Clinical Scorecard: Diabetic Retinopathy Management: Preparing Patients

At a Glance

Key Highlights

• Optometrists play a key role in early diagnosis and patient education on DR treatments.
• In-office treatments include intravitreal anti-VEGF injections, laser photocoagulation (focal, grid, panretinal), or combination therapy.
• Patient education on treatment purpose, procedure, side effects, and follow-up improves treatment experience and loyalty.

Guideline-Based Recommendations

Diagnosis

• Identify diabetic retinopathy and macular swelling via retinal imaging and clinical examination.

Management

• Administer intravitreal anti-VEGF injections (6-8 in first year) to reduce macular swelling and block abnormal vessel growth.
• Consider switching anti-VEGF agents or corticosteroid injections if inadequate response after 3-6 injections.
• Use focal or grid laser photocoagulation to seal leaking vessels in the macula.
• Apply panretinal photocoagulation in advanced DR to reduce risk of severe vision loss by 50%.
• Combine injections and laser therapy when both swelling and abnormal vessels coexist.
• Refer for vitrectomy surgery if complications arise.

Monitoring & Follow-up

• Regular follow-up visits between treatments to monitor DR progression.
• Monitor for signs of infection or complications post-injection, especially after 2 days.
• Advise patients to report visual decline, ocular pain, redness, flashes, or vision loss immediately.

Risks

• Infection risk from intravitreal injections is <0.1%.
• Common injection side effects: mild pain, floaters, redness, light sensitivity resolving within days to a week.
• Laser side effects: mild eye ache, blurry vision, decreased peripheral and night vision; some symptoms may persist due to retinal cell damage.

Patient & Prescribing Data

Patients with diabetic macular edema and proliferative diabetic retinopathy

Patients typically receive 6-8 anti-VEGF injections in the first year with fewer injections thereafter; about 20% may require treatment adjustments due to inadequate response.

Clinical Best Practices

• Provide clear, scripted patient education on treatment options, procedures, and expected outcomes before specialist visits.
• Use supporting documentation and retinal imaging to reinforce verbal education.
• Involve allied staff to repeat education and answer patient questions to optimize time and comprehension.
• Ensure patients understand signs of complications and when to seek urgent care.

References

• Elman MJ et al. Intravitreal Ranibizumab for diabetic macular edema: 5-year randomized trial results