selective loss of inner retinal layer thickness in type 1 diabetic patients with minimal diabetic retinopathy. Invest Ophthalmol Vis Sci. 2009 Jul;50(7):3404-9.[Abstract][Full Text]
24. Sohn EH, van Dijk HW, Jiao C, et al. Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus. Proc Natl Acad Sci U S A. 2016 May 10;113(19):E2655-64.[Abstract][Full Text]
25. Pescosolido N, Barbato A, Stefanucci A, et al. Role of electrophysiology in the early diagnosis and follow-up of diabetic retinopathy. J Diabetes Res. 2015;2015:319692.[Abstract][Full Text]
26. McAnany JJ, Park JC. Reduced contrast sensitivity is associated with elevated equivalent intrinsic noise in type 2 diabetics who have mild or no retinopathy. Invest Ophthalmol Vis Sci. 2018 May 1;59(6):2652-8.[Abstract][Full Text]
27. Drasdo N, Chiti Z, Owens DR, et al. Effect of darkness on inner retinal hypoxia in diabetes. Lancet. 2002 Jun 29;359(9325):2251-3.[Abstract]
28. Hietala K, Forsblom C, Summanen P, et al. Heritability of proliferative diabetic retinopathy. Diabetes. 2008 Aug;57(8):2176-80.[Abstract][Full Text]
29. Arar NH, Freedman BI, Adler SG, et al. Heritability of the severity of diabetic retinopathy: the FIND-Eye study. Invest Ophthalmol Vis Sci. 2008 Sep;49(9):3839-45.[Abstract][Full Text]
30. Skol AD, Jung SC, Sokovic AM, et al. Integration of genomics and transcriptomics predicts diabetic retinopathy susceptibility genes. Elife. 2020 Nov 9;9:e59980.[Abstract][Full Text]
31. Simó R, Sundstrom JM, Antonetti DA. Ocular Anti-VEGF therapy for diabetic retinopathy: the role of VEGF in the pathogenesis of diabetic retinopathy. Diabetes Care. 2014 Apr;37(4):893-9.[Abstract][Full Text]
32. American Academy of Ophthalmology. Diabetic retinopathy PPP 2024. Feb 2025 [internet publication].[Full Text]
33. Forrester JV, Kuffova L, Delibegovic M. The role of inflammation in diabetic retinopathy. Front Immunol. 2020;11:583687.[Abstract][Full Text]
34. Sachdeva MM. Retinal neurodegeneration in diabetes: an emerging concept in diabetic retinopathy. Curr Diab Rep. 2021 Dec 13;21(12):65.[Abstract][Full Text]
35. Middleton TL, Constantino MI, Molyneaux L, et al. Young-onset type 2 diabetes and younger current age: increased susceptibility to retinopathy in contrast to other complications. Diabet Med. 2020 Jun;37(6):991-9.[Abstract][Full Text]
36. Perais J, Agarwal R, Evans JR, et al. Prognostic factors for the development and progression of proliferative diabetic retinopathy in people with diabetic retinopathy. Cochrane Database Syst Rev. 2023 Feb 22;2(2):CD013775.[Abstract][Full Text]
37. Lind M, Pivodic A, Svensson AM, et al. HbA(1c) level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study. BMJ. 2019 Aug 28;366:l4894.[Abstract][Full Text]
38. Li Z, Yuan Y, Qi Q, et al. Relationship between dyslipidemia and diabetic retinopathy in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Syst Rev. 2023 Aug 24;12(1):148.[Abstract][Full Text]
39. Romero-Aroca P, Verges R, Pascual-Fontanilles J, et al. Effect of lipids on diabetic retinopathy in a large cohort of diabetic patients after 10 years of follow-up. J Clin Med. 2023 Oct 22;12(20):6674.[Abstract][Full Text]
40. Liu Z, Shao M, Ren J, et al. Association between increased lipid profiles and risk of diabetic retinopathy in a population-based case-control study. J Inflamm Res. 2022;15:3433-46.[Abstract][Full Text]
41. Larsson LI, Alm A, Lithner F, et al. The association of hyperlipidemia with retinopathy in diabetic patients aged 15-50 years in the county of Umeå. Acta Ophthalmol Scand. 1999 Oct;77(5):585-91.[Abstract]
