SNAP SAMP:
Daisy, a 67-year-old woman with Type 2 diabetes, presents to your clinic with her daughter Skye (age 23) and her grandson Forrest, 9, who both have Type 1 diabetes. All three of them received a diagnosis of diabetes on November 1, the day after Halloween.
At what age do you recommend screening for diabetic retinopathy, and how often do you recommend screening, for
Daisy?
Skye?
Forrest?
Skye is planning to begin conception of a second child. What do you recommend regarding diabetic retinopathy screening?
Daisy read on her local seniors' Facebook group about the importance of antioxidants and asks if these are recommended for diabetic retinopathy. What do you reply?
Answers are below.
The Canadian Ophthalmological Society has released 2017 guidelines for primary care providers regarding screening for diabetic retinopathy. Here are some highlights: WHEN TO START AND HOW OFTEN? TYPE 1 every 1 year; TYPE 2 every 1-2 years**
RETINOP-UBERTY? TYPE 1 - START at puberty. If diagnosed after puberty, start 5 years after diagnosis. TYPE 2 - START at diagnosis. RETINOPA-THREE TIPS: 1) If considering pregnancy, get ophthalmic evaluation before attempting to conceive 2) Recommend Teleophthalmology for rural and remote patients (if available) 3) High-dose Antioxidant use is NOT helpful at preventing retinopathy Finally, KNOW and TREAT Risk factors for diabetic retinopathy:
High blood sugar
Hypertension
Dyslipidemia**
*Interestingly the evidence shows that every 2 years is OK - however the recommendation remains to screen every 1-2 years for fear of poor adherence.
**Treatment has not convincingly been shown to reduce retinopathy, but consider treating to reduce cardiovascular risk if they meet lipid guideline recommendations - see the summary table from the 2016 Canadian guidelines here http://www.onlinecjc.ca/cms/attachment/2069705857/2067775116/gr5.jpg Source: Excerpt from the Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy. Can J Ophthalmol. 52(S1), 2017. http://www.sciencedirect.com/science/article/pii/S0008418217310475