Follow-up
Follow-up of all patients should occur at least annually, with the possible exception of those with retinopathy-free type 2 diabetes. Even in the latter cases, the American Diabetes Association recommends yearly examinations to avoid lost follow-up and to identify patients with more aggressive ocular disease. Of special note, because retinopathy rarely develops in children before puberty, patients with early-onset type 1 diabetes generally do not require screening before 10 years of age. Also, the acceleration of retinopathy during pregnancy demands that all patients with preexisting diabetes be examined during the first trimester. Recently, the availability of high-quality retinal photography with remote interpretation by specialists has become available. This is now thought to be a reasonable substitute when an in-person evaluation is not possible (e.g., in remote areas).