42. Liu L, Quang ND, Banu R, et al. Hypertension, blood pressure control and diabetic retinopathy in a large population-based study. PLoS One. 2020;15(3):e0229665.[Abstract][Full Text]
43. Gallego PH, Craig ME, Hing S, et al. Role of blood pressure in development of early retinopathy in adolescents with type 1 diabetes: prospective cohort study. BMJ. 2008 Aug 26;337:a918.[Abstract][Full Text]
44. Klein R, Klein BE, Moss SE, et al. Is blood pressure a predictor of the incidence or progression of diabetic retinopathy? Arch Intern Med. 1989 Nov;149(11):2427-32.[Abstract]
45. Leske MC, Wu SY, Hennis A, et al. Hyperglycemia, blood pressure, and the 9-year incidence of diabetic retinopathy: the Barbados Eye Studies. Ophthalmology. 2005 May;112(5):799-805.[Abstract]
46. Klein R, Moss SE, Klein BE. Is gross proteinuria a risk factor for the incidence of proliferative diabetic retinopathy? Ophthalmology. 1993 Aug;100(8):1140-6.[Abstract]
47. Mathiesen ER, Ronn B, Storm B, et al. The natural course of microalbuminuria in insulin-dependent diabetes: a 10-year prospective study. Diabet Med. 1995 Jun;12(6):482-7.[Abstract]
48. Newman DJ, Mattock MB, Dawnay AB, et al. Systematic review on urine albumin testing for early detection of diabetic complications. Health Technol Assess. 2005 Aug;9(30):iii-vi, xiii-163.[Abstract][Full Text]
49. Kotlarsky P, Bolotin A, Dorfman K, et al. Link between retinopathy and nephropathy caused by complications of diabetes mellitus type 2. Int Ophthalmol. 2015 Feb;35(1):59-66.[Abstract][Full Text]
50. Diabetes Control and Complications Trial Research Group. Effect of pregnancy on microvascular complications in the diabetes control and complications trial. Diabetes Care. 2000 Aug;23(8):1084-91.[Abstract][Full Text]
51. Sarvepalli SM, Bailey BA, D'Alessio D, et al. Risk factors for the development or progression of diabetic retinopathy in pregnancy: meta-analysis and systematic review. Clin Exp Ophthalmol. 2023 Apr;51(3):195-204.[Abstract]
52. American Diabetes Association Professional Practice Committee for Diabetes. 12. Retinopathy, neuropathy, and foot care: standards of care in diabetes-2026. Diabetes Care. 2026 Jan 1;49(suppl 1):S261-76.[Abstract][Full Text]
53. Gunderson EP, Lewis CE, Tsai AL, et al. A 20-year prospective study of childbearing and incidence of diabetes in young women, controlling for glycemia before conception: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Diabetes. 2007 Dec;56(12):2990-6.[Abstract][Full Text]
54. Jeng CJ, Hsieh YT, Yang CM, et al. Development of diabetic retinopathy after cataract surgery. PLoS One. 2018 Aug 22;13(8):e0202347.[Abstract][Full Text]
55. Dowler JG, Sehmi KS, Hykin PG, et al. The natural history of macular edema after cataract surgery in diabetes. Ophthalmology. 1999 Apr;106(4):663-8.[Abstract]
56. Hykin PG, Gregson RM, Stevens JD, et al. Extracapsular cataract extraction in proliferative diabetic retinopathy. Ophthalmology. 1993 Mar;100(3):394-9.[Abstract]
57. Bain SC, Klufas MA, Ho A, et al. Worsening of diabetic retinopathy with rapid improvement in systemic glucose control: a review. Diabetes Obes Metab. 2019 Mar;21(3):454-66.[Abstract][Full Text]
58. Feldman-Billard S, Larger É, Massin P, et al. Early worsening of diabetic retinopathy after rapid improvement of blood glucose control in patients with diabetes. Diabetes Metab. 2018 Feb;44(1):4-14.[Abstract]
59. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993 Sep 30;329(14):977-86.[Abstract][Full Text]
60. ACCORD Study Group, Cushman WC, Evans GW, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010 Apr 29;362(17):1575-85.[Abstract][Full Text]
61. Scanlon PH. The English National Screening Programme for diabetic retinopathy 2003-2016. Acta Diabetol. 2017 Jun;54(6):515-25.[Abstract][Full Text]
62. Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Circulation. 2012 Sep 18;126(12):1514-63.[Abstract][Full Text]
63. Gale R, Scanlon PH, Evans M, et al. Action on diabetic macular oedema: achieving optimal patient management in treating visual impairment due to diabetic eye disease. Eye (Lond). 2017 May;31(s1):S1-S20.[Abstract][Full Text]
64. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2015 Mar;58(3):429-42.[Abstract][Full Text]
65. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998 Sep 12;352(9131):837-53.[Abstract]
66. UK Prospective Diabetes Study (UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998 Sep 12;317(7160):703-13.[Abstract][Full Text]
67. Chaturvedi N, Porta M, Klein R, et al. Effect of candesartan on prevention (DIRECT-Prevent 1) and progression (DIRECT-Protect 1) of retinopathy in type 1 diabetes: randomised, placebo-controlled trials. Lancet. 2008 Oct 18;372(9647):1394-402.[Abstract]
68. American Diabetes Association. Standards of care in diabetes - 2026. Diabetes Care. 2025 Dec;49(suppl 1):S1-362.[Full Text]
69. American Academy of Ophthalmology. Preferred practice pattern: diabetic retinopathy. Oct 2019 [internet publication].[Full Text]
70. Wong TY, Sun J, Kawasaki R, et al. Guidelines on diabetic eye care: The International Council of Ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings. Ophthalmology. 2018 Oct;125(10):1608-22.[Abstract][Full Text]
71. Samara WA, Shahlaee A, Adam MK, et al. Quantification of diabetic macular ischemia using optical coherence tomography angiography and its relationship with visual acuity. Ophthalmology. 2017 Feb;124(2):235-44.[Abstract]
72. Klein R, Meuer SM, Moss SE, et al. The relationship of retinal microaneurysm counts to the 4-year progression of diabetic retinopathy. Arch Ophthalmol. 1989 Dec;107(12):1780-5.[Abstract]
73. Early Treatment Diabetic Retinopathy Study Research Group. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Ophthalmology. 1991 May;98(5 Suppl):823-33.[Abstract]
74. American Academy of Ophthalmology. Vitreous hemorrhage. Apr 2026 [internet publication].[Full Text]
75. Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS report number 8. Ophthalmology. 1981 Jul;88(7):583-600.[Abstract]
76. McAnany JJ, Persidina OS, Park JC. Clinical electroretinography in diabetic retinopathy: a review. Surv Ophthalmol. 2022 May-Jun;67(3):712-22.[Abstract]
77. McAnany JJ, Park JC, Lim JI. Visual field abnormalities in early-stage diabetic retinopathy assessed by chromatic perimetry. Invest Ophthalmol Vis Sci. 2023 Feb 1;64(2):8.[Abstract][Full Text]
78. Alam M, Toslak D, Lim JI, et al. Color fundus image guided artery-vein differentiation in optical coherence tomography angiography. Invest Ophthalmol Vis Sci. 2018 Oct 1;59(12):4953-62.[Abstract][Full Text]
79. Alam M, Le D, Son T, et al. AV-Net: deep learning for fully automated artery-vein classification in optical coherence tomography angiography. Biomed Opt Express. 2020 Sep 1;11(9):5249-57.[Abstract][Full Text]
80. Waheed NK, Rosen RB, Jia Y, et al. Optical coherence tomography angiography in diabetic retinopathy. Prog Retin Eye Res. 2023 Nov;97:101206.[Abstract][Full Text]
