Birmingham

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Birmingham Midland Eye Centre

• Diabetic Retinopathy
• by
• Naomi HT Bridgwater

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Diabetic Retinopathy

• Diabetic retinopathy is the commonest cause of
  blindness in young and middle aged people in the
  United Kingdom
• Its progress is reducible by early detection and
  treatment

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Diabetic Retinopathy

• 50-80 of Diabetics 20 yrs history
• Of these 1 in 10 may require treatment

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What causes Diabetic Retinopathy

• Cause Unknown
• High Blood Retinal
• Sugar circulation
• inadequacy

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Who will get Diabetic Retinopathy

• Any Diabetic
• Mild, diet controlled
• Severe, insulin dependent

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Diabetic Retinopathy Risk Factors

• Poor glycaemic control
• Long standing diabetes
• Diabetes hypertension
• Diabetes pregnancy
• Other Diabetic Complications
• Obesity

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How does Diabetic Retinopathy affect the eye

• Retinal Blood vessels
• Abnormal new blood vessels may haemorrhage
• Retinal Detachment
• Maculopathy
• Vision reduction

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Diabetic Retinopathy can be classified into

• Background retinopathy
• Maculopathy
• Pre-Proliferative retinopathy
• Proliferative / Advanced

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Normal Fundus
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Background retinopathy presents with

• Retinal vein occlusion
• Microaneurysms red dots
• Retinal Haemorrhages Blots
• Hard exudates yellowish waxy lesions, often
  accumulating in rings around leaking vessels

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Background retinopathy
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Background retinopathy progression
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Background retinopathy progression 2
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Maculopathy

• Macula affected
• Due to deposition of fats (Exudates)
• Waterlogging of the retina
• Visual Acuity is impaired
• Visual acuity tested with a pinhole may be worse

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Flourescein Angiograph of macula oedema
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Flourescein Angiograph of severe maculopathy
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Flourescein Angiograph of circinate maculopathy
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Pre-Proliferative Diabetic Retinopathy

• Multiple cotton wool spots
• Venous beading
• Venous reduplication
• Arteriolar sheathing

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Pre-Proliferative Diabetic Retinopathy
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Arteriolar Sheathing
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Proliferative Diabetic Retinopathy (Advanced)

• Neovascularisation
• The new blood vessels may grow onto the optic
  disc
• They are fenestrated
• Leaky junctions leading to
• Pre-retinal haemorrhage and a tendency to
  vitreous haemorrhage

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New vessel formation
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New vessel formation with retinal haemorrhage
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Large, almost complete vitreous haemorrhage
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Advanced Diabetic Retinopathy

• Leakage into vitreous
• Gel structure collapses
• Detaches from retina
• Detached vitreous
• New vessels
• Fibrous tissue
• Forms traction bands
• Retinal Detachment

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Fibrous proliferation with tractional retinal
detachment
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Other complications of Diabetic Disease

• Rubeosis Iridis
• Glaucoma
• Cataract
• Chronic Iritis

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Likely Investigations

• Visual Acuities with pin hole
• Detailed history
• Urine Test
• Blood Sugar
• Ophthalmoscopy
• Slit lamp examination
• Fluorescein angiography

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Fluorescein Angiography showing laser scars
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Fluorescein Angiography showing laser scars
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Treatment

• Ophthalmic Laser
• High energy beam of light
• A simple outpatient procedure
• Involves mydriatic drops, local anaesthetic and
  contact lens use
• Often requires more than one session

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How does laser work

• Photo co-agulates the abnormal blood vessels
• Reduces the risk of bleeding and retinal
  detachment
• Some maculopathy may be treated in a similar way

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Medical Treatment

• Good diabetic control may delay retinopathy
• Use of Human insulin
• Insulin pumps
• Range of tablets
• Early treatment

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Surgical Treatment

• Vitrectomy
• To free traction bands
• Repair retinal detachment
• To remove large vitreous haemorrhage

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Health Education

• Encourage patient to recognise early signs before
  V.A. affected
• Provide regular checks
• To detect early changes
• screening

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Who will get diabetic retinopathy

• Any diabetic can get diabetic retinopathy even
  those with so-called mild diabetes controlled
  by diet alone

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Summary

• Approximately 50-80 of diabetics with a disease
  history of 20 years or more may have eye changes
• 1 in 10 may have sight threatening eye diseases
  which requires treatment

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Thank you
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Ocular manifestations of Diabetes Mellitus

• Xanthelasma Benign growths due to
  hyperlipodaemia
• Styes Infected hair follicle (lash) on the lid
  margin
• Blepharitis acute/chronic inflammatory
  condition of the lid margins

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Ocular Manifestations of Diabetes

• Extra ocular muscle palsy inflammation of the
  3rd,4th or 6th cranial nerves causing paralysis
  of the extra-ocular muscles, in turn causing
  double vision
• Anterior Uveitis inflammation of the uveal
  tract (iris, ciliary body choroid)

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Ocular manifestations of Diabetes

• Rubiosis Iridis growth of extra unnecessary,
  leaky blood vessels on the iris
• Hyphaema blood in the anterior chamber
• Cataract Partial or total opacity of the lens
• Vitreous haemorrhages-Bleeding into the vitreous
  cavity

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Ocular manifestations of Diabetes

• Diabetic Retinopathy
• Retrobulbar Neuritis Inflammation of the optic
  nerve occuring BEHIND the optic disc.
• Optic Atrophy Pale optic disc and loss of
  pupillary reaction to light, gradual loss of
  vision, scotoma to total blindness