[Ophth] Diabetic Retinopathy Flashcards
what are the consequences of poorly managed diabetes?
- diabetic retinopathy
- nephropathy
- neuropathy
- peripheral vascular disease
what will diabetic retinopathy eventually progress into?
maculopathy
what are the sx of diabetic retinopathy?
asx until advanced
then blurred vision, reduced acuity and ‘floaters’
what is the mx for diabetic retinopathy?
- improve diabetic control, BP and lipid levels
- lifestyle and diet advice
- pharmacological therapies
- stop smoking - prescription glasses/lenses
- laser photocoagulation when advanced
what are the classes of diabetic retinopathy?
- pre-proliferative (mild)
- pre-proliferative (moderate)
- pre-proliferative (severe)
- proliferative
- diabetic maculopathy
what are the sx for pre-proliferative diabetic retinopathy?
none
what are the features seen on fundoscopy for pre-proliferative (mild) diabetic retinopathy?
microaneurysms
what are the features seen on fundoscopy for pre-proliferative (moderate) diabetic retinopathy?
- dot and blot haemorrhages
- hard exudates
what are the features seen on fundoscopy for pre-proliferative (severe) diabetic retinopathy?
- large dot and blot haemorrhages
- cotton wool spots
- venous beading
what are the sx of proliferative diabetic retinopathy?
- floaters
- reduced acuity
what are the features seen on fundoscopy for proliferative diabetic retinopathy?
as in pre-proliferative + new vessel formation
what are the sx of diabetic maculopathy?
- blurred vision
- reduced acuity
what are the features seen on fundoscopy for diabetic maculopathy?
as in proliferative + retinal thickening and macular leaking
what would you do if you saw a pt with proliferative diabetic retinopathy / diabetic maculopathy?
urgent ophthalmology review: ideally same day
what is macular degeneration (MD)?
progressive damage to the macula of the retina, related to age
what are the key features of MD?
- visual loss
- fatty Drusen deposits on retina
what is MD classified into?
- ‘dry’ (90%)
- ‘wet’ (rapidly progressive)
what is the mx for MD?
supportive and conservative
what can be offered for late stage wet MD?
intravitreal injection of anti-VEGF to slow down progression
what are the risk factors for MD?
- smoking
- HTN
- older age
- BMI >30
- high fat diet
- lack of exercise
- FHx
what are the classifications of MD?
- early MD
- intermediate MD
- late dry
- late wet
what is early MD?
small or medium sized drusen
what is intermediate MD?
- large drusen
- retinal pigment abnormalities on retina (e.g. black spots of hypertrophy)
what is late dry MD?
- dense or confluent drusen with advanced pigmentary changes
- central visual loss
what is late wet MD?
- choroidal neovascularisation
- retinal proliferation
- bleeding and leaking on the retina
- central visual loss
- rapidly progressive
dendritic pattern on fluorescin stained cornea. dx?
herpes simplex ulcer
young female, BMI ++, on the OCP with headaches. dx?
idiopathic intracranial HTN → check for papilloedema
white fluid level visible in the anterior chamber. dx?
hypopyon
what is the 1st line ix for DR?
fundoscopy
DR and MD are…?
progressive, irreversible processes
