Diabetic retinopathy. The primary care physician's role in evaluation and management

The primary care physician should educate all diabetics regarding the roles of diet, exercise, and insulin therapy in controlling the course of their disease, as well as the potential complications, including retinopathy. In type I diabetes, blood glucose levels should be controlled as rigidly as possible with multiple insulin injections and self-monitoring of glucose level. Hypertension should be aggressively treated in all diabetics. Yearly eye examination in patients with type I diabetes is important, and ophthalmologic referral should be considered after the disease has been present for five to ten years, with the first evidence of retinopathy, at puberty, during pregnancy, or if ocular symptoms occur. In patients with type II diabetes an ophthalmologist should make an evaluation as soon as the blood glucose level is controlled. Through use of these steps, the risk of blindness in diabetics will be minimized.