Diabetic Retinopathy [aao course]

Question 1

Diabetes Control and Complications Trial (DCCT)

Answer 1

patients treated with intensive glucose control reduced their risk of developing retinopathy by 76% and slowed progression of retinopathy by 54%

Question 2

Which eye condition is an independent risk factor for poor survival?

Answer 2

Proliferative diabetic retinopathy (PDR). PDR is found in 67% of patients with 35 or more years of diabetes mellitus.

Question 3

Nonproliferative Diabetic Retinopathy - 3 types

Answer 3

Mild, moderate, severe NPDR

Question 4

The most common cause of visual loss among patients with DR is ________

Answer 4

diabetic macular edema (DME)

Question 5

Mild NPDR is characterized by __________

Answer 5

the presence of relatively few microaneurysms. There are no changes as noted for moderate or worse NPDR.

Question 6

Moderate NPDR is characterized by _________

Answer 6

cotton-wool spots, intraretinal hemorrhages and/or microaneurysms, venous beading, and intraretinal microvascular abnormalities (IRMA). None of the findings meet the criteria for more severe retinopathy.

Question 7

Severe NPDR is characterized by _____

Answer 7

cotton-wool spots, venous beading, and any 1 of the following recalled by the “4-2-1 rule”:
Intraretinal hemorrhages in 4 quadrants
Venous beading in 2 quadrants
Severe IRMA in 1 quadrant

Question 8

PDR findings may include _______

Answer 8

neovascularization of the disc (Figure 5), neovascularization elsewhere (NVE), vitreous and/or preretinal hemorrhage, traction or traction-rhegmatogenous retinal detachment, and neovascularization of the iris (NVI) and/or neovascularization of the angle (NVA).

Question 9

Diabetic Macular Edema

Answer 9

Breakdown of the blood-retinal barrier and leakage from retinal capillaries is a hallmark of DR and a common cause of vision loss.

Question 10

Clinically Significant Macular Edema
The ETDRS established that all DME did not warrant treatment and coined the term clinically significant macular edema (CSME). It is characterized by the presence of at least 1 of the following:

Answer 10

• Thickening of the retina at or within 500 microns of the center of the macula
• Hard exudates at or within 500 microns of the center of the macula associated with thickening of adjacent retina, not residual hard exudates remaining after disappearance of retinal thickening
• Retinal thickening 1 disc area or larger, any part of which is within 1 disc diameter of the center of the macula

Question 11

Cystoid macular edema is characterized by ________

Answer 11

the presence of round or oval cystoid areas of low reflectivity

Question 12

DME with serous retinal detachment is characterized by ________

Answer 12

the presence of a dome shaped elevation in the subretinal space with an overlying hyper-reflective and thickened outer retina

Question 13

DME with vitreomacular traction is characterized by ______

Answer 13

the presence of epiretinal membrane (ERM) and abnormal vitreoretinal adhesions that result in tractional thickening of the macula

Question 14

Advanced vision loss secondary to diabetic retinopathy can occur secondary to

Answer 14

• CSME
• Macular ischemia
• Vitreous hemorrhage
• Tractional retinal detachment

Question 15

Diagnosis

Answer 15

• macular edema (retinal thickening in the macular area)
• optic nerve head neovascularization and/or neovascularization elsewhere
• signs of severe NPDR (e.g., extensive retinal hemorrhages/microaneurysms, venous beading, and intraretinal microvascular abnormalities).
  These features can often lead to visual impairment.

Question 16

Based on the results of the Diabetic Retinopathy Study (DRS) and ETDRS Research Group, laser photocoagulation is advised for patients with ______

Answer 16

HRPDR &/or CSME. In both instances, individuals who are treated appropriately have better visual outcomes than those who are not treated. Iris and angle neovascularization are also indications for laser photocoagulation.

Question 17

Color fundus photography can detect…

Answer 17

disease that may be overlooked clinically.

Question 18

Fluorescein Angiography should be obtained…

Answer 18

before treating CSME to identify treatable lesions.

Question 19

Wide-field angiograms on average demonstrate…

Answer 19

3.2 times more retinal surface area then the standard 7 fields. This allows for better identification of nonperfusion and neovascularization.

Question 20

Ultrasonography is a useful test in eyes with…

Answer 20

vitreous hemorrhage and other such forms of media opacity to determine the presence or absence of retinal detachment.

Question 21

OCT is very sensitive at detecting…

Answer 21

macular edema, quantifying the edema, and providing a way of monitoring the edema after treatment

Question 22

High-Risk Proliferative Diabetic Retinopathy: according to the Diabetic Retinopathy Study (DRS), there was a 50% reduction in severe vision loss at 5 years in HRPDR patients who received…

Answer 22

PRP treatment versus untreated control eyes.

Question 23

The ETDRS trial demonstrated that eyes with CSME benefited from…

Answer 23

focal argon laser photocoagulation treatment. Treatment under guidance of fluorescein angiogram is recommended.

Question 24

____________ agents are the most commonly used in the management of DME.

Answer 24

Antivascular endothelial growth factor

Question 25

______ not only relieves any tractional forces, but also may improve oxygenation of the retina in patients presenting DME with Vitreomacular Traction.

Answer 25

Vitrectomy

Question 26

The Diabetic Vitrectomy Study (DRVS) found that _______ benefited type 1 diabetics with severe nonclearing vitreous hemorrhage.

Answer 26

early vitrectomy

Question 27

Vitrectomy is recommended in cases of progressive Tractional Retinal Detachment that…

Answer 27

involve or threaten the macula as well as cases of combined tractional and rhegmatogenous detachments.

Question 28

Complications of laser treatment include…

Answer 28

iris stromal burns, accommodative insufficiency and asthenopia, elevated intraocular pressure, exudative retinal detachment, hemorrhage, choroidal neovascularization, subretinal fibrosis, optic neuropathy, visual field loss, and inadvertent foveolar burns.