This month I am delighted to have a guest contribution to my diabetes column from an esteemed colleague, Jeff Gerson, OD, FAAO, of Grin Eye Care in Olathe, KS. Dr. Gerson is passionate about retinal disease, diabetes and optometry, and I have been honored to lecture with him on both diabetes and AMD (age-related macular degeneration) over the past 10 years. —A. Paul Chous, OD
Diabetic retinopathy (DR) in patients is a common finding in optometric practices. When we grade the level of retinopathy, we often do so with findings of the Early Treatment Diabetic Retinopathy Study (ETDRS)in mind.
In the clinic, we evaluate to determine if specific patients need treatment and, if no treatment is needed, we determine an appropriate follow-up schedule for each person. At the same time, ODs also consider the totality of risk factors, including disease duration, degree of diabetes control, and examination findings.
Previously from Dr. Chous: New strategies to assess the risk of diabetes-related vision loss
Of critical importance, the retinopathy grading scale used in ETDRS was based on standardized seven-field stereo photography. This methodology was consistent in how it was performed and read at a reading center. It did not take into account peripheral retinal lesions. We have since come to learn the importance of the peripheral retina in accurately gauging the level of DR and assessing individual risk of progression.
Much emphasis is put on the importance of screening for DR. As it turns out, much of this screening is being done through telehealth programs. For example, the Joslin Vision Network found twice as much retinopathy with ultra-widefield imaging as compared to with traditional non-mydriatic imaging. 1