6. Diabetic Eye Disease Flashcards
(54 cards)
How to we classify diabetic retinopathy
Non- proliferative
- mild
- moderate
- severe
Proliferative e
+/- maculopathy
What is diabetic maculopathy?
It refers to any signs of diabetic retinopathy occurring within the macula.
At what stage of diabetic retinopathy can maculopathy occur?
Maculopathy can occur at any stage of diabetic retinopathy.
What is the significance of seeing diabetic retinopathy signs temporal to the optic disc with a direct ophthalmoscope?
It indicates diabetic maculopathy, as the macula lies temporal to the optic disc.
Why is identifying signs of diabetic maculopathy with a direct ophthalmoscope challenging?
The direct ophthalmoscope has a very narrow field of view, making it harder to assess the entire retina, especially subtle macular changes.
What are hard exudates in NPDR, and what causes them?
Hard exudates are yellow lesions caused by precipitation of protein and lipid from damaged microvasculature.
What are the earliest visible signs of NPDR?
Microaneurysms or dot hemorrhages are typically the earliest visible signs of NPDR.
What are blot hemorrhages, and what do they indicate in NPDR?
Blot hemorrhages are larger, deeper retinal hemorrhages, indicating more severe vascular leakage in NPDR.
What are cotton wool spots, and what do they indicate in NPDR?
Cotton wool spots are fluffy white retinal lesions caused by microinfarctions of the retinal nerve fiber layer, indicating retinal ischemia and moderate to severe NPDR.
What rule is used to define severe NPDR?
The 4-2-1 rule is used to define severe NPDR.
What does the “4” in the 4-2-1 rule for severe NPDR represent?
Severe retinal hemorrhages or microaneurysms in all 4 quadrants of the retina.
What does the “2” in the 4-2-1 rule for severe NPDR represent?
Venous beading in at least 2 quadrants, indicating advanced retinal vascular damage.
What does the “1” in the 4-2-1 rule for severe NPDR represent?
Presence of intraretinal microvascular abnormalities (IRMA) in at least 1 quadrant.
What is the clinical significance of identifying severe NPDR using the 4-2-1 rule?
Severe NPDR has a high risk of progressing to proliferative diabetic retinopathy (PDR) and requires urgent referral to ophthalmology.
What is the hallmark sign of Proliferative Diabetic Retinopathy (PDR)?
The presence of fibrovascular complexes, which are new, fragile blood vessels growing on the retinal surface.
What happens to the new vessels in advanced PDR?
The new vessels are replaced by fibrosis, forming contracting fibrovascular membranes.
What complication can arise from contracting fibrovascular complexes in PDR?
They can lead to tractional retinal detachments, pulling the retina away from the back of the eye.
What should you consider when a diabetic patient has poor vision and “lots of white stuff” on the retinal surface?
Suspect fibrovascular proliferation and retinal traction in advanced PDR, especially if the white material obscures normal retinal anatomy.
How often should screening be done?
yearly
When to start screening
- Type 1 DM at puberty
- Type 2 DM at diagnosis
What is the preferred screening technique for diabetic retinopathy in most settings?
Visual acuity assessment + grading of fundus photographs by trained optometrists.
How is diabetic retinopathy screening typically done in the private sector?
Through a private optometrist who performs visual acuity testing and fundus photography.
How is diabetic eye screening commonly conducted in the public sector?
Via the optometry screening service at local day hospitals, using fundus photography and visual acuity testing.
What is the backup screening method if fundus photography is not available?
Visual acuity assessment + pupil dilation with Tropicamide + direct ophthalmoscopy by a GP.
