Diabetic Retinopathy

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
	Credits

What is diabetic retinopathy?

Many people with diabetes develop a problem with their eyes called diabetic retinopathy. Diabetes damages the small blood vessels in the retina. This is the part of the eye that captures images and sends the information to your brain. Diabetic retinopathy can lead to poor vision and even blindness. You can help avoid damage to the retina by keeping your blood sugar and blood pressure levels near normal. This can slow the progress of retinopathy and prevent vision loss.

Diabetic retinopathy is a progressive condition. During the early stage, the tiny blood vessels in the eye weaken. The blood vessels develop small bulges that may burst and leak into the retina and into the gel-like fluid inside the eye called the vitreous gel.

As the condition progresses, new fragile blood vessels grow on the surface of the retina. This is called proliferative retinopathy. These abnormal blood vessels may break easily, bleeding into the middle of the eye and clouding vision. This bleeding can also cause scar tissue to form, which can pull on the retina and cause the retina to detach from the wall of the eye (retinal detachment).

See an illustration of the eye .

What causes diabetic retinopathy?

Diabetic retinopathy develops when high blood sugar damages the tiny blood vessels of the retina. These blood vessels weaken and develop small bulges, which may burst and leak into the retina. Later, new fragile blood vessels grow on the surface of the retina that may break and bleed into the eye, clouding vision and causing scar tissue to form.

What are the symptoms?

Symptoms occasionally occur early in the disease, but typically they are not noticed until significant damage has occurred and complications have developed. Regular screening exams can identify diabetic retinopathy early in the disease and can help prevent vision loss.

Complications of diabetic retinopathy include swelling in the central part of the retina (macular edema) and retinal detachment. If the disease progresses, permanent damage to the retina and other parts of the eye can develop, leading to severe vision loss or blindness.

How is diabetic retinopathy diagnosed?

Regular screening for eye disease can detect retinopathy before it damages vision. You may not notice symptoms until the disease becomes severe or a complication develops.

The American Diabetes Association recommends screening starting at age 10 or within 3 to 5 years after diagnosis of type 1 diabetes, immediately after diagnosis of type 2 diabetes, and during the first 3 months of pregnancy for a woman who has diabetes. Some experts recommend that an eye exam be done immediately after a person is diagnosed with type 1 diabetes.

People with diabetes should have their eyes examined by an eye specialist (ophthalmologist or optometrist) every year, even if they do not have symptoms of eye disease. However, your eye doctor may decide that you should be examined more or less often, depending on the results of your initial exam. Follow your doctor's instructions.

Many people with diabetes do not have yearly eye exams to check for diabetic retinopathy (or other eye diseases caused by diabetes). As a result, they do not find out that they have the condition until significant vision loss is likely to occur or has already occurred.

Can diabetic retinopathy be prevented?

You can prevent vision loss due to diabetic retinopathy by keeping your blood sugar levels and blood pressure near normal. This can help lower your chance of developing damage to small blood vessels, which decreases the risk of damage to the retina. It can also help slow the progression of retinopathy, if it is already present, and prevent future vision loss.

Experts believe that many cases of vision loss and blindness could be prevented with early detection and treatment and careful long-term follow-up care.¹

How is it treated?

Laser treatment (photocoagulation) is usually very effective in preventing vision loss if it is done before the retina has been severely damaged. Surgical removal of the vitreous gel (vitrectomy) may also help improve vision if the retina has not been severely damaged. At this time, there is no cure for diabetic retinopathy.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Actionsets are designed to help people take an active role in managing a health condition.
	Caring for yourself when you have diabetes and poor vision
	Managing poor eyesight from diabetes

Diabetes damages small blood vessels throughout the body, leading to reduced blood flow. When these changes affect the tiny blood vessels in the eyes, diabetic retinopathy may develop.

In the early stage of diabetic retinopathy, tiny blood vessels in the eye weaken and develop small bulges that may burst and leak into the retina. Later, new fragile blood vessels grow on the surface of the retina. These blood vessels may break and bleed into the eye, clouding vision and causing scar tissue to form.

The scar tissue may pull on the retina, leading to retinal detachment. Retinal detachment occurs when the two layers of the retina become separated from each other and from the wall of the eye. This can lead to vision loss.

You may have diabetic retinopathy for a long time without noticing any symptoms. Typically, retinopathy does not cause noticeable symptoms until significant damage has occurred and complications have developed.

