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III. DIFFERENTIAL DIAGNOSIS
                       Diabetic  retinopathy  may  present  like  or  coexist  with  other  conditions  and  hence
                       one needs to be careful with making a diagnosis. The following disorders may also
                       present similary and hence they have to be ruled out.
                          1.  Hypertensive retinopathy

                          2.  Vascular occlusive disorders
                          3.  Inflammatory chorio retinopathy
                          4.  Radiation retinopathy
                          5.  Age related macular degeneration

                       IV. PREVENTION AND COUNSELLING

                       o  All the diabetic patients are the potential candidates for vision impairment. Strict
                          control of blood glucose level and other risk factors like hypertension,
                          hypercholesterolemia, anaemia will retard the development and progression  of
                          DR..


                       o  Screening of all “known diabetic patients” for DR at their primary point of
                          contact, by physicians/diabetologists as most of the diabetic patients come to
                          the ophthalmologists only after experiencing considerable vision loss will detect
                          early cases.

                       o  All pregnant women with diabetes should have dilated eye examinations during
                          each   trimester of their pregnancy to check for retinopathy


                       o  Educating the community for regular eye check up and having good healthy diet,
                          exercises and avoiding smoking goes a long way in preventing progression of
                          diabetic retinopathy.


                    V.    OPTIMAL          DIAGNOSTIC            CRITERIA,        INVESTIGATIONS,

                    TREATMENT & REFERRAL CRITERIA

                   *Situation  1:  At  Secondary  Hospital/  Non-Metro  situation:  Optimal

                   Standards  of  Treatment  in  Situations  where  technology  and

                   resources are limited

                   a) Clinical Diagnosis:


                       History  taking:    Diabetic  retinopathy  often  has  no  early  warning  signs. Patients
                       usually presents with painless loss of vision. A thorough and complete history taking
                       regarding past duration of diabetes, treatment history, family history and history of

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