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Screening and Referral of Diabetic Retinopathy: A Comparative Review of the Practice Guidelines

Wan, Kelvin Ho-Nam MBChB; Chen, Li Jia PhD; Young, Alvin L. MMedSc(Hons), FRCSI

The Asia-Pacific Journal of Ophthalmology: September/October 2013 - Volume 2 - Issue 5 - p 310–316
doi: 10.1097/APO.0b013e31829df4a3
Review Article

Diabetic retinopathy (DR) is a leading cause of preventable visual impairment in the working age group. The major risk factors for development and progression are duration of disease and the severity of hyperglycemia. The Global Diabetic Retinopathy Project developed a new classification system for DR and macular edema to enhance communication and coordination among the multidisciplinary team of physicians taking care of diabetic patients. Diabetic retinopathy progresses from nonproliferative DR to proliferative DR through a series of stages. Early detection and timely referral are critical for timely interventions to prevent further deterioration. Primary care physicians have an integral role in the community as they are the first point of contact for patients. Guidelines from various associations provide recommendations to physicians taking care of diabetic patients on how to screen and situations where referral to an ophthalmologist is needed. Dilated direct ophthalmoscopy is a convenient method to assess the fundus, but it does not replace retinal photography in the screening of DR. All patients with proliferative DR and diabetic macular edema should be referred to an ophthalmologist, whereas the situation for nonproliferative DR remains unclear as no consensus was drawn from the various guidelines.

From the Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, New Territories; and Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.

Received for publication April 29, 2013; accepted May 29, 2013.

The authors have no funding or conflicts of interest to declare.

Reprints: Alvin L. Young, MMedSc(Hons), FRCSI, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. E-mail:

© 2013 by Asia Pacific Academy of Ophthalmology
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