81. Mizener JB, Podhajsky P, Hayreh SS. Ocular ischemic syndrome. Ophthalmology. 1997 May;104(5):859-64.[Abstract]
82. Claster S, Vichinsky EP. Managing sickle cell disease. BMJ. 2003 Nov 15;327(7424):1151-5.[Abstract]
83. Leitão Guerra RL, Leitão Guerra CL, Bastos MG, et al. Sickle cell retinopathy: what we now understand using optical coherence tomography angiography. A systematic review. Blood Rev. 2019 May;35:32-42.[Abstract]
84. Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs: an extension of the modified Airlie House classification. ETDRS report number 10. Ophthalmology. 1991 May;98(5 Suppl):786-806.[Abstract]
85. Silva PS, Horton MB, Clary D, et al. Identification of diabetic retinopathy and ungradable image rate with ultrawide field imaging in a national teleophthalmology program. Ophthalmology. 2016 Jun;123(6):1360-7.[Abstract]
86. Bragge P, Gruen RL, Chau M, et al. Screening for presence or absence of diabetic retinopathy: a meta-analysis. Arch Ophthalmol. 2011 Apr;129(4):435-44.[Abstract][Full Text]
87. Walton OB 4th, Garoon RB, Weng CY, et al. Evaluation of automated teleretinal screening program for diabetic retinopathy. JAMA Ophthalmol. 2016 Feb;134(2):204-9.[Abstract][Full Text]
88. American Academy of Ophthalmology. Preferred practice patterns: retina summary benchmarks - 2025. Dec 2025 [internet publication].[Full Text]
89. Lueder GT, Silverstein J; American Academy of Pediatrics Section on Ophthalmology and Section on Endocrinology. Screening for retinopathy in the pediatric patient with type 1 diabetes mellitus. Pediatrics. 2005 Jul;116(1):270-3.[Abstract][Full Text]
90. Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: a position statement by the American Diabetes Association. Diabetes Care. 2017 Mar;40(3):412-8.[Abstract][Full Text]
91. National Institute for Health and Care Excellence. Diabetic retinopathy: management and monitoring. Aug 2024 [internet publication].[Full Text]
92. Jorge EC, Jorge EN, Botelho M, et al. Monotherapy laser photocoagulation for diabetic macular oedema. Cochrane Database Syst Rev. 2018 Oct 15;10(10):CD010859.[Abstract][Full Text]
93. Maturi RK, Glassman AR, Josic K, et al. Effect of intravitreous anti-vascular endothelial growth factor vs sham treatment for prevention of vision-threatening complications of diabetic retinopathy: the Protocol W randomized clinical trial. JAMA Ophthalmol. 2021 Jul 1;139(7):701-12.[Abstract][Full Text]
94. Baker CW, Glassman AR, Beaulieu WT, et al. Effect of initial management with aflibercept vs laser photocoagulation vs observation on vision loss among patients with diabetic macular edema involving the center of the macula and good visual acuity: a randomized clinical trial. JAMA. 2019 May 21;321(19):1880-94.[Abstract][Full Text]
95. Lim JI, Kim SJ, Bailey ST, et al. Diabetic retinopathy preferred practice pattern®. Ophthalmology. 2025 Apr;132(4):P75-162.[Abstract][Full Text]
96. Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Ophthalmology. 1991 May;98(5 Suppl):766-85.[Abstract]
97. Macaron MM, Al Sabbakh N, Shami MZ, et al. Anti-VEGF injections vs. panretinal photocoagulation laser therapy for proliferative diabetic retinopathy: a systematic review and meta-analysis. Ophthalmol Retina. 2025 Feb;9(2):105-21.[Abstract]
98. The Diabetic Retinopathy Study Research Group. Indications for photocoagulation treatment of diabetic retinopathy: Diabetic Retinopathy Study Report no. 14. Int Ophthalmol Clin. 1987 Winter;27(4):239-53.[Abstract]
