Posterior Segment
Diabetic Retinopathy
Also known as: diabetic retinopathy, DR, diabetic eye disease, diabetic macular oedema, DME, diabetic maculopathy, DMO, background retinopathy
Filed as: Urgent
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Retinal microvascular changes secondary to chronic hyperglycaemia. Ranges from no retinopathy through non-proliferative (mild, moderate, severe, very severe) to proliferative diabetic retinopathy. Diabetic macular oedema (DME / DMO) can occur at any stage. Screening baseline and interval are determined by RANZCO pathway. Optometrists screen, stage, image, and refer; collaborative monitoring may apply to moderate NPDR under agreed protocols.
Recognition
Symptoms: what patients report
- Often asymptomatic until advanced — emphasises screening importance.
- Blurred vision — may indicate DME / DMO, vitreous haemorrhage, or cataract.
- Sudden vision loss — vitreous haemorrhage, tractional detachment, or neovascular glaucoma; same-day referral.
- Floaters — new floaters suggest vitreous haemorrhage.
- Fluctuating vision — related to glycaemic variation.
Signs: what the examination shows
- Microaneurysms — earliest sign, red dots in the posterior pole.
- Retinal haemorrhages — dot-blot (deep) or flame (nerve fibre layer).
- Hard exudates — waxy yellow deposits, often circinate around leaking microaneurysms.
- Cotton-wool spots — nerve fibre layer infarcts, white fluffy patches.
- Intraretinal microvascular abnormalities (IRMA) — severe NPDR.
- Venous beading and loops — pre-proliferative change.
- Neovascularisation — new vessels on or within one disc diameter of the disc (NVD) or elsewhere (NVE); proliferative disease.
- Macular oedema (DME / DMO) — retinal thickening, exudates at macula; OCT confirms centre-involving status.
- Tractional retinal detachment — traction from fibrovascular proliferation in advanced diabetic eye disease; emergency retina pathway.
What OptoGuide™ covers for diabetic retinopathy
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Diabetic Retinopathy PPP — AAO
- Referral Pathway for Diabetic Retinopathy — RANZCO
- Hypertensive eye disease. Cheung CY, Biousse V, Keane PA, Schiffrin EL, Wong TY. Nature Reviews. Disease Primers. 2022;8(1):14.
- What Does This Retina Examination Show?. Huang W, Mirza RG, Molitch ME. JAMA. 2015;314(23):2555-6.
- Retinal Vein Occlusions Preferred Practice Pattern®. Kovach JL, Bailey ST, Kim SJ, et al. Ophthalmology. 2025;132(4):P303-P343.
- Centre for Eye Health — Chair-side Reference: Diabetic Retinopathy
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.