Synopsis
Recognise diabetic retinal injury before vision is lost, interpret screening as a risk pathway, and connect proliferative disease with timely retinal treatment and systemic care.
- Retinopathy may be advanced while central acuity remains good; screening therefore depends on retinal assessment rather than symptoms.
- England invites people with type 1 or type 2 diabetes from age twelve; two consecutive negative routine screens permit a two-year interval.
- Microaneurysms and haemorrhages reflect vascular injury; new vessels on the disc or elsewhere identify proliferative disease.
Key red flags
New vitreous haemorrhage, a progressive field curtain or rapidly falling acuity requires urgent retinal assessment because tractional detachment may threaten the macula.
Investigation priorities
Establish the time course and the functional effect in each eye before interpreting photographs.
Management branches
The person has diabetes and no new symptom requiring acute assessment.
- Confirm screening registration from age twelve and establish whether recall is annual, two-yearly or a shorter surveillance appointment.
- In England, explain that a two-year interval follows two consecutive routine screens without retinopathy; other results follow their designated pathway.
Key medicines
Ranibizumab, Lucentis 10 mg/mLFor an adult selected for treatment of proliferative retinopathy or diabetic macular oedema, inject 0.5 mg in 0.05 mL intravitreally. Begin monthly treatment until maximum acuity and/or absence of disease activity; three or more consecutive monthly doses may be needed. Never inject the same eye less than four weeks apart; subsequently individualise intervals and stop if continued treatment provides no benefit.