Symptoms of diabetic retinopathy and its complications may include:

• Blurred or distorted vision or difficulty reading.
• Floaters or flashes of light in your field of vision.
• Partial or total loss of vision or a shadow or veil across your field of vision.
• Pain in the eye.

Diabetic retinopathy begins as a mild disease. During the early stage of the disease, the small blood vessels in the retina become weaker and develop small bulges called microaneurysms. These microaneurysms are the earliest signs of retinopathy and may appear a few years after the onset of diabetes. They may also burst and cause tiny blood spots (hemorrhages) on the retina; however, they do not usually cause symptoms or affect vision.

As retinopathy progresses, fluid and protein leak from the damaged blood vessels and cause the retina to swell. This may cause mild to severe vision loss, depending on which parts of the retina are affected. If the center of the retina (macula) is affected, vision loss can be severe. Swelling and distortion of the macula (macular edema), which may result from a buildup of fluid, is the most dangerous complication of retinopathy.

In some people retinopathy progresses over the course of several years. In these cases, reduced blood flow to the retina stimulates the growth (proliferation) of fragile new blood vessels on the surface of the retina. This is called proliferative diabetic retinopathy. As the new blood vessels multiply, one or more complications may develop and damage the person's vision. These complications can include:

• The formation of scar tissue that pulls on the retina, which may lead to retinal detachment.
• Bleeding inside the eye (preretinal or vitreous hemorrhage).
• The growth of new blood vessels on the surface of the iris (rubeosis iridis), which eventually leads to a form of severe glaucoma called neovascular glaucoma.

Any of these later complications may cause severe, permanent vision loss.

Your risk of developing diabetic retinopathy depends largely on two factors: how long you have had diabetes and what type of diabetes you have.

The longer you have diabetes, the more likely you are to develop diabetic retinopathy. In addition, people with type 1 diabetes are more likely to develop diabetic retinopathy than people with type 2 diabetes.

• Of people with type 1 diabetes, 60% have some signs of retinopathy after 10 years, and almost all have retinopathy after 20 years.² About 53% develop the advanced stage called proliferative retinopathy after 20 years.³
• About 21% of people with type 2 diabetes have retinopathy at the time their diabetes is diagnosed, and about 60% develop it after 20 years.²

You can't control some risk factors for diabetic retinopathy. These include:

• A family history of diabetic retinopathy. Your risk of developing retinopathy is higher if you have a close relative with diabetes who has retinopathy.
• Kidney disease (nephropathy). Damage to the blood vessels in the kidneys is a common long-term complication of diabetes. Retinopathy is more likely to be present in people with diabetes who already have excess protein in their urine, an early sign of kidney disease.

You can control some risk factors that may increase your risk for diabetic retinopathy and its complications. Risk factors that you can control include:

• Pregnancy. Women who have diabetes are at increased risk of developing retinopathy during pregnancy. In about half of women who already have retinopathy when they become pregnant, the condition becomes worse during pregnancy.⁴
• Consistently high blood sugar. Long-term studies show that high blood sugar levels increase your risk of retinopathy. Keeping your blood sugar level near normal can reduce your risk of diabetic retinopathy and can slow the progression of the disease if it has already developed.
• High blood pressure. In general, people with diabetes who also have high blood pressure are more likely to develop complications that affect the blood vessels in the body, including those in the eyes. The results of long-term studies suggest that retinopathy is more likely to progress to the severe (proliferative) form of the disease and to macular edema in people who have high blood pressure.^{5, 4}
• Delayed diagnosis and treatment. Getting yearly eye exams cannot prevent retinopathy, but it may reduce your risk of severe vision loss from complications of retinopathy. Early treatment can prevent vision loss and delay the progression of the disease.
• High cholesterol. Some studies suggest that having a high cholesterol level increases the risk of retinopathy. However, it is not known whether reducing high cholesterol levels affects the progression of retinopathy over time.⁴
• Smoking. Some studies suggest that smoking may increase the risk of retinopathy in people with diabetes.

Call your doctor immediately if you have diabetes and notice:

• Floaters in your field of vision. Floaters often appear as dark specks, globs, strings, or dots. A sudden shower of floaters may be a sign of a retinal detachment, which is a serious complication of diabetic retinopathy.
• Flashes of light or sparks when you move your eyes or head. These are easier to see against a dark background. Brief flashes of light may be a sign that scar tissue or the vitreous gel is pulling on the retina, which can sometimes cause a retinal detachment.
• A new visual defect, shadow, or curtain across part of your vision that does not go away. This is another sign of retinal detachment.
• Eye pain or a feeling of pressure in your eye.
• New or sudden vision loss. The sudden onset of partial or complete vision loss is a symptom of many disorders that can occur within or outside the eye, including retinal detachment or bleeding within the eye. Sudden vision loss is always a medical emergency.

