Diabetic retinopathy: How and when to screen

Ideally, all patients with diabetes mellitus should undergo screening for retinopathy by an ophthalmologist, but this is not always feasible. Thus, primary care physicians should routinely screen the eyegrounds of these patients - through a dilated pupil - to detect early signs of retinopathy. Start these eye examinations as soon as you diagnose type II diabetes and 5 years after type I diabetes is diagnosed. The goal is not to determine the grade of retinopathy or to diagnose specific disease entities; instead, look for evidence of an anatomic change from baseline (hard exudates, "dot and blot" hemorrhages in the macula, neovascularization, vitreous hemorrhage). As soon as any of these are found, referral to an ophthalmologist for possible treatment with laser photocoagulation surgery may avert blindness.