Table 1. Summary of important recommendations.

No.	Recommendation	GoR	Consensus (source)
Symptoms and risk factors
2–1	The patient should have regular ophthalmological examinations, because: early (initial) stages of diabetic retinopathy may not be noticeable by the patient, structural changes with implications for treatment often arise before there is any functional impairment, and treatment in an early stage, if indicated, can improve the functional outcome.	↑↑	expert consensus
2–2	The following are warning signs of retinal complications: worsening visual acuity despite best refractive correction (glasses/lenses) difficulty reading or inability to read impaired perception of color general worsening of vision (blurred vision) distorted vision (metamorphopsia) spots before the eyes due to vitreal hemorrhages; in the extreme case, blindness due to recurrent vitreal hemorrhages or traction retinal detachment	statement	expert consensus
2–3	Important general risk factors for the appearance or progression of diabetic retinopathy and/or maculopathy are: the duration of diabetes the degree of hyperglycemia the presence of / the degree of arterial hypertension nephropathy Further risk factors are: pregnancy in type 1 diabetes: male sex	statement	expert consensus (9– 15)
Clinical examination and general treatment strategies
3–2	On referral to the ophthalmologist, the patient should be told not to drive a motor vehicle for a few hours after the ophthalmological examination because the pupils must be dilated as part of the procedure.	↑↑	expert consensus
3–3	The ophthalmological examination for the detection of retinopathy and/or maculopathy and the determination of its severity should include the following: measurement of visual acuity examination of the anterior segment of the eye binocular retinal examination with the pupils dilated to enable assessment of the peripheral portions of the retinae	↑↑	expert consensus
3–4	The intraocular pressure should be measured in patients with advanced retinopathy. In certain clinical situations, fluorescein angiography is indicated.	↑↑	expert consensus (16, 17)
Interval between ophthalmological examinations
4–1	The regular ophthalmological examination of diabetics enables the early diagnosis of pathological changes so that the patient‘s treatment can be adjusted as needed and any indicated ophthalmological treatments can be provided.	statement	expert consensus
4–2	Ophthalmological screening should be performed in patients with type 2 diabetes shortly after the diagnosis is made (first examination), in patients with type 1 diabetes after the age of 10 or after they have had diabetes for 5 years.	↑↑
4–6	Patients should be seen promptly by an ophthalmologist if they develop any of the following new symptoms: worsening of vision distorted vision, blurred vision spots before the eyes	↑↑	expert consensus
Treatment by the primary care physician/diabetologist
5–2	The patient should be told that the presence of retinopathy is not a contraindication for cardioprotective ASA treatment, as the latter does not elevate the risk of retinal hemorrhage.	↑	expert consensus (18– 20)
5–7	If both focal and panretinal laser coagulation are indicated in a patient with combined proliferative diabetic retinopathy and diabetic macular edema without foveal involvement, the maculopathy should be treated first.	↑	expert consensus
Severe complications of proliferative diabetic retinopathy
5–8	Vitrectomy should be offered to patients who have a non-resorbing vitreal hemorrhage or a present or impending central traction retinal detachment.	↑↑	expert consensus (21– 23)
Treatment of clinically significant diabetic macular edema
…without foveal involvement
5–9	Focal laser coagulation can be offered to patients with clinically significant diabetic macular edema that spares the fovea but threatens to impair visual acuity.	↔	(24– 27)
… with foveal involvement
5–11	Intravitreal steroid therapy can be offered to patients with an inadequate or absent response to intravitreal therapy with VEGF inhibitors.	↔	expert consensus (28)
Provision of magnifying visual aids
5–14	Patients who lose the ability to read despite best refractive correction and whose blood glucose levels and ophthalmological findings are stable should be offered magnifying visual aids (either optical or electronic).	↑	expert consensus

Recommendations are numbered as in the guideline. ↑↑ strong recommendation, ↑ weak recommendation, ↔ open recommendation.

ASA, acetylsalicylic acid; GoR, grade of recommendation; PDR, proliferative diabetic retinopathy; VEGF, vascular endothelial growth factor