Diabetes:
Diabetic retinopathy
Olga Brochner
Ophthalmology,
ADHB
Plan
• The eye
• Diabetic retinopathy
(D.R.)
• Influencing factors
• Signs & stages
• Management
• Questions
D.M. & eye
• Lens changes - cataract, refraction
changes
• Iris changes - diminished pupillary
responses, rubeosis, anterior
synechiae
• Optic neuropathy
• Extraocular muscle palsy
Posterior segment
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Sclera
Choroid
Optic disc
Vitreous
Retina
Macula
Retinopathy
• Abnormal, pathological processes in
retina
• D.R. = microvascular
• Asymptomatic
until BAD
• Prevention / monitor
There is no cure
Influencing Factors
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•
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Length of time
Diabetic control
Hypertension
Lipids (?)
HbA1c
Small difference in HbA1c = significant
reduction on rate of complications
Diabetic retinopathy
• Leading cause of blindness in
working age group (Western World)
• Retinopathy universal diabetic related
complication
• Asymptomatic
• Stages of DR
• Diabetes epidemic
D.R. stages / signs
• Nil
• Nonproliferative =
Mild – severe
• Proliferative DR
• Maculopathy
(any time)
Visual loss
2 pathways:
• Ischaemia
• Leakage /
oedema
Pathogenesis
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•
•
•
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Structural changes
 vascular permeability
Ischaemia
Angiogenic factors
Neovascularisation
Vit haem & traction detachments
Loss of
vision /
blindness
• Ischaemia
• Leakage
Signs
• Structural changes capillary walls
• Microaneurysm (MA)
• Haemorrhages
• Increased permeability
= “hard” exudates
• Retinal oedema
• IRMA
• New vessels
• Cotton wool spots
Proliferative D.R.
• Intra-retinal microvascular abnormalities
(IRMA)
• New vessels (neovascularisaton)
• Vitreous haemorrhages
• Fibrous tissue
• Traction detachments
( & rhegmatogenous)
Maculopathy
• Results in visual loss
• Retinal thickening / exudate within
macula
• Soggy ground
= soggy vision
• OCT
What to do???
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Education
Diet
Lifestyle
Monitoring
Medications
LASER treatment
Surgery (ret det)
Photoscreen
Eye Clinic review
• Dilate
• Time
• Driving ….
LASER
• Application of
light energy to
retina
• Focal / grid laser
• PRP = pan retinal
photocoagulation
Via Silt-lamp
Intravitreal
Triamcinolone /
Avastin
Intravitreal = steroid /
anti VEGF
1. Prevent further VA
loss
2. Complications
3. Repeat & with laser
VR surgery
Outcomes
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Retina is vital for sight
Anxiety of vision loss
Macula involved???
Chronic condition
Long term follow-up
= huge demand
Summarise
• No visual symptoms until
well advanced
• Regular checks
• Early treatment always more effective &
long-term better result
• Can not improve sight – aims to stop
worsening
Thank you
Questions?