Dear colleague,

I wanted to update you on our mutual patient.

They were seen today for their follow up eye examination.  Their diabetic retinopathy appears worse from their previous visit and now is complicated with diabetic macular edema.  Given the morbidity of macular edema, I plan to proceed with intravitreal anti-VEGF injections for which I routinely start with Avastin (Bevacizumab).  I follow a treat-and-extend protocol in where injections are performed every 4 weeks until the eye fully responds, then extend the interval of injections until the return of the macular edema. .  I reiterated the importance of tight glucose control in preventing the worsening of their diabetic eye disease.  

​Please let me know if you have any questions or concerns regarding their injections.
​
Thank you again for allowing me to participate in their care.

Sincerely,

Gintien Huang, M.D.
​San Bernardino Eye Specialists

DM2 NEW - NO Retinopathy
1) NO Retinopathy
2) NO Retinopathy+GS
3) NO Retinopathy+Cataract (VS)
4) NO Retinopathy+Dry AMD
5) NO Retinoapathy+Wet AMD (Needs IVA)

DM2 NEW - NPDR, no CME
6) NPDR no CME
7) NPDR no CME + GS
8) NPDR no CME + Cataract (VS)
9) NPDR no CME  + Dry AMD
10) NPDR no CME  + Wet AMD (Needs IVA)

DM2 NEW - NPDR with CME
​11) NPDR with CME
12) NPDR with  CME + GS
13) NPDR with  CME + Cataract (VS)
14) NPDR with  CME  + Dry AMD
15) NPDR with CME  + Wet AMD (IVA)

DM2 NEW - PDR
16) PDR Needs injection+laser
17) PDR, Stable
18) PDR, Stable + Cataract
19) PDR, Stable + GS
20) PDR, Stable +Dry AMD
21) PDR, Stable, + Wet AMD (Needs IVA)

DM2 FOLLOW UP
22) No Retinopathy, Stable
23) NPDR, Stable
24) NPDR, Worsening, no treatment
25) NPDR, Worsening, now CME
26) NPDR, Worsening, now PDR
27) PDR, Stable
28) PDR, Worse, Needs injection/laser


OTHER
29) Cataracts, Needs surgery
30) Glaucoma Suspect
31) Glaucoma 
32) Dry AMD
​33) Wet AMD (Plan for IVA)