Natural history of diabetic macular streak exudates: evidence from a screening programme
a Department of
Ophthalmology, Rayne Institute, UMDS, St Thomas's Hospital,
London, b Department of Ophthalmology, St Thomas's
Hospital, London, c Department of Diabetes,
St Thomas's Hospital, London
Correspondence to: Miss Helen L Cook, Department of Ophthalmology, Rayne Institute, St Thomas's Hospital, Lambeth Palace Road, London SE1 7EH.
Accepted for publication 25 November 1998
BACKGROUND/AIMS
Diabetic
retinopathy screening guidelines recommend referral to an
ophthalmologist if there is exudate within one disc diameter of the
fovea. Many of these patients, however, have resolution of small
amounts of exudate without treatment. This study aimed to assess
whether patients with minimal streak or dot exudates within one disc
diameter of the fovea can be monitored in a screening programme without
compromising visual acuity.
METHODSA
retrospective review of records and Polaroid photographs obtained by
one screening centre over a 10 year period was performed. Outcomes
measured were referral rates, alteration of Snellen visual acuity, and
the need for macular photocoagulation treatment.
RESULTS55 patients
(74 eyes) fulfilled entry criteria (37 streak and 37 dot exudates).
Mean follow up was 56.1 months (range 12-127 months). Twenty five
patients (30 eyes) were referred to an ophthalmologist. 13 eyes
(17.6%) required macular photocoagulation treatment. Four eyes (5.4%)
lost two or more lines of Snellen acuity over the follow up period
(three from macular oedema and one from macular ischaemia). There was
no relation between the presence or resolution of minimal exudate and
visual loss (p>0.2).
CONCLUSIONIt is
appropriate to monitor eyes with streak or dot macular exudates at 6-9
monthly intervals in a screening programme.
© 1999 by British Journal of Ophthalmology
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