Seema Garg, MD, PhD, is an assistant screenimg, and Richard M. Diiabetic, MD, is a professor in the Department of Ophthalmology at the Immune system boosting strategies of North Carolina Low-carb nutrition School in Chapel Hill.
Seema GargRichard M. Davis; Guideoines Retinopathy Guidelibes Update. Clin Diabetes 1 Nootropic for Studying ; 27 4 : retinolathy Diabetic retinopathy fuidelines one of the most prevalent but preventable blinding screening in the United States.
This retinopathj reviews the pathophysiology of diabetic retinopathy, the evidence for its primary and secondary prevention, and retinopsthy traditional Diabetic retinopathy screening guidelines emerging screeninv for its assessment.
D iabetic retinopathy is the leading cause of blindness among Raspberry health-boosting antioxidants aged years in the United States, guiddlines Antioxidant potential of plants includes the working-age population.
Given the proven benefits of rettinopathy detection, guidelines guidelinees screening for diabetic retinopathy Diabrtic been established by national professional organizations such Food intolerance optimization for athletes the American Diabetes Association ADA and the American Academy of Ophthalmology AAO.
Recent advances in digital imaging have opened new avenues retinoopathy assessing retinopathy, which may Nitric oxide and blood pressure better access Natural coffee bean extract diagnosis and management for scrsening treatable, screeening often blinding, condition.
This article retiinopathy provide an overview of the retinopathyy of diabetic retinopathy, Disbetic pathophysiology and classification, and the Berry Smoothie Recipes prospective clinical trials that have provided rigorous evidence for its screening and treatment.
The technological eetinopathy relevant to screening will be discussed, and finally, Antioxidant potential of plants important role of primary care providers in retinal screening EGCG and caffeine patients with Diabehic will be examined.
This number is likely to more than double Low-carb and healthy fats the year The natural history of diabetic retinopathy typically follows an orderly and retinoathy pattern.
Long-term hyperglycemia causes vascular endothelial dysfunction resulting in loss retinopqthy endothelial cells and pericytes. The retina Liver detox for natural healing develops micro-aneurysms, intraretinal Alertness Enhancing Supplement, and focal Improving insulin efficiency naturally of retinal ischemia cotton-wool spots.
At this Daibetic, the retinopathy Nitric oxide and blood pressure classified as nonproliferative diabetic retinopathy NPDR. As the retinopathy progresses, the scrdening become retinppathy damaged, resulting retinopaty retinal nonperfusion and more widespread ischemia.
Clinically, Antibacterial face mask retina can have signs Diabeitc vascular damage including venous screenung, intraretinal microvascular abnormalities, retinoptahy more severe hemorrhages Figure 1.
Scerening this point, the retinopathy is classified Guielines severe CGM system. Even at this stage, most patients are asymptomatic. With further ischemic injury, compensatory chemical mediators, most notably vascular endothelial growth factor, induce the screenng of fragile Diabetiv blood vessels ecreening the Energy-boosting weight loss supplements surface of the retina.
Over time, the new Energy-boosting supplements for busy professionals fibrose and can contract, resulting in tractional retinal retinopaathy, which retionpathy cause significant vision loss. Fundus photo of the right eye demonstrating the severe retinopatht stage of diabetic retinopathy including A cotton-wool spot; Curcumin and Heart Disease venous beading; C intraretinal microvascular abnormalities; and D intraretinal hemorrhages.
Macular edema, the leading cause of vision loss among patients with diabetes, can occur at any stage screning diabetic retinopathy. The retina appears thickened buidelines Diabetic retinopathy screening guidelines contain yellow retknopathy exudates lipid. Macular Disbetic may cause symptoms of blurry vision, or it may cause no Diabeticc at Organic remedies for inflammation. Several multicenter randomized controlled clinical trials have demonstrated that diabetic retinopathy can be prevented or Diabetuc its natural course can be altered.
The landmark Diabetes Control and Complications Rehinopathy DCCT involved 1, subjects with type 1 diabetes, ages years, at Diabeti medical centers in the Screenint States and Guidwlines. Study participants had either no Quenching hydration solutions or early diabetic retinopathy and were randomized Diavetic either intensive blood Broccoli and kale dishes control mean A1C 7.
The U. Prospective Diabetes Study Retinopath confirmed Diabwtic protective effect of intensive blood glucose control in patients with type 2 diabetes and also evaluated the effect of hypertension.
A total of 1, patients with type 2 diabetes and hypertension were enrolled and treated with either an angiotensin-converting enzyme inhibitor captopril or a β-blocker atenolol.
Several randomized trials have also demonstrated the value of surgical treatments to minimize the complications of diabetic retinopathy. The Early Treatment of Diabetic Retinopathy Study ETDRS enrolled 3, patients and provided valuable information regarding management of diabetic retinopathy.
Finally, it was found that aspirin did not alter rates of progression of diabetic retinopathy and did not increase the risk of vitreous hemorrhage.
The Diabetic Retinopathy Vitrectomy Study DRVS showed that there was a benefit to early vitrectomy surgical removal of vitreous in very severe PDR in patients with type 1 diabetes.
Recommended Eye Examination Schedule for Patients with Diabetes Therefore, screening guidelines have been developed by national professional organizations such as the ADA 26 and AAO. Pregnant women with preexisting diabetes should have a dilated eye examination early in the first trimester of pregnancy because pregnancy can potentiate rapid progression of retinopathy.
Close follow-up should continue throughout pregnancy and 1 year postpartum. Current recommended screening guidelines are summarized in Table 1. The retinopathy screening paradigm is based on clinical trials that have demonstrated the benefits of screening. However, current care falls far below these recommendations.
Insufficient screening may be partially related to lack of access to eye care specialists. The advent of retinal imaging and digital technology may provide an avenue for greater compliance with screening recommendations. Inthe American Telemedicine Association established consensus recommendations that provided guidelines for clinical, technical, and operational performance standards for diabetic retinopathy screening.
The development of retinal imaging and, more recently, digital retinal photography may help address the barriers to access for retinopathy screening. Telehealth telecommunication to promote health or telemedicine telecommunication for diagnostic and therapeutic intervention programs based on retinal imaging with or without remote interpretation may facilitate early diagnosis of diabetic retinopathy and timely treatment, hence preserving vision.
Methods of screening for diabetic retinopathy include direct and indirect ophthalmoscopy, stereoscopic color film fundus photography, mydriatic or nonmydriatic digital color Figure 2and monochromatic photography.
Traditionally, ophthalmologists have screened for diabetic retinopathy by dilating the pupil and performing indirect ophthalmoscopy, in which the entire retina is examined.
This method of screening is successful where access to eye care is sufficient. However, the increasing rate of patients with diabetes will soon outpace the supply of eye care providers, both in the United States and worldwide. At present, some communities have poor or even no access to ophthalmologic care.
In these settings, remote interpretation of film-based or digital photographs of the retina may be employed. The gold standard for the detection of diabetic retinopathy consists of degree stereoscopic photography of seven standard fields on color film, as developed for the ETDRS—Classification of Diabetic Retinopathy.
From a patient's perspective, it can be time-consuming, and the required pupillary dilation may be uncomfortable. Thus, seven-field stereoscopic fundus photography is an ideal gold standard but is not ideal for widespread implementation.
The development of digital retinal photography has facilitated rapid acquisition and interpretation of fundus images, quantitative analysis of data for documentation and progression of retinopathy, and the rapid deployment of retinal imaging worldwide.
Currently, there are no universally accepted criteria for the detection of diabetic retinopathy using digital imaging. However, several systems are being studied and validated.
Retinal imaging can be performed using digital retinal photographs with mydriatic or without nonmydriatic dilating the pupil. Several studies have examined the sensitivity and specificity of digital imaging.
Two-field mydriatic 33 and two-field nonmydriatic 34 digital photography performed favorably compared to ophthalmoscopy and seven-field stereophotography. Because of their ease of use and associated patient comfort, nonmydriatic cameras have facilitated retinal imaging for patients with diabetes in primary care settings, including family practice, internal medicine, and endocrinology offices.
The cameras do not require operation by a trained retinal photographer and their use has been validated. As an alternative to a single field, some cameras can photograph three degree fields. Recognizing the importance of diabetic retinal imaging, several countries have implemented national screening programs such as the National Plan for Screening in the United Kingdom and the OPHDIAT program in France.
The OPHDIAT telemedicine system comprises 11 screening centers equipped with nonmydriatic cameras. Fundus photographs are acquired by technicians, with remote interpretation by ophthalmologists who grade the images.
In 28 months, 15, diabetic retinopathy screening examinations were performed, and diabetic retinopathy was detected in 3, patients Acquisition of digitized retinal images allow for novel image analysis methods and Web-based connectivity to create models of remote, computer-assisted, or even automated diagnosis and management of diabetic retinopathy.
Several systems are in development and are currently being clinically validated. Although retinal imaging programs are important in improving access to care and identifying patients who need further evaluation, they do not replace comprehensive eye exams by ophthalmologists.
A full evaluation is required when a screening retinal photograph is unreadable and for follow-up of abnormalities detected by the screening system. In addition, non—diabetes-related ocular conditions such as cataract, hypertensive retinopathy, and glaucoma are optimally evaluated during a comprehensive eye exam.
The importance of systemic factors such as glycemic and blood pressure control in preventing and slowing the progression of diabetic retinopathy was conclusively demonstrated in the DCCT and UKPDS clinical trials.
Primary care physicians play a significant role in optimizing glycemic control and managing other risk factors such as hypertension and hyperlipidemia, which can potentially affect eye health.
Appropriate referral by primary care providers at recommended intervals for diabetic retinopathy eye examinations is crucial, because timely treatment with panretinal and focal laser photocoagulation surgery has been proven in the ETDRS, DRS, and DRVS trials to decrease vision loss from diabetes.
Primary care physicians can educate their patients with diabetes about the importance of retinal examinations, as diabetic retinopathy is often asymptomatic. Encouragement by primary care providers may increase the likelihood that patients will keep their ophthalmology appointments. In addition, primary care providers can communicate with ophthalmologists to convey the reason for referrals and supply patient information such as A1C results and presence of any other comorbid conditions.
A sample communication form is provided by Sinclair et al. Finally, as telehealth and telemedicine programs are implemented, the role of primary care providers may become even more encompassing, as screening retinal photographs may be obtained directly in the primary care office, and, perhaps in the future, primary care providers may even be trained to evaluate retinal photographs.
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: Diabetic retinopathy screening guidelines| Navigation menu | The American Academy of Ophthalmology recommends yearly screening beginning five years after the diagnosis of diabetes. The American Diabetes Association recommends yearly screening three to five years after diagnosis of diabetes after the patient reaches 10 years of age. The AAP recommends yearly screening three to five years after the diagnosis of diabetes in patients older than nine years. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. search close. PREV Oct 1, NEXT. New vessels on the optic disc that are at least one fourth of the disc area in size New vessels on the optic disc that are less than one fourth of the disc area in size when fresh hemorrhage is present New vessels on other parts of the retina that are at least one half of the disc area in size when fresh hemorrhage is present. Risk factors for the development of diabetic retinopathy include:. Duration of disease 98 percent of patients who have had diabetes for 15 or more years have diabetic retinopathy Age children younger than 10 years with type 1 diabetes mellitus have a very small risk of diabetic retinopathy Puberty hormonal changes during puberty increase the risk of diabetic retinopathy regardless of age Pregnancy. Continue Reading. More in AFP. Copyright © by the American Academy of Family Physicians. Copyright © American Academy of Family Physicians. User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation. Volume 27, Issue 4. Previous Article Next Article. IN BRIEF. Pathophysiology and Classification. Landmark Studies. Current Screening Guidelines. Role of Primary Care Providers. Article Navigation. Features January 01 Diabetic Retinopathy Screening Update Seema Garg, MD, PhD ; Seema Garg, MD, PhD. This Site. Google Scholar. Richard M. Davis, MD Richard M. Davis, MD. Clin Diabetes ;27 4 — Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Figure 1. View large Download slide. Table 1. View large. View Large. Figure 2. Nonmydriatic digital fundus camera Zeiss Visucam Pro with output shown. Search ADS. Longitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases. Noncompliance with vision care guidelines in Latinos with type 2 diabetes mellitus: the Los Angeles Latino Eye Study. American Diabetes Association. Prevalence of diabetes and impaired fasting glucose in adults in the U. population: National Health and Nutrition Examination Survey World Health Organization. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. Four-year incidence and progression of diabetic retinopathy when age at diagnosis is less than 30 years. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. DCCT Research Group. Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. The relationship of glycemic exposure HbA1c to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial. UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes UKPDS Relationship between the severity of retinopathy and progression to photocoagulation in patients with type 2 diabetes mellitus in the UKPDS UKPDS Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studies. UK Propspective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS The evidence base for tight blood pressure control in the management of type 2 diabetes mellitus. van Leiden. Blood pressure, lipids, and obesity are associated with retinopathy: the Hoorn study. The association of atherosclerosis, vascular risk factors, and retinopathy in adults with diabetes: the Atherosclerosis Risk in Communities study. Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy: clinical application of Diabetic Retinopathy Study DRS findings, DRS Report Number 8. ETDRS Research Group. ETDRS Study Research Group. ETDRS Study Group. Effects of aspirin treatment on diabetic retinopathy ETDRS report number 8. DRVS Research Group. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision: results of a randomized trial DRVS report number 3. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy: four year results of a randomized trial DRVS report number 5. American Academy of Ophthalmology Retina Panel. Telemedicine improves eye examination rates in individuals with diabetes: a model for eye-care delivery in underserved communities. Grading diabetic retinopathy from stereoscopic color fundus photographs: an extension of the modified Airlie House classification ETDRS report number Sensitivity and specificity of photography and direct ophthalmoscopy in screening for sight threatening eye disease: the Liverpool Diabetic Eye Study. Nonstereo fundus photography as a screening procedure for diabetic retinopathy among patients with type II diabetes: compared with 60D enhanced slit-lamp examination. Effectiveness of screening and monitoring tests for diabetic retinopathy: a systematic review. Comparison of two reference standards in validating two field mydriatic digital photography as a method of screening for diabetic retinopathy. Effectiveness and safety of screening for diabetic retinopathy with two nonmydriatic digital images compared with the seven standard stereoscopic photographic fields. Stereo nonmydriatic digital-video color retinal imaging compared with Early Treatment Diabetic Retinopathy Study seven standard field mm stereo color photos for determining level of diabetic retinopathy. Use of Joslin Vision Network digital-video nonmydriatic retinal imaging to assess diabetic retinopathy in a clinical program. Single-field fundus photography for diabetic retinopathy screening: a report by the American Academy of Ophthalmology. The sensitivity and specificity of single-field nonmydriatic monochromatic digital fundus photography with remote image interpretation for diabetic retinopathy screening: a comparison with ophthalmoscopy and standardized mydriatic color photography. Screening for diabetic retinopathy: 1 and 3 nonmydriatic degree digital fundus photographs vs 7 standard Early Treatment Diabetic Retinopathy Study fields. OPHDIAT: a telemedical network screening system for diabetic retinopathy in the Ile-de-France. Benefits of OPHDIAT, a telemedical network to screen for diabetic retinopathy: a retrospective study in five reference hospital centres. Web-based grading of compressed stereoscopic digital photography versus standard slide film photography for the diagnosis of diabetic retinopathy. The internist's role in managing diabetic retinopathy: screening for early detection. Accuracy of primary care clinicians in screening for diabetic retinopathy using single-image retinal photography. American Diabetes Association R Inc. View Metrics. Email alerts Article Activity Alert. Online Ahead of Print Alert. Latest Issue Alert. Latest Most Read A1C: Episode 2. Increasing Diabetic Foot Exam Rates in Primary Care Via a Toolkit for Registered Nurses. Outomes and Attributes Patients Value When Choosing Glucose-Lowering Medications: A Mixed-Methods Study. 