Diabetic Retinopathy Documentation System

Complete diabetic eye exam documentation with retinopathy grading, macular edema assessment, and PCP communication.

Diabetic retinopathy documentation includes severity grading, macular assessment, and coordination with primary care. Doctora automates DR classification, generates PCP letters, and ensures appropriate follow-up scheduling based on severity.

Common Symptoms

Often asymptomatic in early stages

Blurred vision

Floaters or spots

Dark areas in vision

Difficulty with color perception

Vision loss (advanced stages)

Diagnostic Tests

Dilated Fundus Exam

Retinal assessment

Fundus Photography

Document retinal changes

OCT Macula

Detect macular edema

Fluorescein Angiography

Vascular assessment

Wide-field Imaging

Peripheral retina evaluation

Documentation

Essential Documentation for Diabetic Retinopathy

DR severity grading

Critical

Macular involvement

Critical

HbA1c documentation

Important

PCP communication

Critical

Follow-up scheduling

Critical

AI Solutions

How Doctora Streamlines Diabetic Retinopathy Documentation

Automated DR grading

Consistent severity classification

PCP letter templates

One-click communication to primary care

Photo documentation

Integrate retinal images with notes

Follow-up calculator

Schedule based on DR severity

Patient education

Generate severity-specific handouts

Treatment

Treatment Options for Diabetic Retinopathy

Blood Sugar Control

Primary prevention strategy

Anti-VEGF Injections

For macular edema

Laser Photocoagulation

For proliferative DR

Vitrectomy

For advanced complications

Steroid Injections

Alternative for DME

Billing Codes

Common ICD-10 Codes for Diabetic Retinopathy

Doctora automatically suggests appropriate codes based on your documentation

E11.319

Type 2 DM with unspecified DR without macular edema

E11.3211

Type 2 DM with mild NPDR with macular edema, right eye

E11.3591

Type 2 DM with proliferative DR with macular edema, right eye

Patient Education Topics

Importance of blood sugar control

Regular eye exam schedule

Warning signs to report

Lifestyle modifications

Follow-up Protocol

Annual for no DR, 6-9 months for mild-moderate NPDR, 3-4 months for severe

Streamline Your Diabetic Retinopathy Documentation Today

Join optometrists using Doctora to improve documentation quality while saving hours daily.

14-day free trial • No credit card required • Works with your EHR