Screening for diabetic retinopathy has been expanded from ophthalmology-based assessments. Retinal photography can be used in primary care by trained photographers, and then graded by trained staff using Telemedicine. Ultrawide retinal cameras can now capture over 80% of the retina from a single image. It may be more predictive of progression to proliferative retinopathy than the traditional views, but cost of equipment for benefit is unclear. There have been advances in Deep Learning for retinopathy grading which have been well studied from standard datasets and in study populations. Failure rate of retinal photography requires more face to face assessment. Optical coherence tomography (OCT) is useful for measurement of retinal thickness and detection of macular oedema. There are also more portable devices for retinal screening for diabetic retinopathy.
At the same time we are learning more about risk factors and biomarkers, which may help define more appropriate screening intervals for retinopathy progression. There are promising results of albumin creatinine ratio as a biomarker of increased risk for retinopathy progression from the AdDIT study. Another promising biomarker is retinovascular geometry with initial vasodilatation of arterioles and venules over the standard central field. Vitreous biomarkers have been shown to be angiogenic (VEGF) and antioangiogenic.
Anti-VEGF therapy used frequently and administered intraocularly has been shown to be superior to Laser therapy with less side effects. Laser panretinal photocoagulation therapy reduces peripheral vision, colour vision, contrast sensitivity, and night vision.
Prevention remains the major focus of diabetes management with glycaemic control and longer duration the major determinants of disease and loss of vision. Blood pressure control may reduce risks of severe disease.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology