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SPM- Opthamology > Diabetic Eye Disease > Flashcards

Diabetic Eye Disease Flashcards

1
Q

What is the biggest risk factor for developing diabetic retinopathy?

A

Poor glycaemic control

As for any micro-vascular complication of diabetes

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2
Q

What factors increase the likelihood of a diabetic patient developing retinopathy?

A 
Poor glycaemic control
Earlier diagnosis so longer expsoure
High cholesterol
HTN
Smoking
Other micro-vascular complications
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3
Q

What is the pathology in diabetic retinopathy?

A

Diabetes causes damage to small blood vessels:
Hyperglycaemic causes thickening of the basement membrane which limits oxygen diffusion
- Pericyte death due to hyperglycaemia
- Leukostasis causing occlusion

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4
Q

What does damage to the small blood vessels cause in diabetes?

A

Microvascular occlusion

Microvascular leakage- causing haemorrhage and exudate

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5
Q

What lesions are seen in diabetic retinopathy on fundoscopy?

A

Micro-aneurysms- dot haemorrhage is an early stage

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6
Q

What are micro-aneurysms?

A

Small localised swelling of blood vessels

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7
Q

What can happen to micro-aneurysms?

A
  • 50% Disappear
  • Burst to cause a small bleed called a blot haemorrhage
  • Infarct to cause a cotton wool spot
  • Leakage to cause exudates and oedema
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8
Q

What is a blot haemorrhage?

A

A small bleed that occurs from micro-aneurysms caused by small vessel damage in diabetic retinopathy

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9
Q

What are hard exudates/oedema?

A

Areas of the retina with a yellow/waxy appearance due to leakage which occurs due to micro-vascular damage with diabetes.

It is an accumulation of lipo-proteins/lipid in the retina

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10
Q

What are cotton wool spots?

A

Fluffy white patches on the retina due to damage to nerve fibres which leads to accumulation of axoplasmic material. They occur due to ischaemic damage to the nerve fibres due to micro-vascular damage which occurs with diabetic retinopathy

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11
Q

What is a circinate?

A

This is a ring of hard exudate (lipids in the retina ) that surround a micro-aneurysm/point of leakage. Exudate occurs due to micro-vascular leakiness.

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12
Q

Why do new vessels form in diabetic retinopathy?

A

This occurs in the proliferative stage of diabetic retinopathy and is due to ischaemia to the retina. This causes release of VEGF which drives new vessel formation. The vessels that form are poorly formed and prone to bleeding.

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13
Q

What does NVD and NVE mean?

A

Ischaemia due to microvascular damage in diabetic retinopathy causes release of VEGF. This drives the formation of new (poorly formed) blood vessels in the retina (proliferative stage).

NVD- New vessels at the disc
NVE- New vessels elsewhere

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14
Q

What are the stages of diabetic retinopathy?

Stage for Retinopathy
Stage for maculopathy
Stage for photocoagulation (laser treatment)

A

No diabetic retinopathy (R0)
Background retinopathy (R1)
Pre-proliferative retinopathy (High risk) (R2)
Proliferative retinopathy (R3)

Maculopathy
If macula is involved it is termed maculopathy (M1).
Macula not affected (M0)

Photocoagulation present (P1) or Absent (P0)

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15
Q

What three factors are included when staging diabetic retinopathy?

A

Retinopathy- None, Background, Pre-Proliferative, Proliferative
Maculopathy- Present or Absent
Photocoagulation- Present or Absent

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16
Q

What is seen for no retinopathy?

A

Normal healthy retina

17
Q

What is seen for background retinopathy?

A

Some micro-aneurysms
Blot haemorrhages (small)
Some hard exudate (lipid in the retina due to leakage from vessels)

18
Q

What is seen in pre-proliferative retinopathy?

A

Beginning to show signs of ischaemia
Cotton wool spots- (build up of axoplasmic material due to neuronal ischaemia)
Larger spots of haemorrhage/flame haemorrhages
Venous looping, reduplication and dilation (causes beading)

19
Q

What is seen in proliferative retinopathy?

A

Signs of ischaemia- blot haemorrhages, larger haemorrhages, cotton wool spots, hard exudate

Plus New Vessel Formation- NVD or NVE.

20
Q

How is proliferative retinopathy sub divided?

A

R3a- Proliferative- Signs of new vessels formation either at the disc (NVD) or elsewhere (NVE)

R3s- Stable disease process and this is post treatment. Presence of peripheral retinal treatment

21
Q

Why are the new blood vessels that form problematic?

A

They are poorly formed and fragile so they’re prone to bleeding. This causes vitreous haemorrhage which is a cause of painless loss of vision.

22
Q

Why is it worrying if there is macula involvement?

A

This is diabetic maculopathy and is the leading cause of blindness in diabetics

23
Q

What is photocoagulation?

A

This is laser treatment for diabetic retinopathy- graded P1 if any signs are present. This is done to reduce VEGF production and so the drive for proliferation of new blood vessels.

24
Q

What is rubeosis?

A

This occurs in very severe diabetic retinopathy. VEGF moves forward and causes proliferation of blood vessels on the iris. These can bleed to cause a hyphaema.

25
Q

What is a cause of sudden loss of vision in patients with diabetic retinopathy?

A

Bleeding of the newly formed blood vessels which causes vitreous haemorrhage

26
Q

What is neo-vascular glaucoma?

A

New vessels form in the drainage angle and obstruct the outflow of aqueous humour- causes very high IOP.

27
Q

How can retinal detachment occur in diabetic retinopathy?

A

Retinal haemorrhages result in inflammation
This causes the formation of fibrotic membranes
Fibrotic membranes pull on the retina and can cause tears and retinal detachment
Called a tractional retinal detachment

28
Q

How often should diabetic patients be screened for the development of retinopathy?

A

A photo should be taken of the back of their eye every year.

Dilator eye drops are given and then a photo of the back of the eye is taken.

29
Q

From what age should diabetic patients be invited for annual screening of the back of their eyes?

A

From 12 years of age

SPM- Opthamology (11 decks)

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