Management of Diabetic Retinopathy - Episode 3
Jose Martinez, MD, discusses the testing for early detection of diabetic retinopathy and the frequency at which these tests should be performed.
Jose Martinez, MD: Diagnosing diabetic eye disease involves a dilated fundus exam looking into the back of the eye. There are 2 other main tests we do. One’s called an OCT [optical coherence tomography] where we measure the thickness of the retina. The very center of the retina is called the macula, and that’s vital for 2020 vision. In diabetic macular edema, you get fluid accumulation in the macula, or the center of the retina. We can do this OCT, sometimes referred to as the macular scan, which shows whether there’s thickening, or edema, in the macula. That’s a very vital test to assess whether macular edema is present in these patients.
The other test we do is retinal angiography where we inject contrast dye in the arm. It flows through the bloodstream and goes to the eye, and we can see abnormal blood vessels very easily on that test, called neovascularization. It gives rise to proliferative diabetic retinopathy; it means there are abnormal blood vessels growing in the back of the eye. That is a disease that needs prompt treatment in order to reduce the risk of vitreous hemorrhaging and scarring in the back of the eye. Those 3 tests, the dilated exam, complemented by the OCT, as well as retinal angiography are typically used to manage diabetic eye disease and help in detecting the degree of disease a patient may have.
The frequency of doing the tests we use in managing diabetic eye disease depends upon the advanced nature of the patient’s disease. In order to screen patients, we need to take a photograph to see if they have any evidence of disease, or we can examine them with a clinical exam with our instruments. For those who have disease, we do an OCT or macular scan. If their scan is healthy and normal, they probably need one once a year in order to follow their disease. The same is true for the angiogram. We don’t need to get that test until they have more advanced disease and we become concerned with how we’re going to treat the patient.
Although patients with no disease need to be seen annually, those with disease will often be seen on a monthly basis if they’re under treatment, depending upon their disease. Sometimes those patients will be getting treatments with injections in their eye in order to control their disease on a monthly basis and will be getting macular scans monthly to assess a response to our treatments. Sometimes, we’ll get them every 3 months or 6 months, depending on whether we’re treating proliferative diabetic retinopathy in order to assess whether they’re responding well to that intervention. It depends on the particular case, but those tests will be done quite frequently in patients being managed with active disease.