My nephew has type 1 diabetes. If someone with diabetes has an eye exam, and is found to have hemorrhages and exudates but no proliferative retinopathy (neovascularization), does it mean this is background retinopathy? Is the treatment only tight glucose control and not laser? When does a person with type 1 diabetes need to have a laser procedure?

You are correct, if there are no proliferative changes, it is considered background retinopathy, and laser treatment is generally not indicated for this stage of retinopathy. Laser treatment is indicated when the retina shows proliferative changes or if eminent proliferative changes appear likely, and the patient is poorly compliant with keeping appointments. Laser is also indicated when there is macular edema that is as close as 0.5 mm from central vision as well as other circumstance dealing with the amount of edema and proximity to central vision regardless if retinopathy is proliferative or not.

The rules for laser intervention are the same for type 1 and type 2 diabetes.

CAG

[Editor’s comment: See Retinopathy.

SS]