Diagnosis and Management of Diabetic Retinopathy—Essentials for the Primary Care Optometrist
Jerry Cavallerano, OD, PhD
Anthony Cavallerano, OD
I.
Overview and epidemiology
II.
Diabetes Mellitus and Vision Loss
A. Causes of vision loss from diabetes mellitus
B. Incidence and prevalence statistics
C. Vision preservation
III.
Risks Factors influencing rate of onset and progression of diabetic retinopathy
A. Glycemic control
B. Hypertension
C. Renal disease
D. Dyslipidemia
E. Abdominal obesity
F. Anemia
G. Pregnancy
IV.
Clinical Pathologic Processes in Diabetic Retinopathy
A. Implications of lesions of diabetic retinopathy
B. Clinical levels of diabetic retinopathy
V.
Diabetic Macular Edema
A. Effects on macular structure and function
B. Diagnosis of diabetic macular edema
VII.
Clinical Considerations
A. Standard of care
B. Ocular examination and referral criteria
C. Advanced diagnostic imaging
VIII.
Diagnosis of level of diabetic retinopathy and diabetic macular edema
A. ETDRS Modified Airlie House Classification
B. International classification of diabetic retinopathy
IX.
Treatment options and modalities
A. ETDRS guidelines
B. Emerging trends and novel treatments
C. Response to treatment
X.
Side Effects and Complications of Treatment
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XI.
Salient Elements of Patient Care
A. Medical/Diabetes History
1. DM type, duration, treatment, control (SMBG, A1c)
2. Medications, systemic complications
B. Ocular History
C. Ocular Findings
D. Diagnosis
E. Treatment and Follow-up
XII.
Catalog of Case studies
A. Mild – Moderate Nonproliferative Diabetic Retinopathy
B. Severe – Very Severe Nonproliferative Diabetic Retinopathy
C. Proliferative Diabetic Retinopathy
D. High Risk Proliferative Diabetic Retinopathy
E. Diabetic Retinopathy in Patients with Cataract
F. Diabetic Papillopathy
G. Diabetic Macular Edema
H. Diabetic Retinopathy and Associated Retinal Vascular Complications
XII.
Summary
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Table 1
ABBREVIATIONS AND COMMONLY USED TERMS
PDR
NPDR
H/Ma
HE
SE or CWS
VCAB
VB
IRMA
NVD
NVE
FPD
FPE
SVL
MVL
CSME
Proliferative Diabetic Retinopathy
Nonproliferative diabetic retinopathy
Hemorrhages and/or microaneurysms
Hard exudates
Soft exudates (cotton wool spots)
Venous Caliber Abnormalities
Venous beading
Intraretinal microvascular abnormalities
New vessels on or within 1 disc diameter (DD) of disc margin
New vessels elsewhere in the retina outside of disc and 1 DD from disc margin
Fibrous proliferations on or within 1 DD of disc margin
Fibrous proliferations elsewhere, not FPD.
Severe visual loss: Visual acuity equal to or less than 5/200
Moderate Visual Loss: A doubling of the visual angle (e.g., 20/40 to 20/80)
Clinically significant macular edema
Table 2
PDR AT 1-YEAR VISIT BY SEVERITY OF INDIVIDUAL LESION
Lesion
Grade
Hard exudates
CWS:
HMA:
IRMA:
Venous beading
PDR in 1 Year
No association
None
15.5%
Severe
33%
Present 2-5 fields
9%
Very severe
57%
None
9%
Moderate in 2-5 fields
57%
Absent
15%
Present 2-5 fields
59%
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