Diabetic Retinopathy

Question 1

Pathophysiology of diabetic retinopathy?

Answer 1

Disease of retinal microvasculature

Long term or severe hyperglycaemia causes…

1. microanuerysms (capillary leaking)
2. hard exudates (precipitates from retinal vessels)
3. Dots, blots and flames: haemorrhages
4. Cotton wool spots: axonal debris
5. Neovascularisation: attempt to revascularise hypoxic tissue

Question 2

What signs would you see in diabetic retinopathy?

Describe them.

Answer 2

1. microanuerysms (capillary leaking)
2. hard exudates (precipitates from retinal vessels)
3. Dots, blots and flames: haemorrhages
4. Cotton wool spots: axonal debris
5. Neovascularisation: attempt to revascularise hypoxic tissue

Question 3

What are:

• cotton wool spots
• hard exudates?

What do they look like?

Answer 3

Cotton wool spots: build up of axonal debris
Pale, poorly defined lesions

Hard exudates: precipitates of lipoproteins that leak from retinal blood vessels
Yellow/cream demarcated lesions

Question 4

Risk factors of DR?

Answer 4

Length of time and severity of hyperglycaemia

Hypertension and CVS risk factors

Renal disease

Pregnancy

Minority ethnic communities

Question 5

Presentation of diabetic retinopathy?

Answer 5

Painless gradual reduction of central vision

Cataract formation

Haemorrhages: dark painless floaters

Acute attack of glaucoma

Question 6

Investigations of DR?

Answer 6

Visual acuity

Visual field

Fudoscopy: dilate pupil, look for signs

Slit lamp maginifcation of fundus

Gold standard is:
- digital retinal photography

Question 7

How often should diabetics have their eyes screened?

Answer 7

Annually

Question 8

Management of DR?

Answer 8

Glycaemic control
BP control
Stop smoking
Lipid control: statin
Better diet

Laser photocoagulation: arrests progression

Intravitreal steroids (triamcinolone) + anti-VEGF (bevacizumab)

Question 9

How does laser treatment treat DR? What’s the fancy name for it?

Answer 9

Photocoagulation

Induces regression of new blood vessels

Reduce macular thickening

Arrests progression, won’t restore vision

Question 10

What other problems can diabetics have with their eyes?

Answer 10

Diabetic maculopathy

Cataracts
Glaucoma

Question 11

What is diabetic maculopathy?

What should you do?

Answer 11

Diabetic retinopathy
But within 1 disc diameter of centre of fovea (macula)

Urgent referral