99. The Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy: the second report of diabetic retinopathy study findings. Ophthalmology. 1978 Jan;85(1):82-106.[Abstract][Full Text]
100. The Diabetic Retinopathy Study Research Group. Four risk factors for severe visual loss in diabetic retinopathy. The third report from the Diabetic Retinopathy Study. Arch Ophthalmol. 1979 Apr;97(4):654-5.[Abstract]
101. Writing Committee for the Diabetic Retinopathy Clinical Research Network. Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy. JAMA. 2015 Nov 24;314(20):2137-46.[Abstract]
102. Gross JG, Glassman AR, Liu D, et al. Five-year outcomes of panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial. JAMA Ophthalmol. 2018 Oct 1;136(10):1138-48.[Abstract][Full Text]
103. Martinez-Zapata MJ, Salvador I, Martí-Carvajal AJ, et al. Anti-vascular endothelial growth factor for proliferative diabetic retinopathy. Cochrane Database Syst Rev. 2023 Mar 20;3(3):CD008721.[Abstract][Full Text]
104. Yates WB, Mammo Z, Simunovic MP. Intravitreal anti-vascular endothelial growth factor versus panretinal LASER photocoagulation for proliferative diabetic retinopathy: a systematic review and meta-analysis. Can J Ophthalmol. 2021 Dec;56(6):355-63.[Abstract]
105. Fallico M, Maugeri A, Lotery A, et al. Intravitreal anti-vascular endothelial growth factors, panretinal photocoagulation and combined treatment for proliferative diabetic retinopathy: a systematic review and network meta-analysis. Acta Ophthalmol. 2021 Sep;99(6):e795-805.[Abstract][Full Text]
106. Zhang W, Geng J, Sang A. Effectiveness of panretinal photocoagulation plus intravitreal anti-VEGF treatment against PRP alone for diabetic retinopathy: a systematic review with meta-analysis. Front Endocrinol (Lausanne). 2022;13:807687.[Abstract][Full Text]
107. Early Treatment Diabetic Retinopathy Study research group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Arch Ophthalmol. 1985 Dec;103(12):1796-806.[Abstract]
108. Do DV, Nguyen QD, Boyer D, et al; da Vinci Study Group. One-year outcomes of the da Vinci Study of VEGF Trap-Eye in eyes with diabetic macular edema. Ophthalmology. 2012 Aug;119(8):1658-65.[Abstract]
109. Brown DM, Nguyen QD, Marcus DM, et al. Long-term outcomes of ranibizumab therapy for diabetic macular edema: the 36-month results from two phase III trials: RISE and RIDE. Ophthalmology. 2013 Oct;120(10):2013-22.[Abstract][Full Text]
110. Diabetic Retinopathy Clinical Research Network, Elman MJ, Aiello LP, et al. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2010 Jun;117(6):1064-1077.e35.[Abstract]
111. The Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study Report no. 4. Int Ophthalmol Clin. 1987 Winter;27(4):265-72.[Abstract]
112. Glassman AR, Baker CW, Beaulieu WT, et al. Assessment of the DRCR retina network approach to management with initial observation for eyes with center-involved diabetic macular edema and good visual acuity: a secondary analysis of a randomized clinical trial. JAMA Ophthalmol. 2020 Apr 1;138(4):341-9.[Abstract][Full Text]
113. Virgili G, Parravano M, Evans JR, et al. Anti-vascular endothelial growth factor for diabetic macular oedema: a network meta-analysis. Cochrane Database Syst Rev. 2018 Oct 16;10(10):CD007419.[Abstract][Full Text]
114. Simmonds M, Llewellyn A, Walker R, et al. Anti-VEGF drugs compared with laser photocoagulation for the treatment of proliferative diabetic retinopathy: a systematic review and individual participant data meta-analysis. Health Technol Assess. 2025 Apr;29(23):1-75.[Abstract]
