diabetic retinopathy Flashcards
defintion
disease of the retina caused by diabetes
diabetic retinopathy
is the commonest cause of new onset blindness in those between 20-65
pathophysiology
chronic hyperglycaemia damages the tiny blood vessels in the retina, this can cause the blood vessels to leak fluid or haemorrhage and in its most advances stage can cause new abnormal blood vessels to proliferate on the surface of the retina
function of the retina
detects light and converts it to signals sent through the topic nerve
retinal haemorrhages described as
dot blot or flame haemorrhages
cotton wool spots on retina are
areas of ischaemia
hard exudates on retina are
lipid breakdown products
IRMA stands for
intra-retinal microvascular abnormalities which means abnormal but patent blood vessels
stages of retinopathy
- mild non-proliferate
- moderate non-proliferative
- severe non-proliferative
- proliferative
mild-non proliferative retinopathy is
also known as background retinopathy where on ophthalmoscopy there are mild abnormalities but person has no symptoms
maculopathy is
a manifestation of diabetic retinopathy, results in oedema and exudates involving the macula
diabetic maculopathy is a
symptomatic manifestation of non-proliferative retinopathy
symptoms of maculopathy
blurred vision, decreased acuity, visual distortion
maculopathy is the
number one cause of blindness in patients with diabetic retinopathy
the macula is the
central area of the retina which provides central vision, in the centre of the macula is the fovea which contains the higher concentration of cones therefore has the clearest vision of all
retinopathy and maculopathy are
graded separately
retinal grading
R0 R1 R2 R3 R4
R0
no diabetic retinopathy
management of R0
rescreen in 12 months
R1
background diabetic retinopathy, there are no symptoms but one or more of the following is present
- dot haemorrhages
- hard exudates
- blot haemorrhages
- micro aneurysms
- cotton wool spots
- flame haemorrhages
management of R1
prescreen in 12 months
R2
moderate non-proliferative retinopathy with four or more blot haemorrhages in one hemi-field only
management of R2
prescreen in 6 months
R3
severe non-proliferative diabetic retinopathy with any of the following features:
- four or five blot haemorrhages in both superior and inferior semi-fields
- venous bleeding
- IRMA
management of R3
refer to ophthalmology
R4
profilerative diabetic retinopathy with any of the following features:
- active new vessels
- vitreous haemorrhage
management of R4
referral to ophthalmology who will treat
macular grading
MI OR M2
M1
any hard exudates within a radius of greater than 1 but less than 2 disc diameters of the centre of the fovea, prescreen in 6 months
M2
any hard exudates or blot haemorrhages within a radius of more than one disc diameters of the centre of the moves, refer to ophthalmology
investigations for diabetic retinopathy
ophthalmoscopy and optical coherence tomography
management
- anti-vascular endothelial growth factor injections (anti-VEGF)
- laser therapy
other eye pathologies in diabetics
cataracts, glaucoma
cataracts
opacity of the crystalline lens causing a haziness/ cloudiness of vision, often the intimal presentation of cataracts is lekocoria (white pupil)
glaucoma
group of eye diseases that are caused by intra-ocular hypertension which damages the optic nerve
