DISEASE (Hypertensive Retinopathy) Flashcards
Complications of Diabetic Retinopathy (VRGB)
-Vitreous hemorrhage
-Retinal detachment
-Glaucoma
-Blindness
Treatment for early diabetic retinopathy
-Good blood sugar control to slow progression
-Collaboration with an endocrinologist to improve diabetes management
Treatment for Proliferative DR (w macular edema)
-Photocoagulation/Focal laser
-Grid laser photocoagulation
-Panretinal photocoagulation (PRP)
-Vitrectomy
also known as focal laser treatment, can stop/slow leakage of blood & fluid in the eye
Photocoagulation/focal laser
usually done in outpatient department or in eye single session clinic
Photocoagulation/focal laser
Surgical procedure for diffuse clinically significant diabetic macula edema
Grid laser photocoagulation
treatment of choice for cases not responding to anti-VEGF & steroids
Grid laser photocoagulation
for “recalcitrant” (stubborn) cases DM Ret
Grid laser photocoagulation
also known as “scatter laser treatment” can shrink abnormal blood vessels
Panretinal photocoagulation (PRP)
some loss of peripheral vision or night vision after the procedure
Panretinal photocoagulation (PRP)
areas of retina away from macula are treated with scattered laser burns
Panretinal photocoagulation (PRP)
uses tiny incision in your eye to remove blood in the vitreous as well as scar tissue thats tugging on retina that can cause tractional retinal detachment
Vitrectomy
done in a surgical center/hospital using local/general anesthesia
Vitrectomy
Pharmacologic therapy for DR
-Anti-VEGF
-Triamicinolone
help stop growth of new blood vessels by blocking effects of growth signals the body send to generate new blood vessels
Anti-VEGF (Ranibizumab, Bevacizumab)
administered intravitreally; corticosteroid used in treatment of diabetic macular edema
Triamicinolone
Diabetes Control & Complications tral found that intensive __________ in px with type 1 diabetes decreased the incidence of progression of DR
Glucose control
Optometric Management for DR
-close monitoring for px suspected for DM Ret
-dilated retinal examination
- refer if:
1. macular edema
2. severe NDR
3. PDR
Prevention for DR
- Regular eye exams
- Reduce risk of getting DR by
Reduce risk of getting DR by the following:
-Manage diabetes
-Healthy diet
-Physical activity part of daily routine
-Moderate aerobic activity (walking)
-Oral diabetes meds or insulin as directed
-Monitor blood sugar level
-Keep bp & cholesterol under control
-Avoid smoking
-Pay attention to vision changes (changes in prescription, sudden vision loss)
-Lifestyle modification
complication of high blood pressure (hypertension)
Hypertensive Retinopathy
due to persistent, untreated high bp can cause damage to the retina
Hypertensive retinopathy
occurs when force of blood against artery walls is too high, causing: DAN
-Damaged over time
-Arteries to stretch
-Narrow
Damage to retina increase with: SL
-Severity of high bp
-Length of time
at risk:
older people
caused by chronically elevated blood pressure
Arteriosclerosis changes of hypertensive retinopathy
elevated blood pressure systolic & diastolic
systolic: 120-129mmHg
diastolic: <80mmHg
Stage 1 hypertension systolic & diastolic
systolic: 130-139mmHg
diastolic: 80-89mmHg
Stage 2 hypertension systolic & diastolic
systolic: equal or less than 140 mmHg
diastolic: >90 mmHg
stage of retinopathy: narrowing of arteries is mild
Grade 1
stage of retinopathy: AV nicking
Grade 2
stage of retinopathy: retinal hemorrhage, cotton-wool spots
Grade 3
stage of retinopathy: combines first two categories into one
Grade 4
stage of retinopathy: severe G3 swelling of optic disc (papilledema)
Grade 4
Patho of HR that differentiates them from other blood vessels: TAP
-The absence of sympathetic nerve supply
-Autoregulation of blood flow
-Presence of blood-retinal barrier
Hypertensive retinopathy phases
a. Vasoconstrictive phase
b. Sclerotic phase
c. Exudative phase
d. Malignant hypertension
phase where the local autoregulatory mechanisms come into play
Vasoconstrictive phase
cause vasospasm & retinal arteriole narrowing, which is evident by decrease in arteriole venule ratio
Vasoconstrictive phase
persistent in BP causes certain vessel wall
Sclerotic phase
Sclerotic phase: persistent increased BP changed in vessel wall (IMA)
Intima layer: thickening
Media layer: hyperplasia
Arteriolar wall: hyaline degeneration
Sclerotic phase changes in vessel wall lead to (SAW)
- Severe form of arteriolar narrowing
- Arteriovenous (AV) crossing changes
- Widening & accentuation of light reflex (silver & copper wiring)
seen in px with severely increased BP
Exudative phase
Exudative phase is characterized by (DL)
- Disruption of blood-brain barrier
- Leakage of blood & plasma into vessel wall
- disrupting autoregulatory mechanisms
Exudative phase: retinal signs (RHNR)
- Retinal hemorrhage (flame-shape & dot blot)
- Hard exudate formation
- Necrosis of smooth muscle cells
- Retinal ischemia (cotton-wool spots)
severe intracranial hypertension leads to optic nerve ischemia & edema (papilledema)
Malignant hypertension
other factors contributing to developing high bp:
-Obesity
-Sedentary lifestyle
- A diet high in salt
-Stress
-Family history of high bp
-Diabetes
-Moderate to high alcohol intake
Signs & symptoms of HR
-Permanent arterial narrowing
-Arteriovenous crossing abnormalities (arteriovenous nicking)
-Arteriosclerosis w moderate vascular wall changes (copper wiring) to more severe vascular wall hyperplasia & thickening (silver wiring)
retinal arterioles appear orange or yellow instead of red
Copper wiring
retinal arterioles look white if they have become occluded
Silver wiring
retinal arterioles look dull white if with severe occlusion
Ghost vessel
___________is a major predisposing factor to development of a branch retinal vein occlusion
arteriovenous nicking
for severe cases, these are the findings:
-superficial flame-shaped hemorrhage
-small, white superficial foci of retinal ischemia (cotton-wool spots)
-yellow hard exudates
-optic disc edema
Treatment for HR (CARD- RGL)
-controlling hypertension
-anti-VEGF
-giving up smoking
-losing weight
-regular exercise
-dietary changes
-reduce alcohol intake
Medications for HR
a. Angiotensin-converting enzyme (ACE inhibitors)
b. Angiotensin-2 receptor blockers (ARBs)
c. Thiazide diuretics
d. Calcium-channel blockers
e. Beta-blockers
Prevention for HR
- careful management oh high bp & related condition like diabetes
- lifestyle changes (lose weight, give up smoking)
- regular monitoring of bp
- regular eye screening
Complications for HR
- Retinal vein occlusion
- Retinal artery occlusion
- Ischemic optic neuropathy
- Malignant hypertension
- Stroke & heart attack
Prognosis for HR
Mild hyper (G1 & G2) - relatively positive, as long as bp is controlled
Severe hyper - if not properly managed, condition can enter “malignant” stage
Optometrist’s role
- Early detection & diagnosis of ocular manifestations associated with HTN
- Lead to timely referral and appropriate management
Challenge to all new & old opto
“We can affirm role of optometrists as primary health care provider, by performing a comprehensive eye examination, including blood pressure evaluation”.
