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Table 2 Recommended timing of retinal examinations in patients with type 2 diabetes[6] These recommended examination intervals will result in an increased work-load for ophthalmologists due to the rising number of diabetic patients. Studies examined the effect of an extension of follow-up intervals and found no increased risk of progression to sight-threatening diabetic retinopathy in patients with good metabolic control (HbA1c Resiquimod of necessary screening examinations could be reduced by 40% according to one study and even by 59% in case a special mathematical algorism is used[31,33]. However, feasibility of these strategies remains to be proven in routine clinical practice and until then ophthalmic screening intervals as indicated above are recommended. GENERAL MEDICAL THERAPY AND INTERVENTIONS Blood glucose and blood pressure control Good metabolic and blood-pressure control are essential for successful ophthalmic care of patients with diabetes. In type 2 diabetes, selleck products a reduction of HbA1c from 7.9% to 7.0% resulted in a decline in the frequency of laser treatments needed[36]. In type 1 patients, improved blood glucose control with a reduction of HbA1c values from 9.1% to 7.1% reduced the risk of developing diabetic retinopathy within 6.5 years by 76%, the risk of progression of diabetic retinopathy by 54%, and the risk of developing proliferative diabetic retinopathy by 47%[37]. Therefore an HbA1c level of about 7% should be aimed for from the ophthalmologist��s point of view[19], 3-MA nmr for the individual patient a bespoke treatment regime may be needed. Rapid improvement of metabolic control may result in temporary worsening of diabetic retinopathy (��early-worsening��) in patients with long-lasting disease and high HbA1c levels. Thus, retinal exams should be performed every three months during the first year after initiation of an improved anti-diabetic treatment[5,38]. However, in the long-term, positive effects of good metabolic control outweigh these initial problems[37,39]. Also a slow decrease of blood sugar levels, which would be a therapeutic challenge, does not have any advantages in the long term and is not recommended from the ophthalmologist��s point of view[19]. Additionally, optimizing blood pressure helps to reduce the necessity of laser photocoagulation and the risk of loss of vision[40]. While some studies suggested a protective effect of ACE inhibitors, according to the results of studies available to date, reduction of blood pressure itself seems to be more important than the type of blood pressure lowering medication[41-43]. Levels of about 140/80 mmHg should be aimed for.
