Patient handout

Diabetic retinopathy and diabetic macular edema

PRODUCTION

1. Your condition

This handout is for diabetic retinopathy and diabetic macular edema. Your care team identified this based on: diabetes mellitus due for screening — t1dm >=5 y from diagnosis or at puberty; t2dm at diagnosis; q1-2 y thereafter; pregnancy pre-conception or first trimester (ada standards 2026; aao ppp dr 2025).

Other reasons your team may use this plan: painless blurred / distorted central vision in a patient with diabetes — diabetic macular oedema (dme) is the dominant cause of vision loss in dr (aao ppp dr 2025); sudden vision loss, dense floaters, or visual curtain in a known diabetic — pre-retinal / vitreous haemorrhage or tractional retinal detachment from pdr (aao ppp dr 2025); rapid hba1c drop (>2 percentage points / 6 months), new sglt2/glp-1 therapy, pregnancy or pre-conception planning — early-worsening dr risk (ada standards 2026).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
glycemic_bp_lipid_optimisation	—	—	—	ADA Standards 2026 + UKPDS: HbA1c to individualised target, BP <130/80, statin therapy. Avoid abrupt large HbA1c drops in severe DR (early-worsening risk). ACCORD-Eye signal supports fenofibrate adjunct.
pregnancy_co_management_with_mfm	—	—	—	ADA Standards 2026 — pregnancy accelerates DR; pre-conception treatment of severe NPDR/PDR where possible; first-trimester screen then q1-3 months.

Plan: DR + DME — systemic optimisation, stage-appropriate intravitreal therapy, PRP / vitrectomy (AAO PPP DR 2025; Protocol S; YOSEMITE/RHINE)

3. When to call your provider

Contact your care team if any of the following happen:

PDR with vitreous haemorrhage / tractional RD → same-day vitreoretinal referral
Pain + redness + hypopyon after intravitreal injection → ophtho.endophthalmitis.core.v1
Rapid HbA1c drop >2 percentage points / 6 months with severe NPDR or pregnancy → tighter follow-up cadence

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

PDR with sudden visual loss + dense floaters / curtain — vitreous haemorrhage or tractional retinal detachment(life-threatening)
Pain + redness + hypopyon after intravitreal injection(life-threatening)
HbA1c drop >2 percentage points within 6 months or new SGLT2/GLP1/intensive-insulin start with pre-existing severe NPDR / PDR
Pregnant patient or pre-conception planning with any DR — pregnancy itself accelerates DR
Severe NPDR by ICDR (4-2-1 rule) — ~50% 1-year PDR conversion risk

5. Follow-up

Lifelong screening + treatment arc. Adjust cadence by ICDR stage: q12-24 mo no DR, q12 mo mild, q6-12 mo moderate/severe NPDR, q1-4 mo PDR / DME on therapy. Pregnancy: pre-conception baseline then q1-3 months. Co-manage cataract surgery (DME can worsen post-op — peri-operative anti-VEGF or steroid). Low-vision rehabilitation for irreversible field loss / advanced disease (AAO PPP DR 2025; ADA Standards 2026).

6. Sources

Guideline: ADA Standards of Care in Diabetes 2026 (retinopathy screening cadence) + AAO Preferred Practice Pattern Diabetic Retinopathy 2025 cycle + Protocol S (Gross et al, JAMA 2015, PMID 26565927 — ranibizumab vs PRP for PDR) + YOSEMITE & RHINE (Wykoff et al, Lancet 2022, PMID 35085503 — faricimab DME with up-to-q16wk durability)