115. Virgili G, Curran K, Lucenteforte E, et al. Anti-vascular endothelial growth factor for diabetic macular oedema: a network meta-analysis. Cochrane Database Syst Rev. 2023 Jun 27;2023(6):CD007419.[Abstract][Full Text]
116. Chen H, Shi X, Zhang W, et al. Aflibercept versus ranibizumab for diabetic macular edema: a meta-analysis. Eur J Ophthalmol. 2024 May;34(3):615-23.[Abstract][Full Text]
117. Wang X, He X, Qi F, et al. Different anti-vascular endothelial growth factor for patients with diabetic macular edema: a network meta-analysis. Front Pharmacol. 2022;13:876386.[Abstract][Full Text]
118. Brown DM, Boyer DS, Do DV, et al. Intravitreal aflibercept 8 mg in diabetic macular oedema (PHOTON): 48-week results from a randomised, double-masked, non-inferiority, phase 2/3 trial. Lancet. 2024 Mar 23;403(10432):1153-63.[Abstract]
119. Khanani AM, Campochiaro PA, Graff JM, et al. Continuous ranibizumab via port delivery system vs monthly ranibizumab for treatment of diabetic macular edema: the Pagoda randomized clinical trial. JAMA Ophthalmol. 2025 Apr 1;143(4):326-35.[Abstract][Full Text]
120. American Academy of Ophthalmology. The use of biosimilars in ophthalmic practice - 2022. Jan 2022 [internet publication].[Full Text]
121. Boyer DS, Yoon YH, Belfort R Jr, et al; Ozurdex MEAD Study Group. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology. 2014 Oct;121(10):1904-14.[Abstract][Full Text]
122. Campochiaro PA, Brown DM, Pearson A, et al. Sustained delivery fluocinolone acetonide vitreous inserts provide benefit for at least 3 years in patients with diabetic macular edema. Ophthalmology. 2012 Oct;119(10):2125-32.[Abstract][Full Text]
123. Rittiphairoj T, Mir TA, Li T, et al. Intravitreal steroids for macular edema in diabetes. Cochrane Database Syst Rev. 2020 Nov 17;11(11):CD005656.[Abstract][Full Text]
124. Hatz K, Ebneter A, Tuerksever C, et al. Repeated dexamethasone intravitreal implant for the treatment of diabetic macular oedema unresponsive to anti-VEGF therapy: outcome and predictive SD-OCT features. Ophthalmologica. 2018;239(4):205-14.[Abstract][Full Text]
125. Totan Y, Güler E, Gürağaç FB. Dexamethasone intravitreal implant for chronic diabetic macular edema resistant to intravitreal bevacizumab treatment. Curr Eye Res. 2016;41(1):107-13.[Abstract]
126. Lau PE, Jenkins KS, Layton CJ. Current evidence for the prevention of endophthalmitis in Anti-VEGF intravitreal injections. J Ophthalmol. 2018;2018:8567912.[Abstract][Full Text]
127. Bates B, Fitzpatrick J, Rosanky C, et al. Endophthalmitis incidence after intravitreal injection of anti-VEGF agents with povidone-iodine versus aqueous chlorhexidine antisepsis. Ophthalmol Retina. 2025 Oct;9(10):928-33.[Abstract]
128. Merani R, McPherson ZE, Luckie AP, et al. Aqueous chlorhexidine for intravitreal injection antisepsis: a case series and review of the literature. Ophthalmology. 2016 Dec;123(12):2588-94.[Abstract][Full Text]
129. Monés J, Srivastava SK, Jaffe GJ, et al. Risk of inflammation, retinal vasculitis, and retinal occlusion-related events with brolucizumab: post hoc review of HAWK and HARRIER. Ophthalmology. 2021 Jul;128(7):1050-9.[Abstract][Full Text]
130. Rice TA, Michels RG, Rice EF. Vitrectomy for diabetic traction retinal detachment involving the macula. Am J Ophthalmol. 1983 Jan;95(1):22-33.[Abstract]
131. Thompson JT, de Bustros S, Michels RG, Rice TA. Results and prognostic factors in vitrectomy for diabetic traction-rhegmatogenous retinal detachment. Arch Ophthalmol. 1987 Apr;105(4):503-7.[Abstract]
