With regards to tight glycemic control in adults with diabetes, the benefit of slowed diabetic retinopathy must be weighed carefully with the risks of hypoglycemia and death in older adults. Eye exams can be discontinued in older adults with no signs of diabetic eye disease or life-limiting conditions (eg, end-stage renal disease). The American Diabetes Association modified their guidelines to recommend individualized adjustment of A1c goals (target 8.5%) in older adults. Fenofibrate has also been shown to delay progression of diabetic retinopathy. 

The mainstay treatment for diabetic retinopathy remains panretinal photocoagulation and vascular endothelial growth factors demonstrate limited efficacy for proliferative diabetic retinopathy. Aflibercept and ranibizumab were approved for the treatment of diabetic macular edema; bevacizumab is not approved for this condition. According to the study, aflibercept “may offer a slight advantage in more advanced cases of diabetic macular edema.” 

Preoperative testing before cataract surgery has not shown to improve outcomes and is not recommended. Phacoemulsification with intraocular lens replacement is the standard surgical approach in the U.S. Further, older patients should be counseled to reduce their exposure to UV light and to stop smoking, as these factors have been associated with accelerated cataract formation.

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Overall, the authors emphasized that family physicians are critical in identifying at-risk patients, counseling, and referring them to specialists for disease-specific treatment.

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