Diabetic Retinopathy

Question 1

What are the signs of R1 (background diabetic retinopathy)?

Answer 1

• Small microaneurysms or intraretinal haemorrhages
• Hard exudates outside the arcades

Question 2

What are the symptoms of R1?

Answer 2

Asymptomatic.

Question 3

What is the management for R1?

Answer 3

• Advise on diabetes control with diet and exercise
• Emphasize the importance of attending all GP checks and diabetic retinopathy screening (DRS)

Question 4

What are the signs of R2 (pre-proliferative diabetic retinopathy)?

Answer 4

• Extensive intraretinal haemorrhages
• Multiple large intraretinal haemorrhages
• Venous beading
• Venous looping
• Intraretinal microvascular abnormalities (IRMA)
• Cotton wool spots

Question 5

What are the symptoms of R2?

Answer 5

May report blurred vision.

Question 6

What is the management for R2?

Answer 6

• Advise on diabetes control with diet and exercise
• Routine referral to Hospital Eye Service (HES)

Question 7

What are the signs of R3 (proliferative diabetic retinopathy)?

Answer 7

• Neovascularisation
• Preretinal or vitreous haemorrhages
• Preretinal fibrosis

Question 8

What are the symptoms of R3?

Answer 8

• Blurred vision
• May see black spots due to vitreous haemorrhage

Question 9

What is the management for R3?

Answer 9

• Urgent referral to HES for surgery
• Pan-retinal photocoagulation to reduce oxygen consumption
• Vitrectomy if vitreous haemorrhage is present
• Anti-VEGF therapy

Question 10

What is the role of pan-retinal photocoagulation in R3?

Answer 10

It destroys photoreceptors to reduce oxygen consumption, making more oxygen available for retinal tissue.

Question 11

When is vitrectomy considered for R3?

Answer 11

If there is a vitreous haemorrhage present.

Question 12

What are microaneurysms in diabetic retinopathy?

Answer 12

Small, round outpouchings of capillaries in the retina.

Question 13

What are cotton wool spots?

Answer 13

Retinal nerve fiber layer infarcts caused by occlusion of precapillary arterioles.

Question 14

What is IRMA in diabetic retinopathy?

Answer 14

Intraretinal microvascular abnormalities, which are abnormal vessels within the retina.

Question 15

What is venous beading in diabetic retinopathy?

Answer 15

Segmentation or irregularities of the retinal veins.

Question 16

What is venous looping?

Answer 16

Abnormal curvature or looping of retinal veins, seen in diabetic retinopathy.

Question 17

What is neovascularisation in R3 diabetic retinopathy?

Answer 17

Abnormal growth of new blood vessels on the retina, optic disc, or iris.

Question 18

How does diabetic retinopathy affect vision in R3?

Answer 18

Blurred vision and potential visual field defects due to neovascularisation and haemorrhage.

Question 19

What is the importance of controlling diabetes in diabetic retinopathy management?

Answer 19

Good diabetes control reduces the risk of progression of diabetic retinopathy and associated vision loss.

Question 20

Why is routine referral to HES necessary in R2?

Answer 20

To monitor and manage the condition before it progresses to proliferative diabetic retinopathy (R3).

Question 21

What is the main goal of anti-VEGF therapy in diabetic retinopathy?

Answer 21

To inhibit the growth of abnormal blood vessels and reduce macular oedema.

Question 22

What is the significance of preretinal fibrosis in R3?

Answer 22

Fibrotic tissue forms on the surface of the retina, potentially leading to retinal detachment.

Question 23

Why is diabetic retinopathy often asymptomatic in early stages?

Answer 23

Early damage to the retina does not significantly affect central vision, so patients may not notice changes.

Question 24

What are hard exudates in diabetic retinopathy?

Answer 24

Lipid deposits in the retina, usually caused by leaking capillaries.

Question 25

How does vitreous haemorrhage cause visual symptoms in R3?

Answer 25

The blood from the haemorrhage obstructs light from reaching the retina, causing black spots or blurred vision.

Question 26

Why is urgent referral needed for R3?

Answer 26

Immediate intervention is required to prevent severe vision loss due to neovascularisation and haemorrhage.

Question 27

What role does the GP play in managing diabetic retinopathy?

Answer 27

Monitoring blood sugar, blood pressure, and cholesterol levels to reduce the progression of retinopathy.

Question 28

What imaging technique is essential for assessing diabetic retinopathy progression?

Answer 28

Fundus photography and optical coherence tomography (OCT) for detailed retinal imaging.

Question 29

What lifestyle advice should be given to patients with diabetic retinopathy?

Answer 29

• Maintain a healthy diet
• Exercise regularly
• Monitor blood sugar levels
• Avoid smoking

Question 30

What is the most common cause of vision loss in patients with diabetic retinopathy?

Answer 30

Macular oedema and neovascular complications, leading to retinal damage.

Question 31

When should pan-retinal photocoagulation (PRP) be initiated for R3 Proliferative Diabetic Retinopathy?

Answer 31

PRP should be started within 4 weeks of offering it, and if not possible, started within 6 weeks of the offer. High-risk cases should be offered treatment the same day.

Question 32

What treatment should be considered if PRP is not sufficient for proliferative diabetic retinopathy?

Answer 32

If PRP is not sufficient, anti-VEGF treatment such as ranibizumab should be considered.

Question 33

What is the recommended timeframe for performing vitrectomy in proliferative diabetic retinopathy with vitreous hemorrhage?

Answer 33

Vitrectomy should be performed within 3 months if vitreous hemorrhage does not clear, known as non-clearing vitreous hemorrhage.

Question 34

What imaging technique is recommended for monitoring proliferative diabetic retinopathy?

Answer 34

Ultrawide-field fundus imaging should be used alongside clinical examination to monitor proliferative diabetic retinopathy.