1. Regular eye exams 2. Reduce risk of getting DR by

DISEASE (Hypertensive Retinopathy) Flashcards by Ashley Mendova

Complications of Diabetic Retinopathy (VRGB)

-Vitreous hemorrhage
-Retinal detachment
-Glaucoma
-Blindness

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Treatment for early diabetic retinopathy

-Good blood sugar control to slow progression
-Collaboration with an endocrinologist to improve diabetes management

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Treatment for Proliferative DR (w macular edema)

-Photocoagulation/Focal laser
-Grid laser photocoagulation
-Panretinal photocoagulation (PRP)
-Vitrectomy

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also known as focal laser treatment, can stop/slow leakage of blood & fluid in the eye

Photocoagulation/focal laser

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usually done in outpatient department or in eye single session clinic

Photocoagulation/focal laser

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Surgical procedure for diffuse clinically significant diabetic macula edema

Grid laser photocoagulation

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treatment of choice for cases not responding to anti-VEGF & steroids

Grid laser photocoagulation

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for “recalcitrant” (stubborn) cases DM Ret

Grid laser photocoagulation

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also known as “scatter laser treatment” can shrink abnormal blood vessels

Panretinal photocoagulation (PRP)

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some loss of peripheral vision or night vision after the procedure

Panretinal photocoagulation (PRP)

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areas of retina away from macula are treated with scattered laser burns

Panretinal photocoagulation (PRP)

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uses tiny incision in your eye to remove blood in the vitreous as well as scar tissue thats tugging on retina that can cause tractional retinal detachment

Vitrectomy

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done in a surgical center/hospital using local/general anesthesia

Vitrectomy

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Pharmacologic therapy for DR

-Anti-VEGF
-Triamicinolone

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help stop growth of new blood vessels by blocking effects of growth signals the body send to generate new blood vessels

Anti-VEGF (Ranibizumab, Bevacizumab)

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administered intravitreally; corticosteroid used in treatment of diabetic macular edema

Triamicinolone

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Diabetes Control & Complications tral found that intensive __________ in px with type 1 diabetes decreased the incidence of progression of DR

Glucose control

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Optometric Management for DR

-close monitoring for px suspected for DM Ret
-dilated retinal examination
- refer if:
1. macular edema
2. severe NDR
3. PDR

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Prevention for DR

Regular eye exams
Reduce risk of getting DR by

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Reduce risk of getting DR by the following:

-Manage diabetes
-Healthy diet
-Physical activity part of daily routine
-Moderate aerobic activity (walking)
-Oral diabetes meds or insulin as directed
-Monitor blood sugar level
-Keep bp & cholesterol under control
-Avoid smoking
-Pay attention to vision changes (changes in prescription, sudden vision loss)
-Lifestyle modification

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complication of high blood pressure (hypertension)

Hypertensive Retinopathy

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due to persistent, untreated high bp can cause damage to the retina

Hypertensive retinopathy

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occurs when force of blood against artery walls is too high, causing: DAN

-Damaged over time
-Arteries to stretch
-Narrow

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Damage to retina increase with: SL

Study These Flashcards

-Severity of high bp
-Length of time

at risk:

older people

caused by chronically elevated blood pressure

Arteriosclerosis changes of hypertensive retinopathy

elevated blood pressure systolic & diastolic

systolic: 120-129mmHg diastolic: <80mmHg

Stage 1 hypertension systolic & diastolic

systolic: 130-139mmHg diastolic: 80-89mmHg

Stage 2 hypertension systolic & diastolic

systolic: equal or less than 140 mmHg diastolic: >90 mmHg

stage of retinopathy: narrowing of arteries is mild

Grade 1

stage of retinopathy: AV nicking

Grade 2

stage of retinopathy: retinal hemorrhage, cotton-wool spots

Grade 3

stage of retinopathy: combines first two categories into one

Grade 4

stage of retinopathy: severe G3 swelling of optic disc (papilledema)

Grade 4

Patho of HR that differentiates them from other blood vessels: TAP

-The absence of sympathetic nerve supply -Autoregulation of blood flow -Presence of blood-retinal barrier

Hypertensive retinopathy phases

a. Vasoconstrictive phase b. Sclerotic phase c. Exudative phase d. Malignant hypertension

phase where the local autoregulatory mechanisms come into play

Vasoconstrictive phase

cause vasospasm & retinal arteriole narrowing, which is evident by decrease in arteriole venule ratio

Vasoconstrictive phase

persistent in BP causes certain vessel wall

Sclerotic phase

Sclerotic phase: persistent increased BP changed in vessel wall (IMA)

Intima layer: thickening Media layer: hyperplasia Arteriolar wall: hyaline degeneration

Sclerotic phase changes in vessel wall lead to (SAW)

1. Severe form of arteriolar narrowing 2. Arteriovenous (AV) crossing changes 3. Widening & accentuation of light reflex (silver & copper wiring)

seen in px with severely increased BP

Exudative phase

Exudative phase is characterized by (DL)

1. Disruption of blood-brain barrier 2. Leakage of blood & plasma into vessel wall - disrupting autoregulatory mechanisms

Exudative phase: retinal signs (RHNR)

1. Retinal hemorrhage (flame-shape & dot blot) 2. Hard exudate formation 3. Necrosis of smooth muscle cells 4. Retinal ischemia (cotton-wool spots)

severe intracranial hypertension leads to optic nerve ischemia & edema (papilledema)

Malignant hypertension

other factors contributing to developing high bp:

-Obesity -Sedentary lifestyle - A diet high in salt -Stress -Family history of high bp -Diabetes -Moderate to high alcohol intake

Signs & symptoms of HR

-Permanent arterial narrowing -Arteriovenous crossing abnormalities (arteriovenous nicking) -Arteriosclerosis w moderate vascular wall changes (copper wiring) to more severe vascular wall hyperplasia & thickening (silver wiring)

retinal arterioles appear orange or yellow instead of red

Copper wiring

retinal arterioles look white if they have become occluded

Silver wiring

retinal arterioles look dull white if with severe occlusion

Ghost vessel

___________is a major predisposing factor to development of a branch retinal vein occlusion

arteriovenous nicking

for severe cases, these are the findings:

-superficial flame-shaped hemorrhage -small, white superficial foci of retinal ischemia (cotton-wool spots) -yellow hard exudates -optic disc edema

Treatment for HR (CARD- RGL)

-controlling hypertension -anti-VEGF -giving up smoking -losing weight -regular exercise -dietary changes -reduce alcohol intake

Medications for HR

a. Angiotensin-converting enzyme (ACE inhibitors) b. Angiotensin-2 receptor blockers (ARBs) c. Thiazide diuretics d. Calcium-channel blockers e. Beta-blockers

Prevention for HR

1. careful management oh high bp & related condition like diabetes 2. lifestyle changes (lose weight, give up smoking) 3. regular monitoring of bp 4. regular eye screening

Complications for HR

1. Retinal vein occlusion 2. Retinal artery occlusion 3. Ischemic optic neuropathy 4. Malignant hypertension 5. Stroke & heart attack

Prognosis for HR

Mild hyper (G1 & G2) - relatively positive, as long as bp is controlled Severe hyper - if not properly managed, condition can enter "malignant" stage

Optometrist's role

1. Early detection & diagnosis of ocular manifestations associated with HTN 2. Lead to timely referral and appropriate management

Challenge to all new & old opto

"We can affirm role of optometrists as primary health care provider, by performing a comprehensive eye examination, including blood pressure evaluation".

DISEASE (Hypertensive Retinopathy) Flashcards

(59 cards)