Eye disease

Arrange or perform eye screening at or around the time of diagnosis. Arrange repeat of structured eye screening annually.
Explain the reasons for, and success of, eye screening systems to adults with type 2 diabetes, so that attendance is not reduced by lack of knowledge or fear of outcome.

Use mydriasis with tropicamide when photographing the retina, after prior informed agreement following discussion of the advantages and disadvantages. Discussions should include precautions for driving.
Use a quality-assured digital retinal photography programme using appropriately trained staff.
Perform visual acuity testing as a routine part of eye screening programmes.

Depending on the findings, follow structured eye screening by:

routine review in 1 year or

earlier review or

referral to an ophthalmologist.

Arrange emergency review by an ophthalmologist for:
sudden loss of vision

rubeosis iridis

pre-retinal or vitreous haemorrhage

retinal detachment.

Arrange rapid review by an ophthalmologist for new vessel formation.

Refer to an ophthalmologist if any of these features are present:
referable maculopathy:

exudate or retinal thickening within 1 disc diameter of the centre of the fovea

circinate or group of exudates within the macula (the macula is defined here as a circle centred on the fovea, with a diameter the distance between the temporal border of the optic disc and the fovea)

any microaneurysm or haemorrhage within 1 disc diameter of the centre of the fovea, only if associated with deterioration of best visual acuity to 6/12 or worse.

referable pre-proliferative retinopathy (if cotton wool spots are present, look carefully for the following features, but cotton wool spots themselves do not define pre?proliferative retinopathy):

any venous beading

any venous reduplication

any intraretinal microvascular abnormalities

multiple deep, round or blot haemorrhages.

any large, sudden unexplained drop in visual acuity.

G MOHAN