Diabetic retinopathy

Question 1

What is the most common cause of blindness in adults aged 35-65 years old?

Answer 1

Diabetic retinopathy

Diabetic retinopathy is a significant public health issue, particularly among those with diabetes.

Question 2

What causes hyperglycaemia in relation to retinal blood flow?

Answer 2

Increased retinal blood flow and abnormal metabolism in the retinal vessel walls

This leads to damage to endothelial cells and pericytes.

Question 3

What does endothelial dysfunction lead to in diabetic retinopathy?

Answer 3

Increased vascular permeability

This causes the characteristic exudates seen on fundoscopy.

Question 4

What is a key factor in the formation of microaneurysms?

Answer 4

Pericyte dysfunction

This is a result of damage caused by hyperglycaemia.

Question 5

What is neovascularization in diabetic retinopathy thought to be caused by?

Answer 5

Production of growth factors in response to retinal ischaemia

This process can lead to serious complications if not managed.

Question 6

What are the classifications of diabetic retinopathy?

Answer 6

Non-proliferative diabetic retinopathy (NPDR), proliferative retinopathy (PDR), and maculopathy

Each classification has distinct features and management strategies.

Question 7

What characterizes mild non-proliferative diabetic retinopathy (NPDR)?

Answer 7

1 or more microaneurysm

This is the least severe form of NPDR.

Question 8

What are the features of moderate non-proliferative diabetic retinopathy (NPDR)?

Answer 8

• Microaneurysms
• Blot haemorrhages
• Hard exudates
• Cotton wool spots
• Venous beading/looping
• Intraretinal microvascular abnormalities (IRMA)

Moderate NPDR shows more severe changes than mild NPDR.

Question 9

What defines severe non-proliferative diabetic retinopathy (NPDR)?

Answer 9

• Blot haemorrhages and microaneurysms in 4 quadrants
• Venous beading in at least 2 quadrants
• IRMA in at least 1 quadrant

This is a critical stage requiring close monitoring.

Question 10

What are the key features of proliferative diabetic retinopathy (PDR)?

Answer 10

• Retinal neovascularisation
• Fibrous tissue forming anterior to retinal disc
• More common in Type I DM

PDR can lead to significant vision loss if not treated.

Question 11

What is the significance of maculopathy in diabetic retinopathy?

Answer 11

Based on location rather than severity; anything is potentially serious

Maculopathy can lead to significant visual impairment.

Question 12

What is the management strategy for all diabetic retinopathy patients?

Answer 12

• Optimise glycaemic control
• Manage blood pressure and hyperlipidemia
• Regular review by ophthalmology

Comprehensive management is crucial to prevent progression.

Question 13

What treatment is indicated for maculopathy if there is a change in visual acuity?

Answer 13

Intravitreal vascular endothelial growth factor (VEGF) inhibitors

These treatments can help manage vision changes effectively.

Question 14

What is the management for severe or very severe non-proliferative retinopathy?

Answer 14

Consider panretinal laser photocoagulation

This is a preventive measure to reduce the risk of progression.

Question 15

What is the primary treatment for proliferative retinopathy?

Answer 15

Panretinal laser photocoagulation

This treatment helps to reduce the risk of blindness.

Question 16

What is a common complication following panretinal laser photocoagulation?

Answer 16

Notable reduction in visual fields due to scarring of peripheral retinal tissue

Other complications may include decreased night vision and generalised decrease in visual acuity.

Question 17

What are intravitreal VEGF inhibitors used for in diabetic retinopathy?

Answer 17

To slow progression of proliferative diabetic retinopathy and improve visual acuity

Examples include ranibizumab.

Question 18

What should be done if there is severe diabetic retinopathy or vitreous hemorrhage?

Answer 18

Vitreoretinal surgery

This surgical intervention may be necessary to preserve vision.