• Diabetic retinopathy (DR) is the leading cause of new cases of blindness among young adults in the United States.
• Retinopathy may not produce apparent symptoms until visual loss develops and, thus, early detection and treatment is important in reducing rates of diabetes-related vision problems.
• This study examined the feasibility and efficacy of using a non-mydriatic camera to screen for DR among youth with type 1 or type 2 diabetes.
• Of the 236 youths with type 1 or type 2 diabetes screened with non-mydriatic camera in this study, DR was detected in 3.8% and 9.1% were visually impaired.
• A non-mydriatic fundus camera is feasible and efficacious for DR screening in youth with diabetes.
• DR screening at routine endocrinology visits may be beneficial in managing youth with diabetes and preventing irreversible vision loss, particularly for those in regions where diabetes rates are high.

• Diabetic retinopathy (DR) has become increasingly common as the prevalence of diabetes has increased and early detection of DR is crucial to preventing blindness.
• Every patient with diabetes should have a comprehensive eye exam by an ophthalmologist or optometrist on at least an annual basis, and more frequently if the patient has significant DR.
• Fundus photography is a useful tool in the evaluation and monitoring of diabetic retinopathy but should not be used in place of an ophthalmic exam by an eye care professional.
• Fluorescein angiography is also a useful tool in the evaluation of ocular vasculature and can show areas of retinal nonperfusion in patients with diabetes.
• Optical coherence tomography is a fast, non-invasive technology that can produce very detailed images of the retina and is useful in the evaluation and treatment of diabetic macular edema.

Summary points

• There will be an estimated 552 million persons with diabetes globally by the year 2030, with over half of these individuals expected to develop diabetic retinopathy (DR).
• Telemedicine programs have the capability to distribute quality eye care to virtually any location and address the lack of access to ophthalmic services but there is a shortage of specially trained retinal image graders.
• Automatic retinal image analysis (ARIA) systems designed for use in telemedicine have the potential to provide automated real-time patient evaluation, predictive patient and population analyses and possible identification of previously unrecognized novel markers of disease risk.
• A major challenge to fully realizing the potential of this technology is the lack of a uniform validation for ARIA systems.
• Large-scale implementation of ARIA systems for DR will require the involvement of primary care providers and a simple action-oriented process to allow easy detection of referable ocular disease and prompt access to appropriate eye care services.

Summary points

• Ultra widefield fundus imaging, with both color photography and fluorescein dye angiography, enables views of the central and far peripheral retina.
• The ability to view areas not seen by standard photographic methods may enhance understanding of diabetic retinopathy (DR) severity and pathogenesis as well as allowing for future advances in treatment methods and decision-making.
• Treatment for diabetic eye disease has also seen an increase in the use of intravitreal anti-vascular endothelial growth factor medications and a decrease in the use of retinal laser photocoagulation.
• In this changing landscape, the role of peripheral retinal disease on DR progression, risk of vision loss, and indications for intervention becomes even more important to understand.
• As the population of diabetic individuals continues to grow worldwide, the ability to capture a widefield image in a single photograph may lead to improved diagnosis, grading, and treatment of diabetic eye disease.

• Diabetic retinopathy (DR) is the leading cause of new vision loss and legal blindness in working-aged patients in the United States and developed countries.
• Of the varying manifestations of DR, diabetic macular edema (DME) is the most frequent mechanism of vision loss in these patients.
• Optical coherence tomography (OCT) has allowed for characterization and monitoring of disease severity in DR, including DME, tractional retinal detachment, epiretinal membrane formation, and diabetic papillopathy.
• In clinical studies investigating the efficacy of anti-vascular endothelial growth factor therapy for the treatment of DME, central macular thickness as determined by OCT is routinely used as a primary study outcome.
• OCT has become integral in clinical decision-making in patients with DR. The case studies featured in this article reflect OCT findings commonly encountered in this patient population.

• Proliferative diabetic retinopathy (PDR) is characterized by neovascularization of the disk or neovascularization elsewhere.
• The prevalence of PDR in the United States has been reported as 1.5% in diabetics over 40 years of age. Type I diabetics have a higher prevalence of PDR.
• Risk factors include: hyperglycemia, duration since diagnosis of diabetes, pregnancy, smoking, cardiovascular risk factors, and renal disease.
• Anti-vascular endothelial growth factor (VEGF) drugs may be used as a temporizing measure to decrease vessel leakage and induce regression of neovascularization (both anterior segment and retinal).
• Anti-VEGF therapy is beneficial as an adjunct to laser photocoagulation, either to cause regression of vessels prior to vitrectomy in treatment refractory PDR, or to expedite resolution of neovascularization of the angle.
• Dilated fundus exam is recommended every 2–3 months for PDR not classified as high risk. More frequent follow-up is needed for high-risk PDR. Pregnant women with PDR should have dilated exams monthly.

• Nonproliferative diabetic retinopathy (NPDR) is characterized by dot/blot hemorrhages, flame-shaped hemorrhages, microaneurysms, hard exudates, cotton wool spots, venous beading, venous loops, and intraretinal microvascular anomalies.
• The major risk factor for development of diabetic retinopathy is duration of diabetes as well as poor control of blood glucose and systemic hypertension.
• Diabetic retinopathy results from microvasculopathy believed to be related to the accumulation of advanced glycation end products.
• Patients with diabetes mellitus (DM) type I should have comprehensive eye exam at 20 years of age. Patients with DM type II should be examined at time of diagnosis with diabetes.
• Prognosis and management depend largely on severity of NPDR.
• Treatment focuses on strict control of blood glucose, hypertension, and lipids. Further lifestyle modifications including diet, exercise, and smoking cessation should be encouraged.