Watchful Waiting

Watchful waiting is not an option if you have diabetes and notice changes in your vision.

If you have diabetes, even if you do not have any symptoms of eye disease, you still need to have your eyes and vision checked every year by an eye specialist (ophthalmologist or optometrist). If you wait until you have symptoms, it is more likely that complications and severe damage to the retina will have already developed. These may be more difficult to treat and may result in permanent vision loss.

Watchful waiting is not an option if you already have diabetic retinopathy but do not have symptoms or vision loss. You will need to return to your ophthalmologist for frequent evaluations (every few months in some cases) so that your doctor can closely monitor changes in your eyes. There is no cure for the disease, but treatment can slow its progression. Your ophthalmologist can tell you how often you need to be evaluated.

Who To See

People with diabetes need to see a health professional who specializes in eye care for their eye evaluations.

• Ophthalmologist
• Optometrist

If you have diabetic retinopathy and need laser treatment or surgery, you need to consult an ophthalmologist who specializes in treating the retina and has special training in the care of eye disease caused by diabetes.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Diabetic retinopathy can be detected during an exam by an ophthalmologist or optometrist. An exam by your primary doctor, during which your eyes are not dilated, is not an adequate substitute for a full exam done by an ophthalmologist. Eye exams for people with diabetes should include:

• Visual acuity testing. Visual acuity testing measures the eye's ability to focus and to see details at near and far distances. It can help detect vision loss and other problems.
• Ophthalmoscopy and slit lamp exam. These tests allow your doctor to see the back of the eye and other structures within the eye. They may be used to detect clouding of the lens (cataract), changes in the retina, and other problems.
• Gonioscopy. Gonioscopy is used to determine whether the area where fluid drains out of your eye (called the drainage angle) is open or closed. This test is done if your doctor thinks you may have glaucoma, a group of eye diseases that can cause blindness by damaging the optic nerve.
• Tonometry. This test measures the pressure inside the eye, which is called intraocular pressure (IOP). It is used to help detect glaucoma. Diabetes can increase your risk of glaucoma.

Your doctor may also perform a test called fluorescein angiogram to check for and locate leaking blood vessels in the retina, especially if you have symptoms, such as blurred or distorted vision, that suggest damage to or swelling of the retina.

Fundus photography can track changes in the eye over time in people who have diabetic retinopathy and especially in those who have been treated for it. Fundus photography produces accurate pictures of the back of the eye (the fundus). An eye doctor can compare photographs taken at different times to monitor the progression of the disease and evaluate the effectiveness of treatment.

Early Detection

Early detection and treatment of diabetic retinopathy can help prevent vision loss. For people in whom diabetic retinopathy has not been diagnosed, the American Diabetes Association recommends that screening be done based on the following guidelines:²

• People with type 1 diabetes who are age 10 and older should have an eye exam within 3 to 5 years after diabetes is diagnosed and then once per year.
• People with type 2 diabetes should have an exam as soon as diabetes is diagnosed and then once per year. Your eye doctor may consider follow-up exams every 2 years if you do not have a high risk for vision damage.
• Women with type 1 or type 2 diabetes who become pregnant should have an exam before becoming pregnant, if possible, and then once during the first 3 months (first trimester) of pregnancy. The eye doctor can decide whether you need further screening for retinopathy during pregnancy based on the results of the first-trimester exam.

Note: Pregnant women who develop gestational diabetes are not at risk for diabetic retinopathy and do not need to be screened for it. (However, women who develop gestational diabetes during pregnancy have a greater chance of developing type 2 diabetes later in life, which can put them at increased risk for retinopathy and other eye problems.)

People who have diabetes are also at increased risk for other eye diseases, including glaucoma and cataracts. Regular eye exams can help detect these diseases early and prevent or delay vision loss.

There is no cure for diabetic retinopathy. However, laser treatment (photocoagulation) is usually very effective at preventing vision loss if it is done before the retina has been severely damaged. Surgical removal of the vitreous gel (vitrectomy) may also help improve vision if the retina has not been severely damaged. Because symptoms may not develop until the disease becomes severe, early detection through regular screening is important. The earlier retinopathy is detected, the easier it is to treat and the more likely vision will be preserved.

