[Ophth] Diabetic Retinopathy

Question 1

what are the consequences of poorly managed diabetes?

Answer 1

• diabetic retinopathy
• nephropathy
• neuropathy
• peripheral vascular disease

Question 2

what will diabetic retinopathy eventually progress into?

Answer 2

maculopathy

Question 3

what are the sx of diabetic retinopathy?

Answer 3

asx until advanced

then blurred vision, reduced acuity and ‘floaters’

Question 4

what is the mx for diabetic retinopathy?

Answer 4

1. improve diabetic control, BP and lipid levels
   - lifestyle and diet advice
   - pharmacological therapies
   - stop smoking
2. prescription glasses/lenses
3. laser photocoagulation when advanced

Question 5

what are the classes of diabetic retinopathy?

Answer 5

• pre-proliferative (mild)
• pre-proliferative (moderate)
• pre-proliferative (severe)
• proliferative
• diabetic maculopathy

Question 6

what are the sx for pre-proliferative diabetic retinopathy?

Answer 6

none

Question 7

what are the features seen on fundoscopy for pre-proliferative (mild) diabetic retinopathy?

Answer 7

microaneurysms

Question 8

what are the features seen on fundoscopy for pre-proliferative (moderate) diabetic retinopathy?

Answer 8

• dot and blot haemorrhages

- hard exudates

Question 9

what are the features seen on fundoscopy for pre-proliferative (severe) diabetic retinopathy?

Answer 9

• large dot and blot haemorrhages
• cotton wool spots
• venous beading

Question 10

what are the sx of proliferative diabetic retinopathy?

Answer 10

• floaters

- reduced acuity

Question 11

what are the features seen on fundoscopy for proliferative diabetic retinopathy?

Answer 11

as in pre-proliferative + new vessel formation

Question 12

what are the sx of diabetic maculopathy?

Answer 12

• blurred vision

- reduced acuity

Question 13

what are the features seen on fundoscopy for diabetic maculopathy?

Answer 13

as in proliferative + retinal thickening and macular leaking

Question 14

what would you do if you saw a pt with proliferative diabetic retinopathy / diabetic maculopathy?

Answer 14

urgent ophthalmology review: ideally same day

Question 15

what is macular degeneration (MD)?

Answer 15

progressive damage to the macula of the retina, related to age

Question 16

what are the key features of MD?

Answer 16

• visual loss

- fatty Drusen deposits on retina

Question 17

what is MD classified into?

Answer 17

• ‘dry’ (90%)

- ‘wet’ (rapidly progressive)

Question 18

what is the mx for MD?

Answer 18

supportive and conservative

Question 19

what can be offered for late stage wet MD?

Answer 19

intravitreal injection of anti-VEGF to slow down progression

Question 20

what are the risk factors for MD?

Answer 20

• smoking
• HTN
• older age
• BMI >30
• high fat diet
• lack of exercise
• FHx

Question 21

what are the classifications of MD?

Answer 21

1. early MD
2. intermediate MD
3. late dry
4. late wet

Question 22

what is early MD?

Answer 22

small or medium sized drusen

Question 23

what is intermediate MD?

Answer 23

• large drusen

- retinal pigment abnormalities on retina (e.g. black spots of hypertrophy)

Question 24

what is late dry MD?

Answer 24

• dense or confluent drusen with advanced pigmentary changes

- central visual loss

Question 25

what is late wet MD?

Answer 25

• choroidal neovascularisation
• retinal proliferation
• bleeding and leaking on the retina
• central visual loss
• rapidly progressive

Question 26

dendritic pattern on fluorescin stained cornea. dx?

Answer 26

herpes simplex ulcer

Question 27

young female, BMI ++, on the OCP with headaches. dx?

Answer 27

idiopathic intracranial HTN → check for papilloedema

Question 28

white fluid level visible in the anterior chamber. dx?

Answer 28

hypopyon

Question 29

what is the 1st line ix for DR?

Answer 29

fundoscopy

Question 30

DR and MD are…?

Answer 30

progressive, irreversible processes