Serious retinopathy in a diabetic clinic: prevalence and therapeutic implications

In a series of 1000 patients examined consecutively in a large diabetic clinic, 95 (9.5%) were classified as having serious diabetic retinopathy. The definition was confined to exudative retinopathy (macular oedema or hard exudates encroaching upon the macula), proliferative retinopathy, and retinal ischaemia (as evidenced by the presence of soft exudates in the absence of hypertension, together with characteristic vascular changes). The diagnosis of serious diabetic retinopathy is always accompanied by a need for specialised ophthalmological assessment (including fluorescein angiography) and, often, urgent photocoagulation. Investigation and treatment are time-consuming, and such patients therefore constitute a major workload for the ophthalmological services: the average time for an ophthalmic consultation was found to be 20 min, and when fluorescein angiography was added to this the time increased to 40 min. The average time spent on photocoagulation for neovascularization was 2 h for each eye, and for exudative retinopathy 30 min for each eye.