Recognising and managing diabetic retinopathy

Key learning points • Detecting and diagnosing diabetic retinopathy is not complicated. There are clinical signs which can be seen with an ophthalmoscope or a slit lamp and 90or 78-dioptre lens. • Diabetic retinopathy is treatable. Treatment usually maintains vision, but does not restore vision that has alread y been lost. • In diabetic maculopathy, laser or anti-VEGF injections are both proven to work. Intravitreal steroid is ineffective in most patients. • Laser treatment should use small spots and just enough power to produce a visible reaction. • Proliferative retinopathy is best treated with pan-retinal laser. The commonest error is undertreatment, and laser should be applied until there is regression of the new vessels or there is no room for further treatment. • Vitrectomy is useful for vitreous haemorrhage and late complications of proliferative retinopathy. Pre-treatment with bevacizumab reduces the risk of surgical complications.