Natural history of diabetic macular streak exudates: evidence from a screening programme

Background/aims-Diabetic retinopathy screening guidelines recommend referra l to an ophthalmologist if there is exudate within one disc diameter of the fovea. Many of these patients, however, have resolution of small amounts o f exudate without treatment. This study aimed to assess whether patients wi th minimal streak or dot exudates within one disc diameter of the fovea can be monitored in a screening programme without compromising visual acuity. Methods-A retrospective review of records and Polaroid photographs obtained by one screening centre over a 10 year period was performed. Outcomes meas ured were referral rates, alteration of Snellen visual acuity, and the need for macular photocoagulation treatment. Results-55 patients (74 eyes) fulfilled entry criteria (37 streak and 37 do t exudates). Mean follow up was 56.1 months (range 12-127 months). Twenty f ive 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 p resence or resolution of minimal exudate and visual loss (p > 0.2). Conclusion-It is appropriate to monitor eyes with streak or dot macular exu dates at 6-9 monthly intervals in a screening programme.