International Council of Ophthalmology

ICO International Clinical Guidelines:

Duration of diabetes [A:I]
Past glycemic control (hemoglobin A1c) [A:I]
Medications [A:III]
Systemic history (e.g., onset of puberty [A:III], obesity [A:III], renal disease [A:II], systemic hypertension [A:I], serum lipid levels [A:II], pregnancy [A:I])

Best-corrected visual acuity [A:I]
Measurement of IOP [A:III]
Gonioscopy when indicated (for neovascularization of the iris or increased IOP) [A:III]
Slit-lamp biomicroscopy [A:III]
Dilated funduscopy including stereoscopic examination of the posterior pole [A:I]
Examination of the peripheral retina and vitreous, best performed with indirect ophthalmoscopy or with slit-lamp biomicroscopy, combined with a contact lens [A:III]

Classify both eyes as to category and severity of diabetic retinopathy, with presence/absence of CSME. [A:III] Each category has an inherent risk for progression.

Visual acuity [A:I]
Measurement of IOP [A:III]
Slit-lamp biomicroscopy with iris examination [A:II]
Gonioscopy (if neovascularization is suspected or present or if intraocular pressure is increased) [A:II]
Stereo examination of the posterior pole with dilation of the pupils [A:I]
Examination of the peripheral retina and vitreous when indicated [A:II]

Discuss results of exam and implications. [A:II]
Encourage patients with diabetes but without diabetic retinopathy to have annual dilated eye exams. [A:I]
Inform patients that effective treatment for diabetic retinopathy depends on timely intervention, despite good vision and no ocular symptoms. [A:II]
Educate patients about the importance of maintaining near-normal glucose levels and near-normal blood pressure and lowering serum lipid levels. [A:III]
Communicate with the attending physician, e.g., family physician, internist, or endocrinologist regarding eye findings. [A:III]
Provide patients whose conditions fail to respond to surgery and for whom treatment is unavailable with proper professional support and offer referral for counseling, rehabilitative, or social services as appropriate. [A:III]
Refer patients with significant visual impairment to a provider experienced in vision rehabilitation who can equip the patient with appropriate aids. [A:III]

Fundus photography is seldom of value in cases of minimal diabetic retinopathy or when diabetic retinopathy is unchanged from the previous photographic appearance. [A:III]
Fundus photography may be useful for documenting significant progression of disease and response to treatment. [B:III]
Fluorescein angiography is used as a guide for treating CSME [A:I] and as a means of evaluating the cause(s) of unexplained decreased visual acuity. [A:III] Angiography can identify macular capillary nonperfusion [A:II] or macular edema (or both) as possible explanations for visual loss.
Fluorescein angiography is not routinely indicated as part of the examination of patients with diabetes. [A:III]
Fluorescein angiography is not needed to diagnose CSME or PDR, both of which are diagnosed by means of the clinical exam.