You may not need treatment for diabetic retinopathy unless it has affected the center (macula) of the retina or, in rare cases, if your side (peripheral) vision has been severely damaged. However, you need to have your vision checked every year.

If the macula has been damaged by macular edema, you may need laser treatment. Surgical removal of the vitreous gel (vitrectomy) is done only when there is bleeding (vitreous hemorrhage) or retinal detachment, which are rare in people with early-stage retinopathy. Vitrectomy is also done when there is severe scar tissue formation.

For more severe retinopathy, you may need either laser treatment or vitrectomy. These procedures can help prevent, stabilize, or slow vision loss when they are done before the retina has been severely damaged.

Treatment for diabetic retinopathy is often very effective in preventing, delaying, or reducing vision loss, but it is not a cure for the disease. People who have been treated for diabetic retinopathy need to be monitored frequently by an eye doctor to check for new changes in their eyes. Many people with diabetic retinopathy need to be treated more than once as the condition progresses.

Ideally, laser treatment should be done early in the course of the disease to prevent serious vision loss rather than to try to treat serious vision loss after it has already developed.

People with diabetes who have any signs of retinopathy need to be examined as soon as possible by an ophthalmologist.

There are steps you can take to reduce your chance of vision loss from diabetic retinopathy and its complications:

• Control your blood sugar levels. Long-term studies show that keeping blood sugar levels as close to normal as possible reduces the risk of the development and progression of retinopathy.^{6, 7} Keep blood sugar levels near normal by eating a diet that spreads carbohydrate throughout the day, frequently monitoring your blood sugar levels, getting regular physical exercise, and taking insulin or medicines for type 2 diabetes if prescribed. One study found that teens who kept their blood sugar levels near normal reduced their risk for developing diabetic retinopathy and also reduced kidney damage during young adulthood.⁸
• Control your blood pressure. Long-term studies suggest that retinopathy is more likely to progress to the severe form and that macular edema is more likely to occur in people who have high blood pressure. It is not clear whether treating high blood pressure can directly affect long-term vision but, in general, keeping blood pressure levels close to normal can reduce the risk of many different complications of diabetes.⁷ For more information about how to control your blood pressure, see the topic High Blood Pressure.
• Have your eyes examined by an eye specialist (ophthalmologist or optometrist) every year. Screening for diabetic retinopathy and other eye problems will not prevent diabetic eye disease, but it can help you avoid vision loss by allowing for early detection and treatment.
• See your eye doctor if you have changes in your vision. Changes in vision (such as floaters, flashes of light, pain or pressure in the eye, blurry or double vision, or new vision loss) may be symptoms of serious damage to your retina. In most cases, the sooner the problem can be treated, the more effective the treatment will be.

Many doctors suspect that the risk of developing severe retinopathy and vision loss may be reduced further if you:

• Reduce high cholesterol. It is not known whether reducing high cholesterol levels directly affects the progression of retinopathy and vision loss, but some studies suggest that high cholesterol may increase the risk of vision loss in people with diabetes.³
• Don't smoke. Although smoking has not been proven to increase the risk of retinopathy, smoking does increase your blood pressure and may aggravate many of the other health problems faced by people with diabetes, including disease of the small blood vessels.³
• Avoid hazardous activities. Certain physical activities, like weight lifting or some contact sports, may trigger bleeding in the eye through impact or increased pressure. Avoiding these activities when you have diabetic retinopathy can help reduce the risk of damage to your vision.
• Get adequate exercise. Exercise helps keep blood sugar levels near normal, which can reduce the risk of vision damage from diabetic retinopathy.⁹

You can help prevent or slow the progression of diabetic retinopathy. Even if you have vision loss, it is important for you to be an active participant in your daily diabetes care. The following key points can help you maintain an active and healthy lifestyle.

Keep blood sugar levels near normal

Keeping your blood sugar levels near normal is one of the most effective ways you can prevent or delay the worsening of diabetic retinopathy. Controlling your diet and getting adequate exercise can help keep your blood sugar levels near normal.⁹

• If you do not have signs of diabetic retinopathy, keeping your blood sugar levels near normal can help lower your risk for developing the condition by 76%.⁶
• If you already have diabetic retinopathy, keeping your blood sugar levels near normal can lower your risk for progression of the condition by 54% if you have type 1 diabetes and 20% to 25% if you have type 2 diabetes.³ For more information on controlling blood sugar levels, see the topics Type 1 Diabetes and Type 2 Diabetes: Living With the Disease.