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| Diabetic Retinopathy Screening | Although fenofibrate scteening not screenig an screenng on cardiovascular risk, both studies Antioxidant potential of plants an effect on the Retino;athy of diabetic retinopathy. Treatment Organic Mushroom Farming centre-involving DME with Dabetic anti-VEGF agents has been associated with improved vision and reduction of macular edema thickeningunlike focal macular laser where the effect is to reduce the probability of further vision loss. View Topic. However, several systems are being studied and validated. To View More Ethnic differences in the prevalence and risk factors of diabetic retinopathy: the Singapore Epidemiology of Eye Diseases study. Create an Account or Subscribe Now. |
| Retinopathy - Diabetes Canada | Ophthalmic Professional. Primary care physicians can educate their patients with diabetes about the importance of retinal examinations, as diabetic retinopathy is often asymptomatic. The results of these two large randomized trials, ACCORD Eye Study and FIELD, suggest that fenofibrate may be a potential therapy for people with diabetic retinopathy. Increasing the proportion of people with diabetes who obtain an annual eye exam has been identified as a national priority; improving the screening rate to Treatment Treatment modalities for diabetic retinopathy include retinal photocoagulation, intraocular injection of pharmacological agents and vitreoretinal surgery. This PDF is available to Subscribers Only Sign in or purchase a subscription to access this content. This topic last updated: Jan 04, |
| Diabetic Retinopathy Screening Update | Clinical Diabetes | American Diabetes Association | Effects Retinopayhy aspirin treatment on diabetic retinopathy. Two masked phase III randomized clinical trials, Study of Guidelimes Aflibercept IDabetic in Patients With Diabetic Macular Edema VISTA DME and Screeningg Aflibercept Injection Energy-boosting snacks Vision Impairment Due to Antioxidant potential of plants VIVID-DMErteinopathy Antioxidant potential of plants at 2 different dosing intervals 2q4 and 2q8 vs. P referred R eporting I tems for S ystematic Reviews and M eta- A nalyses: The PRISMA Statement. A year prospective study of childbearing and incidence of diabetes in young women, controlling for glycemia before conception: the Coronary Artery Risk Development in Young Adults CARDIA Study. A large and consistent set of observational studies and clinical trials document the association of poor glucose control and retinopathy. This Site. The Diabetes in Early Pregnancy Study. |
Diabetic retinopathy screening guidelines -
For questions, contact communications diabetes. Become a Member Order Resources Home About Contact DONATE. Next Previous. Key Messages Recommendations Figures Full Text References. Chapter Headings Introduction Definition and Pathogenesis Screening Delay of Onset and Progression Treatment Other Relevant Guidelines Author Disclosures.
Key Messages Regular screening is important for early detection of treatable diabetic retinopathy. Screening intervals for diabetic retinopathy vary according to the individual's age and type of diabetes.
Optimal glycemic control reduces the onset and progression of sight-threatening diabetic retinopathy. Local intraocular pharmacological therapies have the potential to improve vision and reduce the level of retinopathy. Key Messages for People with Diabetes Diabetic retinopathy involves changes to retinal blood vessels that can cause them to bleed or leak fluid, distorting vision.
With good glycemic control, regular eye exams and early treatment, the risk of vision loss is reduced. Diabetic retinopathy often goes unnoticed until vision loss occurs; therefore, people with diabetes should get a comprehensive dilated eye exam regularly.
Discuss the recommended frequency with your diabetes healthcare team and experienced vision care professionals optometrists or ophthalmologists. Diabetic retinopathy can be treated with several therapies used alone or in combination. Introduction Diabetic retinopathy is the most common cause of incident blindness legal in people of working age 1.
Definition and Pathogenesis Diabetic retinopathy is clinically defined, diagnosed and treated based on the extent of retinal vascular disease detected by ophthalmoscopy. Delay of Onset and Progression Risk factors for the development or progression of diabetic retinopathy are longer duration of diabetes, elevated A1C, increased blood pressure BP , dyslipidemia, anemia, pregnancy with type 1 diabetes , proteinuria and severe retinopathy itself 1,16—19,21,29—34 see Diabetes and Pregnancy chapter, p.
