Diabetic Retinopathy

Question 1

What is diabetic retinopathy?

Answer 1

A progressive microangiopathy of the retinal blood vessels caused by chronic hyperglycemia

Question 2

What is the most common cause of moderate to severe vision loss between ages 25 and 74 years?

Answer 2

Diabetic retinopathy

Question 3

What are the two major layers of the retina?

Answer 3

1) Inner neurosensory retina (NSR)
2) Outer retinal pigment epithelium (RPE)

Question 4

Where does the retinal blood supply come from?

Answer 4

1) Central retinal artery
2) Choroidal circulation

Question 5

What is the pathogenesis of diabetic retinopathy?

Answer 5

Microangiopathy which has features of both microvascular leakage and occlusion

Question 6

Loss of pericytes results in:

Answer 6

1) Distention of capillary wall
2) Disruption of the inner Blood-retinal barrier

Question 7

Distention of the capillary wall causes __.

Answer 7

Microaneurysms

Question 8

Disruption of the inner Blood-retinal barrier causes:

Answer 8

Plasma constituents to leak into the retina =
1) Retinal edema
2) Hard exudates

Question 9

Hypoxic retinas produce:

Answer 9

VEGF (Vascular Endothelial Growth Factor)

Question 10

What is the hallmark of proliferative diabetic retinopathy

Answer 10

New vessels

Question 11

With time, the fibrous component of new vessels
contracts and results in:

Answer 11

Traction retinal detachment

Question 12

Microvascular occlusion leads to:

Answer 12

1) Basement membrane thickening
2) Endothelial cell damage
3) Deformed RBCs
4) Platelet stickiness and aggregation

Question 13

Early signs of non-proliferative diabetic retinopathy:

Answer 13

1) Microaneurysms
2) Dot and blot hemorrhages
3) Flame-shaped hemorrhages
4) Cotton-wool spots
5) Hard exudates
6) Edema
7) Venous changes (heading and looping)
8) Intraretinal microvascular abnormalities (IRMAs)

Question 14

What is the EARLIEST clinical sign of diabetic retinopathy?

Answer 14

Microaneurysms

Question 15

What do microaneurysms look like?

Answer 15

Small red dots in the superficial
retinal layers

Question 16

A microaneurysm rupture produces:

Answer 16

Dot, blot, and flame shaped hemorrhages

Question 17

What are dot and blot hemorrhages?

Answer 17

Microaneurysm ruptures in the deeper layers of the retina

Question 18

What causes hard exudates?

Answer 18

Breakdown of the blood-retina
barrier = leakage of serum proteins and lipids from the vessels.

Question 19

What causes cotton-wool spots?

Answer 19

Nerve fiber layer infarction from
occlusion of precapillary arterioles

Question 20

What are intraretinal microvascular abnormalities?

Answer 20

Abnormal branching, sinuous shunt vessels that typically develop adjacent to areas of capillary non-perfusion

Question 21

The International Clinical Diabetic Macular Edema (DME) Disease Severity Scale says that if diabetic macular edema us present, then that means:

Answer 21

There is some retinal thickening or hard exudates (HE) present in the posterior pole

Question 22

Diabetic Macular Edema (DME) is categorized as:

Answer 22

1) Mild DME
2) Moderate DME
3) Severe DME

Question 23

Mild DME is:

Answer 23

Some retinal thickening or hard exudates are present in the posterior pole but distant from the center of macula.

Question 24

Moderate DME is:

Answer 24

Retinal thickening or hard exudates approaching the center of the macula but not involving its center.

Question 25

Severe DME is:

Answer 25

Retinal thickening or hard exudates involving the center of the macula.

Question 26

What are the LATE signs of proliferative diabetic retinopathy?

Answer 26

1) Neovasclaization (NVDs,NVEs and NVIs) 2) Vitreous hemorrhages 3) Per retinal hemorrhages 4) Traction retinal detachment 5) Neovacular glaucoma

Question 27

What is Rubeosis Iridis?

Answer 27

Neovascularization of the iris

Question 28

Criteria for mild non-proliferative diabetic retinopathy?

Answer 28

Microaneurisms only

Question 29

Criteria for moderate non-proliferative diabetic retinopathy?

Answer 29

1) Microaneurysms and/or dot and blot hemorrhages in more than 1 quadrant 2) Soft exudates (Cotton wool spots) 3) Venous beading in one quadrant

Question 30

Criteria for severe non-proliferative diabetic retinopathy?

Answer 30

1) Microaneurysms in 4 quadrants 2) Venous changes in 2 quadrants 3) IRMA in one quadrant

Question 31

Proliferative diabetic retinopathy is characterized by:

Answer 31

1) Proliferation of new vessels from retinal veins 2) New vessels on the optic disc 3) New vessels elsewhere on the retina

Question 32

Treatment for Mild & Moderate NPDR?

Answer 32

No treatment, only control diabetes and other comorbidities.

Question 33

Treatment for severe NPDR?

Answer 33

Follow up with opthamologist

Question 34

Treatment for clinically significant Macular Edema?

Answer 34

1) Intra-vitreal anti-VEGF 2) Laser photocoagulation to minimize risk of visual loss

Question 35

What is Circinate retinopathy?

Answer 35

Hard exudates in a ring around leaking aneurysms

Question 36

Treatment for proliferative diabetic retinopathy?

Answer 36

1) Retinal laser photocoagulation 2) Anti-VEGF intravitreal injection, like Avastin

Question 37

What is Neovascular Glaucoma a complication of?

Answer 37

Rubeosis iridis

Question 38

What is Neovascular Glaucoma?

Answer 38

When new vessels cause angle closure and obstruct aqueous outflow = ↑ ICP

Question 39

Neovascular glaucoma causes __ distortion as the __ gets pulled.

Answer 39

Pupil; Iris

Question 40

Neovascular glaucoma symptoms include:

Answer 40

1) Pain 2) Redness 3) Loss of vision

Question 41

Which conditions can cause blindness?

Answer 41

1) Non-clearing vitreous hemorrhage 2) Neovascular glaucoma 3) Tractional retinal detachment 4) Macular ischemia