Have regular eye exams

Your eye specialist can tell you how often you need to return for follow-up eye exams. Follow the schedule he or she recommends. Call for an earlier appointment if you notice any changes in your vision. These changes may be a sign that complications of diabetic retinopathy have developed. Remember, early detection and treatment can help prevent vision loss.

If you have diabetic retinopathy and are planning to become pregnant, have an eye exam sometime during the year before you become pregnant, and then have regular eye exams while you are pregnant.

If you have vision loss

You need to find ways to adapt so that you can use your remaining eyesight to its greatest potential.

• Have an eye evaluation. If your eye specialist has told you that your visual acuity is 20/70 or worse with glasses or contacts, have a complete low-vision evaluation done by a vision specialist. This evaluation will help you use your remaining vision and identify the kinds of vision aids that are most helpful for you.
• Make some changes. You can continue to do most—if not all—of your daily diabetes care and other activities even though your eyesight is not good and may fluctuate from day to day. Some simple tricks, such as using felt-tip markers to label your medicines and diabetic supplies, may be all that you need. If diabetic retinopathy has severely damaged your vision, there are vision aids that can help you with daily tasks. Use the information below to help you find the things that can help you remain independent and in control of your diabetes care.

  Caring for yourself when you have diabetes and poor vision

  Living with poor eyesight from diabetes

There are no medicines proven to prevent or slow the development of diabetic retinopathy. However, some medicines have been found to be helpful in preventing or delaying complications from diabetes.³

• Aspirin may prevent or delay the development of diabetic retinopathy. Once retinopathy develops, aspirin does not slow or stop the progression. People with diabetes can still take aspirin to prevent or delay diabetes complications related to damage of large blood vessels in the body, such as a heart attack or stroke. Aspirin does not increase the risk for bleeding within the eye.
• Angiotensin-converting enzyme (ACE) inhibitors may reduce the risk of progression of retinopathy.

Some medicines, such as aldose reductase inhibitors (for example, sorbinil and tolrestat), are not helpful in preventing or slowing the progression of diabetic retinopathy.³ Antioxidants, such as vitamin C, vitamin E, and beta-carotene, do not slow the progression of retinopathy in people with type 2 diabetes.

Growth-hormone inhibitors (such as octreotide) are being studied to see whether they might slow the progression of severe retinopathy and delay the need for laser surgery.¹⁰

Surgical removal of the vitreous gel (vitrectomy) is one of only two effective treatments for diabetic retinopathy. Laser treatment is the other. Vitrectomy does not cure the disease, but it may improve vision in people who have developed bleeding into the vitreous gel (vitreous hemorrhage), retinal detachment, or severe scar tissue formation.

Without either surgery or laser treatment, vision loss caused by diabetic retinopathy and its complications may progress until blindness occurs. Early treatment is therefore vital to slowing vision loss, which can happen quickly otherwise.

Unfortunately, by the time some people are diagnosed with retinopathy (especially late-stage retinopathy), it is often too late for vitrectomy or laser treatment to provide much benefit. Even with treatment, vision will continue to decline.

Early detection of retinopathy through yearly eye exams can help you decide to have surgery when it is most effective.

Surgery Choices

Vitrectomy is the surgical removal of the vitreous gel.

For more information about laser treatment (photocoagulation), see the Other Treatment section of this topic.

What To Think About

Vitreous surgery (vitrectomy) for diabetic retinopathy is effective in preventing vision loss when a person has bleeding into the vitreous gel (vitreous hemorrhage) or retinal detachment, but it is not a cure. This surgery is not usually done unless these complications or severe scar tissue has already developed.

Once a person has had most of the vitreous gel removed by vitrectomy, later surgery to remove scar tissue or to repair a new retinal detachment may be needed.

Vitrectomy is a more complicated procedure than laser treatment. It requires general anesthesia and, in some cases, an overnight hospital stay. Laser treatment is almost always an outpatient procedure.

Laser treatment (photocoagulation) can be an effective treatment for diabetic retinopathy, but it does not cure the disease. It can prevent, delay, and sometimes reverse vision loss. Without either laser treatment or surgery, vision loss caused by diabetic retinopathy and its complications may progress until blindness occurs. Early treatment is therefore vital to slowing vision loss, which can otherwise happen quickly.

