Highlights & Basics
- Sight-threatening signs of diabetic retinopathy include macular edema, retinal or optic disk new vessels, and vitreous hemorrhage.
- Main measures to prevent visual loss include improvement in glycemic, lipid, and hypertensive control, and the early identification of sight-threatening disease.
- Main therapies are intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents, panretinal laser photocoagulation, and vitrectomy surgery. Intravitreal corticosteroid and macular laser therapy may be considered for patients refractory to anti-VEGF agents.
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: new vessels elsewhere (red arrow), venous beading (blue arrow), intraretinal microvascular abnormality (green arrow)
Proliferative diabetic retinopathy: retrohyaloid hemorrhage (red arrow), venous beading (blue arrow), cluster hemorrhage (white circle), panretinal laser burns (black 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. Preferred practice pattern: diabetic retinopathy. Oct 2019 [internet publication].[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]
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]
American Diabetes Association. Standards of care in diabetes - 2024. Diabetes Care. 2024 Jan;47(suppl 1):S1-321.[Full Text]
American Academy of Ophthalmology. Preferred practice patterns: retina summary benchmarks. Dec 2023 [internet publication].[Full Text]
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