Retinopathy

Question 1

What is the commonest cause of blindness in working age in people in the UK?

Answer 1

Diabetic retinopathy

Question 2

What are the risk factors for diabetic retinopathy?

Answer 2

• poor diabetic control
• age
• blood pressure

Question 3

What does capillary leakage result in?

Answer 3

Retinal haemorrhages (dot + blot)

Exudates

Macular oedema

Question 4

What does occlusion of capillaries often cause?

Answer 4

Locally → cotton wool spots

Widespread occlusion of capillaries → global retinal ischaemia

Question 5

Neovascularisation (new blood vessels) is an unhelpful response to retinal ischaemia. This is also known as proliferative diabetic retinopathy (PDR).

What happens to the new blood vessels that are formed in PDR?

Answer 5

Bleed from retina into vitreous → vitreous haemorrhage

Fibrose + pull off retina → tractional retinal detachment

Grow on the iris + block trabecular meshwork → glaucoma

Question 6

What is the treatment of proliferative diabetic retinopathy?

Answer 6

Lasering whole retina except macula

This removes ischaemic tissue + therefore the drive to produce new vessels

Question 7

All diabetics are screened for retinopathy with annual dilated retinal exams/photos

Photos are graded by trained screeners and patients referred if problems found

What is the current grading system used?

Answer 7

R0 → no retinopathy

R1 → mild non proliferative (haemorrhages + microaneurysms)

R2 → severe non proliferative (venous abnormalities, lage h’ges, cotton wool spots)

R3 → proliferative retinopathy (new vessels at disc or elsewhere on retina)

M0 → no maculopathy

M1 → maculopathy (significant macular oedema or ischaemic macula)

Question 8

Hypertensive retinopathy is retinal vascular damage caused by hypertension. Signs usually develop late in the disease.

What does fundoscopic examination show?

Answer 8

• arteriolar constriction
• arteriovenous nicking
• vascular wall changes
• flame-shaped haemorrhages
• cotton wool spots
• yellow hard exudates
• optic disc oedema

Question 9

What are the main effects on capillaries in diabetic retinopathy?

Answer 9

Leakage

Occlusion

Question 10

Management of capillary leakage/macular oedema

Answer 10

Intravitreal anti-VEGF injections