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C CLINICAL RESEARCH

Appendix 1: Diagnostic characteristics, recommended follow-up, and referral by stage
of diabetic retinopathy

Suggested Frequency of Eye Examination for Patients with Diabetes
(subject to resource availability, specifically medical/surgical retinal specialists)
Stage of Diagnostic Macular Frequency of Referral Timing and Treatment
retinopathy characteristics status Examination
No apparent No abnormalities No DME Every 12 months No referral necessary
retinopathy
No DME Every 12 months No referral necessary
Mild NPDR MA DME Every 4 to 6 months No referral necessary
CSME Every month Within 1 month: consider focal laser, anti-VEGF
No DME Every 6 to 12 months No referral necessary
MA
IRH No referral necessary: monitor carefully for
Moderate NPDR DME Every 3 to 6 months
HE CSME
CWS
CSME Every month Within 1 month: consider focal laser, anti-VEGF
Any one of No DME Every 2 to 6 months If very severe, within 1 month: consider PRP
‘4:2:1 Rule’: Review at least every 6 months once stabilized
4: IRH (particularly If very severe, within 1 month: consider PRP
dark-blot IRH) in DME Every 2 to 4 months Review at least every 6 months once stabilized
4 retinal quadrants
Severe or very 2: venous beading
severe NPDR
in 2+ quadrants
1: IRMA in 1+ Within 1-2 weeks: consider PRP, focal laser,
quadrant CSME Every month anti-VEGF
Review at least every 6 months once stabilized.
Very severe NPDR:
2 or more features
of severe NPDR
Within 2 weeks: consider PRP
No DME Every 2 to 4 months
Review at least every 6 months once stabilized
NVD
NVE DME Every 2 to 3 months Within 2 weeks: consider PRP
PDR Review at least every 6 months once stabilized.
VH
PRH Within 1 week: consider PRP, focal laser, anti-
CSME Every month VEGF
Review at least every 6 months once stabilized
Severe NVD: No DME Every 2 to 3 months Within 1 week: PRP and/or anti-VEGF
larger than 1/4 Review at least every 6 months once stabilized
to 1/3 disc area
Within 1 week: PRP and anti-VEGF; consider
Severe NVE: DME Every 1 to 3 months focal laser
larger than Review at least every 6 months once stabilized
High-risk PDR
1/2 disc area
VH or PRH with Within 1 week: PRP and anti-VEGF; consider
fibrovascular CSME Every month focal laser
proliferation or Review at least every 6 months once stabilized
tractional RD
Diabetic macular edema (DME) is defined as: Retinal thickening or HE detected through stereoscopic examination of the
posterior pole, but not within the criteria set for clinically significant macular edema (CSME).
CSME is defined as: Retinal thickening at or within 500 microns of the centre of the macula; and/or HE at or within 500
microns of the centre of the macula with adjacent retinal thickening; and/orRetinal thickening of one disc-diameter in size, at
least part of which is within one disc-diameter of the centre of the macula.
Refer CSME to ophthalmology for immediate treatment (within 1-2 weeks if accompanied by more advanced retinopathy).
Review at least every 3 to 6 months once stabilized.
A patient with sudden severe vision loss or signs/symptoms of retinal detachment should be immediately referred to an
ophthalmologist able to treat proliferative disease/CSME.

26 CANADIAN JOURNAL of OPTOMETRY | REVUE CANADIENNE D’OPTOMÉTRIE VOL. 79 SUPPLEMENT 2, 2017