Clinic: Diabetes Workup Flashcards
How often should we screen diabetes patients?
At least every 2 years (usually annually)
List 4 vision related history considerations we should make in diabetes patients
VA - is it reduced or fluctuating or stable?
Any spots in vision? (retinal/vitreal haem, RD)
Any diplopia? (H or V, monoc or binoc, onset, D/N)
Any metamorphosia/wavy vision? (mac oedema + exudate, proliferative ret)
What general diabetes info would we like to know in history? (4)
How long Meds used (meds or diet controlled) Hba1c level (should be <7 ideally) Lifestyle (diet, exercise, smoking, overall GH)
What should we do after a consult with a diabetes patient, typically?
Write a report to their GP/Endo
How do we perform a standard DM workup? (6)
Distance VA
Pupils (D/C/N?/MG/equal/shape) (gross inspection + later with SL)
Motility (excursions + CT – CNIII, CNIV, CNVI)
Lids
Refractive change (check pinhole too if VA reduced)
DFE: Dilated Fundus Exam
What might a hyperopic shift in a DM patient suggest? What should we do in response?
Might be a sign of macula oedema pushing the macula forwards, this is particularly true if only in one eye.
Assess this with OCT
List 4 additional tests we can use on DM patients
OCT to ensure not missing mac oedema (not required unless indication e.g. hyperopic shift)
Visual fields (incl. Amslwer) (check for oedema)
Potential Acuity Meter (not that useful now that we have OCTs)
Contrast sensitivity (can generally be reduced in DM)
How do you grade Mild NPR?
Only microaneurysms
Grading moderate NPR?
More than microaneurysms but less than severe
e.g. MA + ret haem or CWP or hard exudates or venous beading
Grading severe NPR
No signs of PDR, with any of:
- > /= 20 intraret haems in each of the 4 quadrants
- Venous beading in at least 2 quadrants
- Prominent IRMA in one or more quadrants
Grading PDR
Nevasc and/or vit/pre-retinal haem present
