New Test Recommended by American Academy of Ophthalmology for Patient’s with Diabetes
📋 2025 Preferred Practice Pattern: Key Recommendations & Updates
1. Screening
- Type 1 diabetes: Begin annual dilated eye exams 5 years after diagnosis.
- Type 2 diabetes: Start immediately upon diagnosis, then continue yearly.
- Only about 60 % of people with diabetes get recommended annual screenings en.wikipedia.org+2guidelinecentral.com+2researchgate.net+2.
- Preferred methods: dilated fundus exam is gold standard, but validated digital retinal imaging is an effective alternative en.wikipedia.org+12guidelinecentral.com+12researchgate.net+12.
2. Systemic Risk Factor Management
- Strict control of blood glucose (HbA1c) and blood pressure reduces risk of diabetic retinopathy development and progression glance.eyesoneyecare.com+4guidelinecentral.com+4researchgate.net+4.
- However, rapid glucose lowering, especially with newer agents like semaglutides, can accelerate retinopathy onset guidelinecentral.com+1reference.medscape.com+1.
3. Special Situations
- Pregnancy: Women with pre-existing diabetes should have early and frequent eye exams; gestational diabetes alone does not require screening aao.org+11guidelinecentral.com+11en.wikipedia.org+11.
- Puberty: Faster progression risk-closer monitoring recommended during adolescence reference.medscape.com.
4. Diabetic Macular Edema (DME) & Treatment Approaches
- Center-involving DME with vision loss: First-line treatment is intravitreal anti-VEGF agents.
- Benefits: not only reduce edema but also help regress diabetic retinopathy and treat proliferative DR en.wikipedia.org+3guidelinecentral.com+3reference.medscape.com+3.
- For CI-DME with preserved vision (20/30 or better), deferring treatment is reasonable reference.medscape.com.
- Panretinal photocoagulation (PRP) remains essential for proliferative DR, especially where anti-VEGF is not optimal glance.eyesoneyecare.com+6guidelinecentral.com+6reference.medscape.com+6.
5. Intravitreal Injection Protocols
- Routine use of topical povidone-iodine is strongly recommended before injections to reduce endophthalmitis risk reference.medscape.com.
6. Functional Testing – ERG
- For the first time, electroretinography (ERG) has been included in this guideline, highlighting its emerging role as a diagnostic and monitoring tool in DR management clinicalkey.com+15lkc.com+15glance.eyesoneyecare.com+15.
🗓 Summary Table
| Domain | Key Recommendations |
|---|---|
| Screening | Type 1: begin after 5 years; Type 2: at diagnosis, then annually |
| Systemic control | Tight HbA1c and BP control; avoid overly rapid glucose lowering |
| Pregnancy & Puberty | Early/frequent exams as needed; gestational diabetes does not require screening |
| DME Treatment | Anti-VEGF first-line for vision loss; observation OK if VA ≥20/30 |
| Proliferative DR | PRP remains critical; anti-VEGF may supplement |
| Intravitreal Protocols | Mandatory povidone-iodine antisepsis before injections |
| Functional Testing (ERG) | Recognized as valuable in diagnosis and disease progression assessment |
🔍 What’s New Compared to Previous (2020) PPP
- Inclusion of ERG as a tool for DR management.
- Emphasis on the risks of fast glucose lowering.
- Continued prioritization of povidone-iodine antisepsis.
- Reinforced guidance on deferring CI-DME treatment when vision remains good.