St. Luke's Family Medicine Residency - Bethlehem, 801 Ostrum St, Bethlehem, PA 180150.
FP Essent. 2022 Aug;519:24-28.
Diabetic retinopathy (DR), a microvascular complication of diabetes, is the most common cause of vision loss in adults ages 20 to 74 years in many countries. Initial screening for DR should occur within 5 years of a type 1 diabetes diagnosis and at the time of a type 2 diabetes diagnosis. Slowing of DR progression involves optimization of glycemic control, blood pressure management, control of diet and lipid levels, and lifestyle modification. Panretinal photocoagulation (PRP) can prevent progression of proliferative DR with minimal risk of damaging the macula. Ranibizumab, an anti-vascular endothelial growth factor (VEGF) drug, can be an effective alternative to PRP. Age-related macular degeneration (AMD) is a leading cause of visual impairment and vision loss in developed countries. AMD leads to progressive loss of central vision and distortion of images. Smoking is the strongest modifiable risk factor. Hypertension and hyperlipidemia also have been associated with AMD. The initial patient evaluation should include a comprehensive eye examination, visual acuity measurement, assessment with the Amsler grid, and fundus photography. Smoking cessation should be recommended for patients with AMD who smoke. For patients with wet, or neovascular, AMD, first-line therapy is an intravitreal anti-VEGF drug (ie, ranibizumab, bevacizumab, aflibercept [Eylea]).
糖尿病性视网膜病变（DR）是糖尿病的一种微血管并发症，是许多国家 20 至 74 岁成年人视力丧失的最常见原因。DR 的初步筛查应在 1 型糖尿病诊断后 5 年内和 2 型糖尿病诊断时进行。减缓 DR 进展涉及优化血糖控制、血压管理、控制饮食和血脂水平以及生活方式改变。全视网膜光凝（PRP）可以预防增生性 DR 的进展，对黄斑的损害风险最小。雷珠单抗，一种抗血管内皮生长因子（VEGF）药物，可作为 PRP 的有效替代药物。年龄相关性黄斑变性（AMD）是发达国家视力损害和视力丧失的主要原因。AMD 导致中心视力逐渐丧失和图像变形。吸烟是最强的可改变的危险因素。高血压和高血脂也与 AMD 有关。初始患者评估应包括全面的眼科检查、视力测量、Amsler 网格评估和眼底摄影。应建议吸烟的 AMD 患者戒烟。对于患有湿性或新生血管性 AMD 的患者，一线治疗是眼内抗 VEGF 药物（即雷珠单抗、贝伐单抗、阿柏西普[Eylea]）。
