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Diabetic Retinopathy
Ahmed Sallam, MD PhD FRCOphth (UK)
Director Uveitis Service
Retina Specialist
Associate Professor of Ophthalmology
University of Arkansas for Medical Sciences
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Retinopathy & maculopathy classification
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Retinopathy features & levels (No DR = R0 / Level 10)
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Ci DME
Cn DME
CSME
nCSME
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Cni DMECi DME
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Follow up of patients with
diabetic retinopathy
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Retinopathy/
Maculopathy Severity
AAO Follow up
(Months)
Recommendation for
Optometrists
(Months)
Referral to Retina
Specialist
(Weeks)
Normal or
minima NPDR
12 12
Moderate NPDR 6-12 4-6
Severe NPDR 3 Refer to Retina
Specialist
4 weeks
PDR/ HRC PDR 3 vs. PRP Refer to Retina
Specialist
<1 week ……
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Retinopathy/
Maculopathy Severity
Follow up
(Months)
Recommendation for
Optometrists
(Months)
Referral to Retina
Specialist
(Weeks)
MA or heme only Based on DR grading Based on DR grading
Refer if decreased vision
20/40 or less
1-4 weeks
Maculopathy >
MA/heme
3-4 vs.Treatment Refer to Retina
Specialist
1-4 weeks
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Referral to Retina Specialist:
1. Severe NPDR or worse
2. Macular exudate ‘within arcades’
3. Macular thickening on OCT
4. Other urgent pathology clinically or by OCT e.g. VH, RD, etc..
5. Unexplained decreased vision