diabetic eye disease

Question 1

diabetic retinopathy - how is it classified?

Answer 1

non-proliferative: mild, mod, severe
proliferative (neovascularisation)

maculopathy

Question 2

diabetic retinopathy - indications for eye referral

Answer 2

fall in VA - cataracts or maculopathy
cotton wool spot
3 blot haemorrhages
anything at macula
new vessels - emergency

Question 3

diabetic retinopathy - management

Answer 3

laser (esp for new vessels) to reduce local GFs

Question 4

non-proliferative diabetic retinopathy - features on fundoscopy

Answer 4

microaneurysms
blot haemorrhages
hard exudates
cotton wool spots
venous beading/looping

Question 5

what causes neovascularisation in diabetic retinopathy?

Answer 5

production of growth factors in response to retinal ischaemia

Question 6

how does diabetes damage the eyes?

Answer 6

hyperglycaemia increases retinal blood flow + causes abnormal metabolism, which damages endothelial cells + pericytes

endothelial damage causes increased vascular permeability and results in the exudates seen

pericyte damage causes microaneurysms

Question 7

proliferative diabetic retinopathy on fundoscopy

Answer 7

neovascularisation - may cause vitreous haemorrhage

Question 8

endstage diabetic retinopathy

Answer 8

vitreous haemorrhage from fragile vessels
scarring
retinal detachment
blindness

Question 9

non-proliferative diabetic retinopathy - classification

Answer 9

mild - 1+ microaneurysm

moderate
blot haemorrhages
hard exudates
cotton wool spots
venous beading/looping

severe
blot haemorrhages + microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
intraretinal microvascular abnormalities in at least 1 quadrant