Diabetic Retinopathy

Question 1

what is the cause of diabetic retinopathy?

Answer 1

diabetes

Question 2

what are the risk factors to developing diabetic retinopathy?

Answer 2

duration of diabetes, poor blood sugar control, hypertension, hypercholesterolaemia, pregnancy, smoking, dramatically improved diabetic control leads to short term worsening

Question 3

what are the two components of diabetic retinopathy?

Answer 3

macular oedema

retinal neovascularisation

Question 4

what is the overarching mechanism of diabetic retinopathy?

Answer 4

Vascular Dysfunction and Permeability

Question 5

what are the types of diabetic retinopathy?

Answer 5

No retinopathy
Background retinopathy
Maculopathy
Pre-proliferative retinopathy
Proliferative 
Advanced retinopathy

Question 6

what is the definition of no retinopathy?

Answer 6

There are no abnormal signs present on the retina. Vision normal.

Question 7

what is the definition of background retinopathy?

Answer 7

Signs of microvascular leakage (microaneurysms, haemorrhage, exudates) away from the macula. Vision normal.

Question 8

what is the definition of maculopathy?

Answer 8

Exudates and haemorrhages within the macular region and/or evidence of retinal oedema, and/or evidence of retinal ischaemia within the macular. Vision is reduced; sight threatening

Question 9

what is the definition of pre-proliferative retinopathy?

Answer 9

Evidence of arteriolar occlusions (IRMA, cotton wool spots). The veins become irregular and may show loops. Vision normal.

Question 10

what is the definition of proliferative retinopathy?

Answer 10

The occlusive changes have led to the release of a vasoproliferative substance from the retina, resulting in the growth of new vessels either on the disc (NVD) or elsewhere on the retina (NVE). Vision norml; sight threatening

Question 11

what is the definition of advanced retinopathy?

Answer 11

Proliferative changes result in bleeding into the vitreous or between the vitreous and the retina. Neuroretina may be pulled from its overlying pigment epithelium by a fibrous proliferation associated with the growth of the new vessels. Vision is reduced, often acutely, with vitreous haemorrhage; sight threatening.

Question 12

what is the pathophysiology of diabetic retinopathy?

Answer 12

• Chronic hyperglycaemia
• Glycosylation of protein/basement membrane (of retina vasculature)
• Loss of pericytes (capillaries become leaky)
• Reduced O2 transport – tissue hypoxia
• Vasoformative factors are produced – neovascularisation
• vessels are of poor - haemorrhage and scarring

Question 13

what are flame haemorrhages of the eyes?

Answer 13

rupture of vessels microaneurysms at the nerve fibre level

Question 14

what are blot haemorrhages?

Answer 14

deep haemorrhages

Question 15

what are the different stages of diabetic retinopathy?

Answer 15

Mild NPDR
Moderate NPDR
Severe NPDR
Proliferative
Macular Oedema

Question 16

what is the definition of mild NPDR?

Answer 16

1 or more microaneurysm

Question 17

what is the definition of moderate NPDR?

Answer 17

o microaneurysms
o blot haemorrhages
o hard exudates
o cotton wool spots, venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR

Question 18

what is the definition of severe NPDR?

Answer 18

o blot haemorrhages and microaneurysms in 4 quadrants
o venous beading in at least 2 quadrants
o IRMA in at least 1 quadrant

Question 19

what is the definition of proliferative NPDR?

Answer 19

Characterised by neovascularisation
o New vessels on posterior vitreous - lacy new vessels and cotton wool spots
o Grow on disc, periphery and iris
o Posterior vitreal detachment

Question 20

what is the definition of macular oedema?

Answer 20

o Leading cause of blindness is diabetes
o Can present at any stage
o As oedema, patient will notice blurry central visiom
o Seen as hard exeudates
o Fluid build up under RPE layer – seen on OCT

Question 21

what is the management of retinopathy (DR)?

Answer 21

o No proliferative – observe/rescreen
o Proliferative – laser – abolish peripheral to preserve central
 Surgery? – virectomy

Question 22

What is the management of maculopathy (DR)?

Answer 22

o Reduced vision only
o Anti-VEGF
o Occasional “focal” laser

Question 23

what is the pathophysiology of hypertension retinopathy?

Answer 23

• Hypertension results in diffuse constriction of retinal vessels
• Can become persistent, leading to thickening with focal constriction
• Breaking tight junctions leads to microaneurysms, macroaneurysms

Question 24

what are the fundoscopic features of hypertension retinopathy?

Answer 24

• Attenuated blood vessels – copper or sliver wiring
• Cotton wool spots
• Ard exudates
• Retinal haemorrhage
• Optic disc oedema

Question 25

what is the management of hypertension retinopathy?

Answer 25

optimise management, usually improve once BP is under control