ABSTRACT
Diabetic retinopathy (DR) is characterized by gradually progressive alterations in the retinal microvas-culature, leading to areas of retinal nonperfusion, increased vasopermeability, and pathologic intraocular proliferation of retinal vessels. Rheologic changes occur in DR as a result of increased platelet aggregation, integrin-mediated leukocyte adhesion, and endothelial damage. Proliferating new vessels in DR are fragile and have a tendency to bleed, resulting in preretinal and vitreous hemorrhages. In short, causes of visual loss from complications of diabetes mellitus include retinal ischemia involving the fovea, macular edema at or near the fovea, preretinal or vitreous hemorrhages, retinal detachment, and neovascular glaucoma. The optimal ophthalmic care of a patient with diabetes necessitates a team approach that includes patient identification, routine lifelong follow-up, accurate disease severity assessment, timely therapeutic intervention, and comprehensive optimization of glycemic, blood pressure, and lipid control. The elderly diabetic patient has additional risks in terms of disease progression as well as limitations and side effects associated with treatment.
