2: Diabetic and HTN Retinopathy

Question 1

What is diabetic retinopathy

Answer 1

progressive destruction of retinal microvasculature caused by chronic hyperglycaemia

Question 2

What is the main cause of blindness in 25-65 year-olds

Answer 2

diabetic retinopathy

Question 3

What are 3 risk factors for diabetic retinopathy

Answer 3

Age
Uncontrolled diabetes
HTN

Question 4

what are 3 common symptoms of diabetic retinopathy

Answer 4

Blurred vision
Floaters
Sudden visual-loss

Question 5

How can diabetic retinopathy be classified

Answer 5

Proliferative and Non-Proliferative diabetic retinopathy

Question 6

How is non-proliferative diabetic retinopathy divided

Answer 6

Mild
Moderate
Sevre

Question 7

What is 1 feature of mild non-proliferative diabetic retinopathy

Answer 7

1 or more micro aneurysms

Question 8

What are the 6 features for moderate non-proliferative diabetic retinopathy

Answer 8

1. Micro-aneurysms
2. Blot haemorrhage (Flame-shaped haemorrhage)
3. Hard exudates
4. Cotton wool spots
5. Venous loops
6. Intra-retinal microvascular abnormality

Question 9

What are the 3 features for severe non-proliferative diabetic retinopathy

Answer 9

1. Micro-aneurysms in >4
   quadrants
2. Venous bleed in >2 quadrants
3. IRMA in one-quadrant

Question 10

What is a more common type of retinopathy in T1DM

Answer 10

Proliferative diabetic retinopathy

Question 11

What is risk of proliferative diabetic retinopathy

Answer 11

Neovascularisation increases risk of vitreous haemorrhage

Question 12

What are the earliest sign of diabetic retinopathy

Answer 12

Micro-aneurysms

Question 13

What are micro aneurysms

Answer 13

Dilations of capillary

Question 14

How do micro aneurysms appear on fundoscopy

Answer 14

Red dots - often in clusters

Question 15

What is a blot (or flame-shaped) haemorrhage also known as

Answer 15

Intra-retinal haemorrhage

Question 16

What decides if an intra-retinal haemorrhage is called a blot or flame-shaped haemorrhage

Answer 16

Retinal depth

Question 17

What is a flame-shaped haemorrhage

Answer 17

Superficial layer of retina

Question 18

What is a blot haemorrhage

Answer 18

Deeper layer of retina

Question 19

How do hard exudates appear on retinopathy

Answer 19

yellow patches

Question 20

What causes hard exudates

Answer 20

extracellular lipids leaking from defective capillaries

Question 21

Where are hard exudates more commonly found

Answer 21

by the macula

Question 22

Explain venous loops

Answer 22

dilation and duplication of veins occurs as retina undergoes ischaemia

Question 23

what is intra-retinal microvascular abnormalities (IRMA)

Answer 23

areas of new capillary formation that occurs secondary to retinal ischaemia

Question 24

Explain neovascularisation

Answer 24

As retinal ischaemia occurs - new blood vessels arise

Question 25

How does neovascularisation present on fundoscopy

Answer 25

'tufts'

Question 26

How can progression of diabetic retinopathy be classified

Answer 26

1. Diabetes without retinopathy 2. Non-proliferative DR 3. Proliferative DR

Question 27

Explain diabetes without retinopathy

Answer 27

Hyperglycaemia causes damage to pericytes (cells responsible for surrounding blood vessels to control flow)

Question 28

What does damage to pericytes in non-proliferative DR cause

Answer 28

1. Damage to pericytes causes weakening of capillaries leading to micro aneurysms 2. Damage to pericytes increases permeability of capillaries enabling lipids to leak into retinal tissue causing hard exudates

Question 29

When does non-proliferative DR often onset after diagnosis

Answer 29

15-20 years

Question 30

Explain proliferative DR

Answer 30

- Microvascular damage thus far causes retinal ischaemia - To compensate, retina releases VEGF - This increases proliferation of vessels - These vessels are insufficient to supply the retina and can lead to vitreous haemorrhage

Question 31

What other eye condition does diabetes increase the risk of

Answer 31

cataracts

Question 32

Why does diabetes increase the risk of cataracts

Answer 32

glucose is absorbed by the lens and converted to sorbitol where it precipitates

Question 33

If individuals have maculopathy, non-proliferative DR or proliferative DR how soon should they be reviewed by opthalmology

Answer 33

Urgently

Question 34

Explain screening for diabetes

Answer 34

Individuals are screened at diagnosis and annually thereafter

Question 35

How is screening for diabetic retinopathy performed

Answer 35

Dilated fundus photography

Question 36

Why is dilated fundus photography performed

Answer 36

to identify neovascularisation early to enable photocoagulation laser treatment

Question 37

When should individuals be referred to surgeons from diabetic retinopathy screening

Answer 37

if pre-proliferative retinopathy, proliferative, macuolopathy

Question 38

On diabetic eye-screening what is R0

Answer 38

No retinopathy

Question 39

On diabetic eye-screening what is R1

Answer 39

Mild non-proliferative retinopathy

Question 40

On diabetic eye-screening what is R2

Answer 40

Severe non-proliferative retinopathy

Question 41

On diabetic eye-screening what is R3

Answer 41

Proliferative retinopathy

Question 42

On diabetic eye-screening what is M0

Answer 42

No maculopathy

Question 43

On diabetic eye-screening what is M1

Answer 43

Maculopathy

Question 44

What is the treatment for diabetic retinopathy

Answer 44

Laser photocoagulation treatment

Question 45

What can be used in addition to laser photocoagulation treatment to treat diabetic retinopathy

Answer 45

Intra-vitreal triamcinolone or anti-VEGF

Question 46

What should also be controlled in diabetic retinopathy

Answer 46

BP: aim for less than 130/80

Question 47

What BP defines HTN

Answer 47

>140/90

Question 48

What BP defines malignant HTN

Answer 48

>220/120

Question 49

What classification is used for HTN retinopathy

Answer 49

Keith-Wegner

Question 50

Of the Keith-Wegner classification, what stages are usually seen in chronic HTN

Answer 50

Stage 1 and 2

Question 51

Of the Keith-Wegner classification, what stages are usually seen in malignant HTN

Answer 51

Stage 3 and 4

Question 52

What are the 3 signs of stage I keith-wegner HTN retinopathy

Answer 52

1. AV narrowing and increases tortuosity 2. Increased light reflex 3. Sclerosis - causing silver wiring

Question 53

What is a sign of stage 2 ketih-wegner HTN retinopathy

Answer 53

AV nicking

Question 54

What is a sign of stage 3 Keith wegner HTN retinopathy

Answer 54

Cotton wool spots | Flame-shaped haemorrhages

Question 55

What is a sign of stage 4 Keith wegner HTN retinopathy

Answer 55

Papilloedema

Question 56

How may malignant HTN present

Answer 56

Headache, eye pain, reduced visual acuity

Question 57

What is the target BP if hypertensive retinopathy

Answer 57

<130/90

Question 58

if a diabetic has proteinuria what is the target BP

Answer 58

<125/75

Question 59

What visual conditions can HTN retinopathy pre-dispose to

Answer 59

- Accelerates diabetic retinopathy - Retinal artery and vein occlusion - Vitreous haemorrhage - Papilloedema