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Shared Care and Ocular Therapeutics > Diabetic Eye Disease > Flashcards

Diabetic Eye Disease Flashcards

1
Q

Types of Diabetic Eye Disease

A

Anterior Segment
- Dry eye
- Diabetic keratopathy
- Uveitis
- Cataract

Posterior Segement
- Vitreous haemorrhages
- Diabetic retinopathy

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2
Q

Diabetic Keratopathy

A
  • Cornea experiences 4x higher level in diabetes
  • Examples
    • Superficial punctate keratitis
    • Recurrent corneal erosion
    • Persistent epithelial defect
    • Diabetic neurotrophic keratopathy
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3
Q

Features of Diabetic Neurotrophic Keratopathy

A
  • Involves reduction of corneal nerve density
  • May lead to permanent vision loss
  • Has three stages
  • Characterised by structural/functional changes
    • Impaired sensitivity
    • Epithelial defects (loss of protective function)
    • Impaired healing
    • Corneal ulceration
    • Loss of vision
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4
Q

Diabetic Retinopathy Risk Factors

A
  • Hyperglycaemia
  • Hypertension
  • Diabetes duration
  • Ethnicity (African, Hispanic, South Asian)
  • Puberty and pregnancy (in type 1)
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5
Q

R0 Retinopathy

A
  • No diabetic retinopathy anywhere
  • Rescreen in 12 months
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6
Q

R1 Retinopathy

A
  • Presence of any one of the following
    • Dot haemorrhages
    • Microaneurysms
    • Hard exudates
    • Cotton wool spots
    • Blot haemorrhages
    • Flame haemorrhages
  • Rescreen in 12 months
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7
Q

R2 Retinopathy

A
  • Four or more blot haemorrhages in one hemi-field only
  • Rescreen 6 months
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8
Q

R3 Retinopathy

A
  • Any of the following:
    • Four or more blot haemorrhages in both hemi-fields
    • Venous beading
    • IRMA
  • Refer to ophthalmology
    • Likely to not receive immediate treatment
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9
Q

R4 Retinopathy

A
  • Proliferative
    • Active new vessels
    • Vitreous haemorrhage
  • Refer to ophthalmology
    • Likely to receive treatment
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10
Q

R6 Retinopathy

A
  • Retina no suitably visible
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11
Q

M0 Maculopathy

A
  • No features <2 disc diameters from fovea sufficient to qualify as M1 or M2
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12
Q

M1 Maculopathy

A
  • Lesions sufficient to qualify for M1 or M2 within a radius of >1 but <2 disc diamteters from fovea
  • Any hard exudates
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13
Q

M2 Maculopathy

A
  • Lesions sufficient to qualify for M1 or M2 within a radius of <1 disc diamteter from fovea
  • Any hard exudates
  • Any blot haemorrhages
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14
Q

Suspect Diabetic History and Symptoms

A
  • Vision
    • May fluctuate throughout day (and refraction)
  • GH
    • May be being investigated for DM
    • May not think of themselves as diabetic
    • May be diet controlled
  • Family History
    • Who
    • Type
    • Onset
    • Effect on eyes
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15
Q

Monitoring Diabetic History and Symptoms

A

Need to know:
- Type
- Duration/onset
- Medications
- Stability
- Who monitors it
- When was last GP checkup
- Attending DRS?
- If yes, when and any advise/changes?
- If no, why not? Consider annual recall

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16
Q

Shared Care Management and Recall

A

Monitor
- Every 2 years if attending DRS
- Every year if not attending DRS

Letter to GP
- To reassess blood glucose levels and medications if clinically indicated

Referral:
- To GP if first presentation for diagnosis
- To Ophthalmology if clinically indicated

17
Q

GP Investigation

A
  • Assessment of blood glucose level
    • Blood test
    • Urine test
  • Patient name goes on diabetes list if diagnosed
  • All diabetics are invited to annual screening
18
Q

GP Diabetes Management

A
  • Management of DM depending on type 1 or 2
  • Monitor frequently to check general health
  • Referral to community optometry and DRS
19
Q

How Does DRS Work?

A
  • Nationwide service
  • All diabetics over 12 invited
  • Screening based on digital fundus images
  • All images graded by medical retina optometrist
20
Q

Optometrist Role at DRS

A
  • Medical retina specialists
  • Grading of fundus images
  • Run slit lamp clinics (if image of insufficient quality)
  • Referral decision making (seen by 2 optometrists)
  • Referral is directly to ophthalmology outpatients with a letter sent to GP
21
Q

Ophthalmologist Management Options

A
  • Pan-retinal Photocoagulations
  • Anti-VEGF injections
  • Intravitreal steroids
  • Vitrectomy
22
Q
A

Shared Care and Ocular Therapeutics (10 decks)

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