Diabetic Retinopathy

Question 1

What might cause vision loss in diabetic retinopathy?

Answer 1

• retinal oedema affecting the fovea
• vitreous haemorrhage
• scarring/tractional retinal detachment

Question 2

How is diabetic retinopathy classified?

Answer 2

No retinopathy
Non-proliferative retinopathy:
- mild
- moderate
- severe
Proliferative retinopathy

Question 3

What are the signs of non-proliferative retinopathy?

Answer 3

Microaneurysms –> dots
Haemorrhages –> flame shaped/blots
Hard exudates –> yellow patches

Signs of significant ischaemia:

• engorged tortuous veins
• cotton wool spots (ischaemic nerve fibres)
• large blot haemorrhages

Question 4

How is proliferative retinopathy defined?

Answer 4

NEOVASCULARISATION

• fine new vessels appear on the optic disc and retina
• can cause vitreous haemorrhage

Question 5

What are the symptoms of diabetic retinopathy?

Answer 5

Asymptomatic until very advanced

- picked up on screening

Question 6

How often are diabetics screened for retinopathy and what happens at screening?

Answer 6

Screened at diagnosis and then at least annually

- dilated fundus photography

Question 7

If no retinopathy is seen on screening, what happens?

Answer 7

Re-screen in 12 months

Question 8

What counts as mild NPDR and what is done if this is seen on screening?

Answer 8

1 or more dot haemorrhage/microaneurysm

–> re-screen in 12 months

Question 9

What counts as moderate NPDR and what is done if this is seen on screening?

Answer 9

4 or more blot haemorrhages in one half only

–> re-screen in 6 months

Question 10

What counts as severe NPDR and what is done if this is seen on screening?

Answer 10

Any of:

• 4 or more blot haemorrhages in both semi-fields
• venous beading
• intro-retinal microvascular abnormality (IRMA)

–> refer to ophthalmology

Question 11

What counts as proliferative DR and what is done if this is seen on screening?

Answer 11

New vessels +/- vitreous haemorrhage

–> refer urgently to ophthalmology

Question 12

What is maculopathy?

Answer 12

Leakage from vessels close to the macula –> macular oedema (sight threatening)

Question 13

How is maculopathy classified on screening?

Answer 13

No maculopathy
Observable maculopathy
Referable maculopathy

Question 14

What is considered ‘observable maculopathy’ and what is done if this is seen on screening?

Answer 14

Exudes between 1 and 2 disc diameters from centre of fovea

–> re-screen in 6 months

Question 15

What is considered ‘referable maculopathy’ and what is done if this is seen on screening?

Answer 15

Any blots or hard exudates within 1 disc diameter of fovea

–> refer to ophthalmology

Question 16

How can lifestyle factors help in the management of DR?

Answer 16

Ensure target BP <140/80 or <130/80 if end-organ damage

Good glucose control prevents new vessel formation

Question 17

What might accelerate the progression of DR?

Answer 17

Pregnancy
Dyslipidaemia
High BP
Renal disease
Smoking
Anaemia

Question 18

What is the treatment for proliferative DR?

Answer 18

Panretinal (scatter) laser photocoagulation

Question 19

What does the retina look like after treatment with laser?

Answer 19

Black patches seen on fundoscopy

Question 20

What is the treatment for maculopathy?

Answer 20

Anti-VEGF + triamcinolone (intravitreal injections)

Focal/grid laser photo-coagulation