How is the diagnosis of diabetic retinopathy made

It is based on a comprehensive ophthalmologic evaluation, which should be performed by an ophthalmologist. As expected, some studies have shown that evaluation by an ophthalmologist has greater effectiveness and sensitivity in detecting retinal damage. However, the initial evaluation by the primary physician (general practitioner, diabetologist, endocrinologist), who should perform a minimal ophthalmologic exam, is also important. In this way, possibly serious damage that could go undetected can be prevented. A comprehensive ophthalmologic exam includes visual acuity evaluation, pupil reaction to light (myosis of the pupil on application of light on it), and fundoscopy. Monoocular examination with the direct ophthalmoscope is not always able to detect all possible retinal lesions, especially when the examiner is not very experienced. Furthermore, diagnosis of maculopathy with simple fundoscopy is difficult to detect in detail, even by very experienced ophthalmologists. For this reason, examination with a slit-lamp is essential. More specialized examinations, such as fundus photography for further evaluation and follow-up of the lesions, fluorescein retinal angiography, measurement of intraocular pressure and possibly fundus ultrasonography, should be performed by a specialist ophthalmologist if this is necessary. Fluorescein angiography includes the intravenous injection of a special substance, fluorescein, which is bound to serum albumin and accumulates in the retinal vessels, revealing their anatomy. Recently, the new technique of optical coherence tomography (OCT) of the macula (available in specialized centres) allows the diagnosis of macular oedema to be made objectively and with great precision and reliability, permitting the diagnosis of maculopathy much more easily than in the past.

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