Diabetic Retinopathy

Question 1

What are the signs of Maculopathy (M1)?

Answer 1

Any microaneurysm or haemorrhage within 1DD of centre of fovea BUT only if associated with VA ≤ 6/12

Exudate within 1DD of fovea
(Circinate or group of exudates within macula)

Retinal thickening within 1DD of centre of fovea

Treatment:
Control blood glucose, BP and lipids
Aim to be seen in HES by ophthalmologist 13wks-18wks

Question 2

What are the signs of Diabetic Retinopathy (Background DR /R1)?

Answer 2

Microaneurysms

Retinal haemorrhages

Treatment:
Control blood glucose, BP and lipids
Routine DM care
and Annual screening

Question 3

What are the signs of Diabetic Retinopathy (Pre-proliferative DR /R2)?

Answer 3

Venous looping, beading or reduplication

Intra Retinal Microvascular Abnormality (IRMA)

Multiple deep, round/blot haemorrhages

Cotton Wool Spots (CWS)

Treatment:
Control blood glucose, BP and lipids
Aim to be seen in HES by ophthalmologist 13wks-18wks

Question 4

What is IRMA?

Answer 4

Extensive closure of capillaries between arteriole and venule leads to dilated capillary remnants.

Poor capillary perfusion results in A-V shunts

Question 5

What are cotton wool spots?

Answer 5

Swollen ends of interrupted axons, where build-up of axoplasmic flow occurs at the edge of the infarct

Most frequently where the nerve fibre is densest such as the nasal side of the optic nerve

Question 6

What are the signs of Diabetic Retinopathy (Proliferative DR/R3)?

Answer 6

Ischaemia

VEGF released

New vessels:
New vessels may occur at the disc = NVD
Or new vessels may occur elsewhere = NVE

Pre-retinal or vitreous haemorrhage - BOAT SHAPED

Pre-retinal fibrosis ± tractional retinal detachment

Treatment:
Control blood glucose, BP and lipids
Aim to be seen in HES by ophthalmologist in 2wks-4wks