132. Anguita R, Ferro Desideri L, Schwember P, et al. Early versus delayed vitrectomy for vitreous hemorrhage secondary to proliferative diabetic retinopathy. Am J Ophthalmol. 2025 Feb;270:237-44.[Abstract][Full Text]
133. Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomized trial: Diabetic Retinopathy Vitrectomy Study report 3. Ophthalmology. 1988 Oct;95(10):1307-20.[Abstract]
134. Diabetic Retinopathy Vitrectomy Study Group. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Four-year results of a randomized trial. Diabetic Retinopathy Vitrectomy Study report 5. Arch Ophthalmol. 1990 Jul;108(7):958-64.[Abstract]
135. Tan Y, Fukutomi A, Sun MT, et al. Anti-VEGF crunch syndrome in proliferative diabetic retinopathy: A review. Surv Ophthalmol. 2021 Nov-Dec;66(6):926-32.[Abstract][Full Text]
136. Arevalo JF, Maia M, Flynn HW Jr, et al. Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy. Br J Ophthalmol. 2008 Feb;92(2):213-6.[Abstract]
137. Bressler NM, Beaulieu WT, Bressler SB, et al. Anti-vascular endothelial growth factor therapy and risk of traction retinal detachment in eyes with proliferative diabetic retinopathy: pooled analysis of five DRCR retina network randomized clinical trials. Retina. 2020 Jun;40(6):1021-8.[Abstract]
138. Jacobson DR, Murphy RP, Rosenthal AR. The treatment of angle neovascularization with panretinal photocoagulation. Ophthalmology. 1979 Jul;86(7):1270-7.[Abstract]
139. Hercules BL, Gayed II, Lucas SB, et al. Peripheral retinal ablation in the treatment of proliferative diabetic retinopathy: a three-year interim report of a randomised, controlled study using the argon laser. Br J Ophthalmol. 1977 Sep;61(9):555-63.[Abstract][Full Text]
140. Ferris F. Early photocoagulation in patients with either type I or type II diabetes. Trans Am Ophthalmol Soc. 1996;94:505-37.[Abstract][Full Text]
141. Diabetic Retinopathy Clinical Research Network, Wells JA, Glassman AR, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 2015 Mar 26;372(13):1193-203.[Abstract][Full Text]
142. Nguyen QD, Brown DM, Marcus DM, et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012 Apr;119(4):789-801.[Abstract][Full Text]
143. Korobelnik JF, Do DV, Schmidt-Erfurth U, et al. Intravitreal aflibercept for diabetic macular edema. Ophthalmology. 2014 Nov;121(11):2247-54.[Abstract][Full Text]
144. Chen KY, Chan HC, Chan CM. Which treatment modality offers the best outcomes for diabetic retinopathy? a systematic review and network meta-analysis. Diabetes Res Clin Pract. 2025 Sep;227:112379.[Abstract]
145. Jackson ML, Virgili G, Shepherd JD, et al. Vision Rehabilitation Preferred Practice Pattern. Ophthalmol. 2023 Mar;130(3):P271-335.[Full Text]
146. Codina CJ, Rhodes M. Low vision services provision throughout NHS Trusts in the UK. Br Ir Orthopt J. 2023 Aug 8;19(1):64-70.[Abstract][Full Text]
147. Klier S, Dananberg J, Masaki L, et al. Safety and efficacy of senolytic UBX1325 in diabetic macular edema. NEJM Evid. 2025 May;4(5):EVIDoa2400009.[Abstract]
148. ClinicalTrials.gov. A study to evaluate the efficacy and safety of OTX-TKI (axitinib implant) in participants with non-proliferative diabetic retinopathy (HELIOS-3). NCT07235085. Mar 2026 [internet publication].[Full Text]
149. ClinicalTrials.gov. Study of EYP-1901 in patients with nonproliferative diabetic retinopathy (NPDR). NCT05383209. Aug 2025 [internet publication].[Full Text]
150. Almeida DRP, Ribeiro R. PAVIA phase 2 trial of EYP-1901 in nonproliferative diabetic retinopathy: 12-month results. Invest Ophthalmol Vis Sci. 2025 Jun;66(8):4762.
