Patient education & prognosis

Patient education

Patient education is one of the important aspects in the management of DR. Patients should know that excellent glucose control is beneficial in any stage of DR and that systemic problems (hypertension, renal disease, hyperlipidemia) contribute to the progression of the retinopathy and should be addressed promptly. Smoking should be reduced, if not outright ceased. Visual symptoms (e.g. changes in vision, redness, pain) could be manifestations of disease progression and should be reported immediately.


Most patients with diabetes develop retinopathy: 50% of patients with type 1 diabetes and 30% of those with type 2 diabetes can expect to develop sight-threatening retinopathy in their lifetime and need intervention to reduce the risk of vision loss. Legal blindness is estimated as 25 times more common in the diabetic population than in the population without the disease. On ophthalmic examination, favorable prognostic factors include circinate exudates of recent onset, well-defined leakage, and good perifoveal perfusion. Unfavorable prognostic factors include diffuse edema/multiple leaks, lipid deposition in the fovea, macular ischemia, cystoid macular edema, preoperative vision of less than 1/10, and hypertension.

DR remains a major cause of preventable blindness worldwide. Prevention of retinopathy should be distinguished from prevention of diabetic blindness. Diabetic blindness can be reduced or prevented without preventing retinopathy. Systematic screening for DR and preventive laser treatment for those who develop macular edema or proliferative retinopathy reduces the rate of blindness in the diabetic population, irrespective of the prevalence of retinopathy. Appropriate and timely laser photocoagulation can reduce the risk of severe visual loss by more than 95%. Similarly, the risk of moderate visual loss from DME can be reduced by 50% with appropriate focal laser photocoagulation.