When diabetic retinopathy causes bleeding (hemorrhage) into the vitreous gel, retinal detachment, or extensive scar tissue formation, surgical removal of the vitreous gel (vitrectomy) may be needed before laser treatment is considered.

Unfortunately, by the time some people are diagnosed with diabetic retinopathy, it is often too late for treatment to provide much benefit. Even with treatment, vision will continue to decline.

Early detection of retinopathy through yearly eye exams can provide the opportunity to have laser treatment when it is most effective.

Other Treatment Choices

Laser photocoagulation uses the heat from a laser to seal or destroy abnormal, leaking blood vessels in the retina.

What To Think About

Laser treatment (photocoagulation) can prevent or delay the progression of diabetic retinopathy, but it is not a cure.³

• Laser treatment for macular edema decreases the risk of moderate vision loss by 20% in people who have mild to moderate diabetic retinopathy.
• Scatter (pan-retinal) laser treatment is used to treat several spots on the retina during one or, most often, two sessions. It reduces the risk of serious bleeding and the progression of severe proliferative retinopathy. It also decreases the need for more invasive surgery (vitrectomy) by 50% in people with type 2 diabetes and people age 40 and older with type 1 diabetes who already have severe retinopathy.

Laser photocoagulation can result in some loss of vision because it destroys some of the nerve cells in the retina. With pan-retinal photocoagulation, this most often affects the outside (peripheral) vision since the laser is directed at that area. Your vision may be worse right after treatment. However, it is less likely to continue to get worse than if you were not treated at all.

Organizations

• Diabetic Nephropathy
• Diabetic Neuropathy
• Retinal Detachment
• Type 1 Diabetes
• Type 2 Diabetes
• Type 2 Diabetes: Living With Complications
• Type 2 Diabetes: Living With the Disease
• Type 2 Diabetes: Recently Diagnosed

Citations

1. Fong DS, et al. (2004). Diabetic retinopathy. Diabetes Care, 27(10): 2540–2553.

2. American Diabetes Association (2002). Diabetic retinopathy. Clinical Practice Recommendations 2002. Diabetes Care, 25(Suppl 1): S90–S93.

3. Begg IS, et al. (2001). Eye disease. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 396–428. Hamilton, ON: BC Decker.

4. Neely KA, et al. (1998). Diabetic retinopathy. Medical Clinics of North America, 82(4): 847–876.

5. Klein R, et al. (1998). The Wisconsin epidemiology study of diabetic retinopathy: XVII. The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes. Ophthalmology, 105(10): 1801–1815.

6. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group (2000). Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. New England Journal of Medicine, 342(6): 381–389.

7. Fong DS, et al. (2003). Diabetic retinopathy position statement. Diabetes Care, 26(Suppl 1): S99–S102.

8. Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group (2001). Beneficial effects of intensive therapy of diabetes during adolescence: Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). Journal of Pediatrics, 139(6): 804–812.

9. Colucciello M (2004). Diabetic retinopathy: Control of systemic factors preserves vision. Postgraduate Medicine, 116(1): 57–64.

10. Grant MB, et al. (2000). The efficacy of octreotide in the therapy of severe nonproliferative and early proliferative diabetic retinopathy. Diabetes Care, 23(4): 504–509.

Other Works Consulted

• Diabetes Control and Complications Trial Research Group (1998). Early worsening of diabetic retinopathy in the Diabetes Control and Complications Trial. Archives of Ophthalmology, 116(7): 874–886.

• Fong DS, et al. (2004). Retinopathy in diabetes: American Diabetes Association Position Statement. Diabetes Care, 27(Suppl 1): S84–S87.

• Frank RN (2004). Medical progress: Diabetic retinopathy. New England Journal of Medicine, 350(1): 48–58.

• Group Health Cooperative (2002). Diabetic retinal screening. Guidelines for Patients With Diabetes, pp. 45–53. Seattle: Group Health Cooperative.

• Harding S (2004). Diabetic retinopathy. Clinical Evidence (11): 849–859.

• Holl RW, et al. (1998). Diabetic retinopathy in pediatric patients with type 1 diabetes: Effect of diabetes duration, prepubertal and pubertal onset of diabetes, and metabolic control. Journal of Pediatrics, 132(5): 790–794.

• Kohner EM, et al. (1998). United Kingdom prospective diabetes study. Archives of Ophthalmology, 116(3): 297–303.

Author:	Christopher Hess	Last Updated April 22, 2005
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Ian MacDonald, MDCM, FRCSC - Ophthalmology
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information. For more information, click here.