Diabetic Eye Disease

Question 1

Effects of diabetes on the eyes

Answer 1

• Increased susceptibilityt to infection (i.e. cellulitis)
• Dry eyes and keratitis
• Cataract
• Diabetic papillitis
• Retinopathy

Question 2

Diabetic retinopathy

Answer 2

• Disease of the retinal microvasculature associated with prolonged hyperglycaemia
• 97^ have DR 15 years after DM diagnosis (25% proliferative)
• Features include:
  
  • Microaneurysms (damage to blood vessels)
  • Blot/dot haemorrhages (damage to blood vessels)
  • Cotton-wool spots (damage to nerve fibres)
  • New vessels
  • Circinate hard exudates
• Management
  
  • Screening programme
  • Pan retinal photocoagulation
    
    • Destroys small patches of ischaemic retina
  • Anti-VEGF

Question 3

Screening programme

Answer 3

• Annual photographs

Question 4

Non-proliferative

Answer 4

• Mild - microaneurysms
• Moderate - microaneurysms, blot haemorrhafes, hard exudates, cotton wool spots and venous beading
• Severe - blot haemorrhages plus microaneurysms in 4 quadrants, venous beading in 2 quadrants, intraretinal microvscular abnormality (IMRA) in any quadrant

Question 5

Proliferative

Answer 5

• Neovascularisation
• Vitreous haemorrhage

Question 6

Complications

Answer 6

• Retinal detachment
• Vitreous haemorrhage
• Rebeosis iridis (new blood vessel formation on the iris)
• Optic neuropathy
• Cataracts

Question 7

Grading of diabetic retinopathy

Answer 7

• R0 - none
• R1 - mild, background, at least 1 dot haemorrhage or microaneurysm without hard exudates
• R2 - moderate, 4 or more blot haemorrhages in one hemi-field only
• R3 - severe, 4 or more blot haemorrhages in both inferior and superior hemo-fields or venous beading or IRMA
• R4 - proliferative, new vessels or vitreous haemorrhage