Diabetic Eye Disease Flashcards
Types of Diabetic Eye Disease
Anterior Segment
- Dry eye
- Diabetic keratopathy
- Uveitis
- Cataract
Posterior Segement
- Vitreous haemorrhages
- Diabetic retinopathy
Diabetic Keratopathy
- Cornea experiences 4x higher level in diabetes
- Examples
- Superficial punctate keratitis
- Recurrent corneal erosion
- Persistent epithelial defect
- Diabetic neurotrophic keratopathy
Features of Diabetic Neurotrophic Keratopathy
- 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
Diabetic Retinopathy Risk Factors
- Hyperglycaemia
- Hypertension
- Diabetes duration
- Ethnicity (African, Hispanic, South Asian)
- Puberty and pregnancy (in type 1)
R0 Retinopathy
- No diabetic retinopathy anywhere
- Rescreen in 12 months
R1 Retinopathy
- Presence of any one of the following
- Dot haemorrhages
- Microaneurysms
- Hard exudates
- Cotton wool spots
- Blot haemorrhages
- Flame haemorrhages
- Rescreen in 12 months
R2 Retinopathy
- Four or more blot haemorrhages in one hemi-field only
- Rescreen 6 months
R3 Retinopathy
- 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
R4 Retinopathy
- Proliferative
- Active new vessels
- Vitreous haemorrhage
- Refer to ophthalmology
- Likely to receive treatment
R6 Retinopathy
- Retina no suitably visible
M0 Maculopathy
- No features <2 disc diameters from fovea sufficient to qualify as M1 or M2
M1 Maculopathy
- Lesions sufficient to qualify for M1 or M2 within a radius of >1 but <2 disc diamteters from fovea
- Any hard exudates
M2 Maculopathy
- Lesions sufficient to qualify for M1 or M2 within a radius of <1 disc diamteter from fovea
- Any hard exudates
- Any blot haemorrhages
Suspect Diabetic History and Symptoms
- 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
Monitoring Diabetic History and Symptoms
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
Shared Care Management and Recall
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
GP Investigation
- Assessment of blood glucose level
- Blood test
- Urine test
- Patient name goes on diabetes list if diagnosed
- All diabetics are invited to annual screening
GP Diabetes Management
- Management of DM depending on type 1 or 2
- Monitor frequently to check general health
- Referral to community optometry and DRS
How Does DRS Work?
- Nationwide service
- All diabetics over 12 invited
- Screening based on digital fundus images
- All images graded by medical retina optometrist
Optometrist Role at DRS
- 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
Ophthalmologist Management Options
- Pan-retinal Photocoagulations
- Anti-VEGF injections
- Intravitreal steroids
- Vitrectomy
