Diabetic retinopathy and other retinal vascular disorders

Question 1

Leading cause of working-age adult blindness

Answer 1

Diabetic retinopathy

Question 2

Type 1 DM risk

Answer 2

30% >10 years

90% >30 years

Question 3

Type 2 DM risk

Answer 3

5% at dx

Question 4

Diabetic retinopathy pathophysiology

Answer 4

Occlusion
Microvascular disease -> BM thickening + endothelial dysfx -> haematological changes -> thrombus -> retinal hypoxia -> ischaemia -> VEGF -> neovascularisation

Leakage
Oedema

Question 5

Majority of diabetic retinopathy symptoms caused by

Answer 5

Macular oedema

Vitreous haemorrhage

Question 6

Signs of diabetic retinopathy

Answer 6

Microaneurism
Exudate
Cotton wool spot
Macular oedema
Vitreous haemorrrhage
Venous beading
IRMA
Neovascularisation

Question 7

Diabetic retinopathy classifications

Answer 7

Background
Preproliferative
Proliferative
Maculopathy
Advanced disease

Question 8

Background diabetic retinopathy

Answer 8

Microaneurism
Exudates
Dot blot haemorrhage

Question 9

Preproliferative diabetic retinopathy

Answer 9

Cotton wool spots
Venous beading
IRMA

Question 10

Proliferative diabetic retinopathy

Answer 10

NVD

NVE

Question 11

Maculopathy

Answer 11

Cystoid macular oedema

w/wo other signs

Question 12

Advanced diabetic retinopathy

Answer 12

Vitreous haemorrhage
Retinal detachment
NVI

Question 13

Diabetic retinopathy screening

Ocular exam

Answer 13

VA
Dilated fundoscopy
Fundus camera
Refer if decreased VA or abnormal fundus

Question 14

Diabetic retinopathy screening

Comorbidities

Answer 14

HbA1c control (DMI)
BP control (DMII)

Question 15

Diabetic retinopathy treatment

Answer 15

Control comorbidities (blood sugar, BP, cholesterol, lifestyle)
Metformin oral tx
Laser photocoagulation
AntiVEGF injection

Question 16

Retinal vein occlusion epidemiology

Answer 16

> 50% occur in pt >65yo

Assoc with HT, dyslipidaemia, diabetic, smoking, contraceptive pill

Question 17

Retinal vein occlusion pathophysiology

Answer 17

Raised IOP
Atherosclerosis
Hypercoaguability
Virchow’s triad

Question 18

Central retinal vein occlusion

Answer 18

Occlusion at lamina cribrosa where v exits
Severe congestion (no blood exits therefore no blood enters)
Extensive oedema and haemorrhage
Blood and thunder
VA 6/60 to HM
RAPD present

Question 19

Branched retinal vein occlusion

Answer 19

Occlusion at AV crossing
Severe congestion but only portion of retinal involvement
VA 6/9 to 6/60 and loss of vision over affected retina
No RAPD

Question 20

Retinal vein occlusion treatment

Answer 20

Macular oedema - antiVEGF
Neovascularisation - antiVEGF or focal laser
Surgery for neovascular glaucoma

Question 21

Retinal artery occlusion epidemiology

Answer 21

HT
Smoker
Dyslipidaemia

Cardiac pt
Inflammatory vasculopathies
Blood dysacrasia

Question 22

Retinal artery occlusion pathophysiology

Answer 22

Embolic event
Permanent or temporary obstruction
Often carotid artery is the source

Question 23

Retinal artery occlusion temporary obstruction

Answer 23

Transient monocular vision loss

Amaurosis fugax

Question 24

Retinal artery occlusion permanent obstruction

Answer 24

Infarct in retina
Pale colour
Attenuated arteries
Permanent visual loss

Question 25

Central retinal artery occlusion

Answer 25

Emboli obstruct in lamina cribrosa region Cherry red spot Extensive visual loss Profound RAPD

Question 26

Branch retinal artery occlusion

Answer 26

Sectoral vision loss | RAPD present

Question 27

Retinal artery occlusion investigations

Answer 27

BP HBA1C Cardiac exam, ECG, carotid auscultation ESR, CRP (giant cell arteritis) Special: Carotid imaging Cardiac imaging Haematological testing to exclude hypercoag

Question 28

Retinal artery occlusion management

Answer 28

Treat comorbidities | Optimise patient

Question 29

Retinopathy of prematurity

Answer 29

Prem/VLBW infant O2 used postdelivery Hyperoxia inhibits vessel growth and then hypoxic retina releases VEGF

Question 30

Retinopathy of prematurity screening

Answer 30

<30/32 weeks <1500g Severe systemic illness

Question 31

Retinopathy of prematurity investigation

Answer 31

Dilated fundoscopy w indirect opthalmoscope every 1-3 weeks until zone 3 vascularised

Question 32

Retinopathy of prematurity treatment

Answer 32

Laser photocoagulation Cryotherapy AntiVEGF Surgical vitrectomy

Question 33

Hypertensive retinopathy clinical signs

Answer 33

``` Generalised narrowing copper/silver wiring AV nipping focal narrowing Flame haemorrhage Cotton wool spots Exudates (macular star) Microaneurism Papilloedema ```

Question 34

Hypertensive retinopathy staging

Answer 34

1 - minimal retinal artery narrowing 2 - (1) + focal narrowing and AV nipping 3 - (1) + (2) + retinal haemorrhage, hard exudate, cotton wool spots 4 - (1), (2), (3) + optic n swelling + macular star 1/2 nonmalignant 3/4 malignant

Question 35

Sickle cell retinopathy

Answer 35

Hb S+C abnormal while Hb A+B normal | Sickled RBCs not flexible enough therefore cause obstruction

Question 36

Non-proliferative sickle cell retinopathy

Answer 36

Arterial occlusion Venous occlusion Salmon patch retinal haemorrhage Black sunburst scars

Question 37

Proliferative sickle cell retinopathy

Answer 37

Arterial obstruction -> AV malformation -> seafan neovascularisation -> vitreous haemorrhage -> retinal detachment

Question 38

Sickle cell retinopathy treatment

Answer 38

Screen known pt regularly Laser photocoagulation Surgical vitrectomy