Ophthalmic survey of a diabetic clinic: II. Requirements for treatment of retinopathy.

The eyes of 658 patients attending a district general hospital diabetic clinic were examined for retinopathy requiring treatment by photocoagulation or vitreoretinal surgery. Although the majority of patients with serious retinopathy were already under ophthalmic supervision, 39 cases (52 eyes) were found which required treatment. Eighty eyes had had previous photocoagulation, and treatment was recommended for maculopathy in 40 eyes, proliferative retinopathy in seven eyes, and combined maculopathy and proliferative retinopathy in five eyes. This suggested that existing referral criteria for photocoagulation in the population studied were reasonably accurate for proliferative retinopathy, but maculopathy was more frequently overlooked. In insulin dependent patients (IDDs) undetected maculopathy was found in 17/416 eyes, (4.0%) and in non-insulin dependent patients (NIDDs) 28/899 (3.1%). Untreated proliferative retinopathy was discovered in 5/416 (1.2%) IDD eyes and 7/899 (0.8%) of NIDD eyes. Vitreoretinal surgery was required in six eyes (0.5%) for vitreous haemorrhage or traction retinal detachment. Equipment for the treatment of diabetic retinopathy is now almost universally available in ophthalmic departments, but time for patient management by trained staff may be inadequate. Each UK ophthalmic consultant needs approximately 100 sessions per year to monitor and treat known cases of retinopathy apart from time required to train junior staff.