Unit 7 - Diabetes part 2

Question 1

How is proliferative DR classified?

Answer 1

Early

High risk:

1 of:

1. NVD with VH
2. NVD
3. NVE with VH

OR 3 or more of:

1. VH or pre-retinal haem
2. Active neovasc
3. Neovasc within 1DD of disc
4. NVD > 1/3 of disc area or NVE > 1/2DD

Gliotic

Question 2

What is the treatment of NV and why does it work?

Answer 2

Laser. Acts by inducing thermal damage to the RPE with minimal photoreceptor damage . Reduces oxygen demand of retina which in turn reduces VEGF production.

Question 3

What are the side effects of PRP?

Answer 3

1. Pain
2. Vitreous haem
3. Decrease in night vision
4. Decrease in peripheral vision
5. Decrease in colour vision
6. Glare
7. Temporary loss of accommodation
8. Photopsia
9. Macula oedema may be aggravated if already present

Question 4

What is the ETDRS classification of diabetic maculopathy?

Answer 4

• Retinal thickening within 500um of fovea
• Hard exudates within 500um of fovea with adjacent thickening
• Retinal thickening of at least 1DD part of which is within 1DD of fovea

Question 5

How is macula ischaemia visualised in DR?

Answer 5

With FFA, irregular FAZ, greaer than 1000 um equate to vision loss

Question 6

What are the treatment options for DMO?

Answer 6

1. Otpimise glycaemic control
2. Optimise BP
3. Consider statin and fenofibrate for type 2
4. Focal laser if not centre involving and meets criteria of clinically significant DM
5. Anti-VEGF

Question 7

What are the indications for Anti-VEGF or steroid treatment for DMO?

Answer 7

1. V/a 6/9 - 4/60
2. FAZ of < 1500um
3. No foveal structrual damage