TY - JOUR T1 - Sight-threatening diabetic eye disease: an update and review of the literature JF - British Journal of General Practice JO - Br J Gen Pract SP - e678 LP - e680 DO - 10.3399/bjgp14X682033 VL - 64 IS - 627 AU - Richard J Symes AU - Gerald Liew AU - Adnan Tufail Y1 - 2014/10/01 UR - http://bjgp.org/content/64/627/e678.abstract N2 - Diabetic eye disease is the third most important cause of visual loss in England and Wales, after age-related macular degeneration and glaucoma.1 In contrast to the first two, the evidence shows that effective treatment for diabetic eye disease begins not in the eye clinic, but in the GP practice. Vision-threatening consequences of diabetes include proliferative retinopathy and maculopathy. Proliferative retinopathy may cause vitreous haemorrhage and retinal detachment with catastrophic loss of vision. Maculopathy refers to oedema at the macula, secondary to retinal capillary leakage, with consequent loss of central visual acuity.In the UK, all patients with diabetes who are not already under the care of the eye clinic should be enrolled in a retinopathy-screening programme.2 Patients are referred to an ophthalmologist if there is evidence of proliferative or pre-proliferative retinopathy or maculopathy. Letters about the patient will refer to the retinopathy grade, which is potentially bewildering, but can be readily decoded (Table 1). In the English system, the retinopathy grades R1, R2, and R3 are equivalent to ‘background’, ‘pre-proliferative’, and ‘proliferative’. The Scottish system is different and incorporates three grades of non-proliferative retinopathy.2 Therefore, (in the English system; Table 1) a patient graded ‘R2 M1 P0’ will have pre-proliferative retinopathy, evidence of maculopathy, and no visible photocoagulation scars.View this table:In this windowIn a new windowTable 1. Making sense of the diabetic patient’s screening letter … ER -