DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

Version 4.0
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
A. Has Patient’s Vision Changed Recently
OBJECTIVE
MODULE E– EYE CARE
ANNOTATIONS
Identify patients with diabetes mellitus (DM) in need of urgent referral to an eye care provider.
RECOMMENDATIONS
1. Patients with an acute change in vision or a change in ocular function should be urgently referred to an eye
care provider.
DISCUSSION
Symptoms such as blurring or loss of vision, severe pain or light sensitivity, double vision, distortion, floaters, or
light flashes may indicate a serious ocular problem. Such complaints require urgent referral to an eye care provider.
Visual symptoms clearly associated with fluctuations in blood glucose should be distinguished from those that are
not, as the former will typically resolve as glycemic control is improved. Nevertheless, it is prudent to seek
consultation with an eye care provider in all instances where there has been a sudden change in vision.
B. Refer patients with Type 1 DM for Initial Eye Retinal Examination
OBJECTIVE
Establish the timing of the initial ocular evaluation for patients with early onset DM or type 1 DM at a later age.
RECOMMENDATIONS
1. Patients with either early diabetes onset (age 3 years. [B]
DISCUSSION
The risk for retinopathy in patients with type 1 diabetes becomes significant after 3 to 5 years of disease. Patients are
unlikely to develop clinically apparent retinopathy within 3 years of onset, but the prevalence rises steadily after that
and may approach 30% by the fifth year (Klein et al., 1984a & 1984b). Patients who do develop retinopathy within 3
years of diagnosis may progress more rapidly than those who do not (Malone et al., 2001). Patients who develop
type 2 diabetes in youth or as young adults are also at risk for developing retinopathy although incidence rates are
generally lower up to approximately 5 years after diagnosis (Krakoff et al. 2003). Thus, it is recommended that the
initial screening for the presence of retinopathy not be deferred beyond 3 years in individuals with onset of diabetes
in youth or young adulthood or in individuals with type 1 diabetes at later ages.
EVIDENCE
Recommendation Sources LE QE SR
1 Initial Screening for Retinopathy Klein et al., 1984a & 1984b I Fair B
in patients with Type 1 Diabetes Malone et al., 2001
with early onset (age