151. ClinicalTrials.gov. A study to evaluate the efficacy and safety of tarcocimab tedromer compared with sham treatment in participants with diabetic retinopathy (DR) (GLOW2). NCT06270836. Mar 2025 [internet publication].[Full Text]
152. Stefansson E, Loftsson T, Larsen M, et al. Topical treatment of diabetic macular edema using dexamethasone ophthalmic suspension: a randomized, double-masked, vehicle-controlled study. Acta Ophthalmol. 2023 Feb;101(1):22-33.[Abstract][Full Text]
153. Euretina. 60-week results from 4D-150 "SPECTRA" treatment for DME phase 3 data reports sustained visual acuity gains. Aug 2025 [internet publication].[Full Text]
154. ClinicalTrials.gov. RGX-314 gene therapy administered in the suprachoroidal space for participants with diabetic retinopathy (DR) with and without center involved-diabetic macular edema (CI-DME) (ALTITUDE®). NCT04567550. Sep 2025 [internet publication].[Full Text]
155. American Academy of Ophthalmology. Comprehensive adult medical eye evaluation: preferred practice pattern. Feb 2026 [internet publication].[Full Text]
156. Hutchinson AK, Morse CL, Hercinovic A, et al. Pediatric eye evaluations Preferred Practice Pattern. Ophthalmology. 2023 Mar;130(3):P222-70.[Abstract][Full Text]
157. Tan L, Wang J, Han J, et al. Socioeconomic deprivation and the risk of sight-threatening diabetic retinopathy: a population-based cohort study in the U.K. diabetes care. 2024 May 1;47(5):844-8.[Abstract]
158. Lane M, Mathewson PA, Sharma HE, et al. Social deprivation as a risk factor for late presentation of proliferative diabetic retinopathy. Clin Ophthalmol. 2015;9:347-52.[Abstract][Full Text]
159. Chaudhury AS, Ige M, Marwah S, et al. Race, social determinants of health, and the quality of diabetic eye care. JAMA Ophthalmol. 2024 Oct 1;142(10):961-70.[Abstract][Full Text]
160. Curran K, Piyasena P, Congdon N, et al. Inclusion of diabetic retinopathy screening strategies in national-level diabetes care planning in low- and middle-income countries: a scoping review. Health Res Policy Syst. 2023 Jan 2;21(1):2.[Abstract][Full Text]
161. Kramer CK, Rodrigues TC, Canani LH, et al. Diabetic retinopathy predicts all-cause mortality and cardiovascular events in both type 1 and 2 diabetes: meta-analysis of observational studies. Diabetes Care. 2011 May;34(5):1238-44.[Abstract][Full Text]
162. Klein BE, Klein R, Moss SE. Incidence of cataract surgery in the Wisconsin Epidemiological Study of Diabetic Retinopathy. Am J Ophthalmol. 1995 Mar;119(3):295-300.[Abstract]
163. Panozzo GA, Gusson E, Panozzo G, et al. Dexamethasone intravitreal implant at the time of cataract surgery in eyes with diabetic macular edema. Eur J Ophthalmol. 2017 Jun 26;27(4):433-7.[Abstract]
164. Chew EY, Benson WE, Remaley NA, et al. Results after lens extraction in patients with diabetic retinopathy: Early Treatment Diabetic Retinopathy Study (ETDRS) report number 25. Arch Ophthalmol. 1999 Dec;117(12):1600-6.[Abstract]
165. Novak MA, Rice TA, Michels RG, et al. Vitreous hemorrhage after vitrectomy for diabetic retinopathy. Ophthalmology. 1984 Dec;91(12):1485-9.[Abstract]
166. McDonald HR, Schatz H. Macular edema following panretinal photocoagulation. Retina. 1985 Winter-Spring;5(1):5-10.[Abstract]
167. Fong DS, Girach A, Boney A. Visual side effects of successful scatter laser photocoagulation surgery for proliferative diabetic retinopathy: a literature review. Retina. 2007 Sep;27(7):816-24.[Abstract]
168. Diabetes Control and Complications Trial Research Group. Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. Ophthalmology. 1995 Apr;102(4):647-61.[Abstract]
169. Preiss D, Logue J, Sammons E, et al. Effect of fenofibrate on progression of diabetic retinopathy. NEJM Evid. 2024 Aug;3(8):EVIDoa2400179.[Abstract]
