Currently, patients who have had type 1 diabetes for 5 years are encouraged to have annual dilated retinal exams to look for possible progression to diabetic retinopathy (DR) or diabetic macular edema (DME). Both of these conditions can lead to severe vision loss and should be treated immediately.
Now, a 30-year study* published in April 2017 in the New England Journal of Medicine has shown significant benefits from customizing exam scheduling to each individual’s current state of retinopathy and glucose level. Researchers found that type 1 diabetes patients who had no retinopathy or macular edema at their initial screening had only a 5% probability of progressing to DR or DME over a period of 4 years. Relative to the patient’s condition, exams gradually increased to as often as 3 months for most severe cases. Over a 20-year period, the frequency of exams was 58% lower with a practical, evidence-based schedule than with routine annual exams.
Following this model of individualizing exam schedules, clinicians could significantly reduce the burden and cost of treatment. The change in protocol would require more effort in scheduling patients, but the trade-off in time and dollars could be worth the extra diligence.