Diabetic retinopathy

Question 1

whats the main eye condition in people with diabetes

Answer 1

diabetic retinopathy

Question 2

what are other eye diseases in people with diabetes (3)

Answer 2

-diabetic cataract
-cranial nerve palsies leading to diplopia
-diabetic papillopathy (involving optic disc)

Question 3

what is DR

Answer 3

its a chronic progressive disease of retina microvasculature

Question 4

what are risk factors for DR (6)

Answer 4

-duration of diabetes
-uncontrolled systemic hypertension
-uncontrolled blood glucose
-renal disease
-hyperlipidemia
-pregnancy

Question 5

what is an unmodifiable risk factor for DR

Answer 5

duration of diabetes

Question 6

DR is a result of what

Answer 6

chronic hyperglycemia

Question 7

what changes are associated with chronic hyperglycemia (3)

Answer 7

• capillary wall damage (loss of pericyctes, thickening of the basement memberane)
  -hematological changes ( deformed RBCs and WBCs, increase in platelet aggregation)
  -microvascular occlusion causing hypoxia

Question 8

what are the classifications of DR (3)

Answer 8

• non proliferative DR
• proliferative DR
• diabetic maculppathy

Question 9

what is NPDR

Answer 9

its the earlier stages of DR where there is no formation of new vessels

Question 10

what is proliferative DR

Answer 10

is an advanced stage where there are abnormal retinal vessels.

Question 11

what can you see in mild moderate NPDR (3)

Answer 11

-blot hemorrhages
-hard exudates
-dot hemorrhages

Question 12

what can you see on severe NPDR (2)

Answer 12

-cotton wool spots
-hemorrhages

Question 13

what can you see in proliferative DR (2)

Answer 13

-new vessels
-pre retinal hemorrhage

Question 14

what can you see in advanced proliferative DR

Answer 14

scar tissue

Question 15

what occurs in diabetic maculopathy(2)

Answer 15

-macula edema (treatable if caught early)
-macula ischemia (not treatable)

Question 16

whats the most common cause of visual loss in persons with diabetic retinopathy

Answer 16

macular edema

Question 17

how can you confirm macular ischemia

Answer 17

fluorescein angiograpthy

Question 18

what investigations can you do for macular ischemia (2)

Answer 18

• fluorescein angiogram
• OCT (optical coherence tomography)

Question 19

How can you manage DR (2)

Answer 19

• control systemic factors
• ophthalmic rx

Question 20

which systemic factors do you control (3)

Answer 20

• blood sugar
• BP
• lipids

Question 21

what are some ophthalmic treatments (4)

Answer 21

• monitoring
• laser
• intravitreal injections
• vitreo-retinal surgery

Question 22

what are the types of laser rx (2)

Answer 22

• pan retinal photocoagulation for proliferative retinopathy
• focal or grid photocoagulation for macular edema

Question 23

what are potential side effects of laser therapy (4)

Answer 23

-loss of peripheral vision, tunnel vision
-night blindness
-colour blindness
-vision can get worse but laser saves sight

Question 24

what medical therapies can be used (2)

Answer 24

• corticosteroids
• anti VEGF agents

Question 25

example of a corticosteroid used

Answer 25

triamcinolon

Question 26

example of anti VEGF agents that be used (3)

Answer 26

- ranibizumab (lucentis) -bevacizumab (avastin) - pegaptanib (macugen)

Question 27

when do you do vitrectomy surgery (3)

Answer 27

for very advanced diabetic retinopathy - vitreous hemorrhage - retinal detachment - some cases of macular edema

Question 27

what is done in primary prevention to control blindness from DR (3)

Answer 27

- lifestyle changes such as increasing physical activities or dietary changes - pharmacological intervention (blood pressure control) -screening for diabetic retinopathy in order to detect onset of DR

Question 28

who does the primary prevention target

Answer 28

persons without diabetes to prevent or delay onset of DR

Question 29

what does secondary prevention aim to do

Answer 29

prevent progression of early DR to advanced stages of DR

Question 30

what does secondary prevention involve (3)

Answer 30

- lifestyle changes - pharmacological intervention for systemic control -regular DR screening to monitor progression of early stages of DR to advanced stages of DR

Question 31

what is the tertiary prevention aimed at

Answer 31

preventing progression of advanced staged to blindness

Question 32

what does tertiary prevention involve(4)

Answer 32

- lifestyle changes - pharmacological interventions for systemic control - regular DR screening to monitor the progression - ophthalmic treatments (laser, surgery, avastin/anti VEGF injections)