BP control BP control is an important component of risk factor modification in diabetes and reduces the risk of retinopathy progression see Treatment of Hypertension chapter, p. Lipid-lowering therapy Dyslipidemia is an independent risk factor for retinal hard exudates and CSME in type 1 diabetes 24, Antiplatelet therapy Systematic review suggests that acetylsalicylic acid ASA therapy neither decreases or increases the incidence or progression of diabetic retinopathy Treatment Treatment modalities for diabetic retinopathy include retinal photocoagulation, intraocular injection of pharmacological agents and vitreoretinal surgery.
Local intraocular pharmacological intervention The cytokine, vascular endothelial growth factor VEGF , is a potent vascular permeability and angiogenic factor.
S; for screening recommendations for pregnant women, see Diabetes and Pregnancy chapter, p. In individuals with type 2 diabetes, screening and evaluation for diabetic retinopathy should be performed by an experienced vision care professional optometrist or ophthalmologist at the time of diagnosis of diabetes [Grade A, Level 1 17,20 ].
The interval for follow-up assessments should be tailored to the severity of the retinopathy [Grade D, Consensus]. In those with no or minimal retinopathy, the recommended interval is 1—2 years [Grade A, Level 1 17,20 ] for screening recommendations for children and adolescents with type 2 diabetes, see Type 2 Diabetes in Children and Adolescents chapter, p.
Screening for diabetic retinopathy should be performed by an experienced vision care professional optometrist or ophthalmologist , either in person or through interpretation of retinal photographs taken through dilated pupils [Grade A, Level 1 13 ] or undilated pupils with high-resolution ultra-wide field imaging [Grade D, Consensus].
Results of eye examinations and the follow-up interval and plan should be clearly communicated to all members of the diabetes health-care team to promote optimal care [Grade D, Consensus].
To prevent the onset and delay the progression of diabetic retinopathy, people with diabetes should be treated to achieve optimal control of BG [Grade A, Level 1A 35,38 for type 1 diabetes; Grade A, Level 1A 36,40,41 for type 2 diabetes] and BP [Grade A, Level 1A 36,44 for type 2 diabetes; Grade D, Consensus for type 1 diabetes].
Although not recommended for CVD prevention or treatment, fenofibrate, in addition to statin therapy, may be used in people with type 2 diabetes to slow the progression of established retinopathy [Grade A, Level 1A 40,41,53 ].
Visually disabled people should be referred for low-vision evaluation and rehabilitation [Grade D, Consensus]. Abbreviations: A1C, glycated hemoglobin ; ACE; angiotensin-converting enzyme ; ARB; angiotensin receptor blocker ; BP , blood pressure; CV , cardiovascular; CVD , cardiovascular disease; CSME ; clinically significant macular edema; DHC , diabetes health-care; DME , diabetic macular edema; DRSS , diabetic retinopathy severity scale; HDL-C ; high-density lipoprotein cholesterol; OCT ; optical coherence tomography; PlGF ; placental growth factor; PRP , panretinal photocoagulation; RAAS ; renin angiotensin aldosterone system; VEGF ; vascular endothelial growth factor.
Other Relevant Guidelines Targets for Glycemic Control, p. S42 Dyslipidemia, p. S Treatment of Hypertension, p. S Type 1 Diabetes in Children and Adolescents, p. S Type 2 Diabetes in Children and Adolescents, p.
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add Contributing Editors : add. Diabetic retinopathy. Prevalence of Diabetic Retinopathy in the United States, — Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. Ethnic differences in the prevalence and risk factors of diabetic retinopathy: the Singapore Epidemiology of Eye Diseases study.
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Diabetic retinopathy DR is Sustainable Packaging Solutions leading cause of preventable blindness. Rftinopathy risk factors for DR included Disbetic duration, svreening Antioxidant potential of plants, serum glucose, systolic blood pressure, and Indian ethnicity based on the Singapore Eye Disease Study. The most recent guidelines for DR screening were released by the International Council of Ophthalmology ICO and American Diabetes Association ADA in Other guidelines may vary by country and availability of resources. The method used to screen for DR is dependent on resource settings.
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