Diabetic retinopathy

Question 1

Name 4 features you may see on fundoscopy for patients with diabetic retinopathy?

Answer 1

Microaneurysms

Dot and blot haemorrhages (dot haemorrhages occur in inner retinal layers while blot haemorrhages are larger and occur in the nerve fibre layer)

Hard exudates (leakage of protein from damaged arterial walls)

Soft exudates (nerve fibre layer microinfarcts)

Question 2

Name 3 risk factors for diabetic retinopathy?

Answer 2

Duration of diabetes (most common)
Pregnancy
Ethnicity
Nephropathy (end-organ damage)

Question 3

How would you categorise diabetic retinopathy?

Answer 3

Proliferative and non-proliferative. Non-proliferative can be broken down into background retinopathy and pre-proliferative diabetic retinopathy

Question 4

What might you see in severe pre-proliferative diabetic retinopathy?

Answer 4

4-2-1 rule:

• Blot haemorrhages in 4 quadrants
• Venous beading in 2 quadrants
• Intraretinal microvascular abnormalities in 1 quadrant

Question 5

Complication of diabetic retinopathy?

Answer 5

Neovascular glaucoma

Question 6

Signs and symptoms of diabetic retinopathy?

Answer 6

Asymptomatic

Blurred vision –> central vision distortion

Decreased visual acuity

Blindness

Question 7

Investigations for diabetic retinopathy?

Answer 7

HbA1c

Optical Coherence Tomography

Fluorescein Angiography (to determine vasculature of retina)

Question 8

Management of diabetic retinopathy

Answer 8

Optimise sugar control

Optimise HTN control

Good diet

Exercise

Stop smoking

If proliferative: photocoagulation laser, anti-VEGF treatment (if failed laser Tx)