Screening and Referral of Diabetic Retinopathy: A Comparative Review of the Practice Guidelines

Diabetic retinopathy (DR) is a leading cause of preventable visual impairment in the working age group. The major risk factors for development and progression are duration of disease and the severity of hyperglycemia. The Global Diabetic Retinopathy Project developed a new classification system for DR and macular edema to enhance communication and coordination among the multidisciplinary team of physicians taking care of diabetic patients. Diabetic retinopathy progresses from nonproliferative DR to proliferative DR through a series of stages. Early detection and timely referral are critical for timely interventions to prevent further deterioration. Primary care physicians have an integral role in the community as they are the first point of contact for patients. Guidelines from various associations provide recommendations to physicians taking care of diabetic patients on how to screen and situations where referral to an ophthalmologist is needed. Dilated direct ophthalmoscopy is a convenient method to assess the fundus, but it does not replace retinal photography in the screening of DR. All patients with proliferative DR and diabetic macular edema should be referred to an ophthalmologist, whereas the situation for nonproliferative DR remains unclear as no consensus was drawn from the various guidelines.