Management of diabetic retinopathy.

All persons with diabetes are at risk of retinal complications, although persons with type I (insulin-dependent) diabetes face a greater danger of severe vision loss than persons with type II (noninsulin-dependent) diabetes. Retinopathy has two stages: the nonproliferative stage, which includes intraretinal microaneurysms, hemorrhages, and soft and hard exudates, typically occurs well before the more serious proliferative stage, which is characterized by neovascularization and fibrovascular growth from the retina or optic nerve. Macular edema, a serious development, can occur in either stage. Untreated neovascularization and macular edema are the two major retinal complications that lead to blindness. Good glycemic control has been shown to reduce the development of retinopathy by 76 percent in diabetic patients and to slow progression by 54 percent in those with early retinopathy. Effective hypertension control and diabetic therapy, regular ophthalmologic examinations and properly timed focal laser treatments for macular edema and proliferative retinopathy can markedly reduce the risk of vision loss.