Diabetic Retinopathy Histology Pathogenesis online folderonline folder 14 years of diabetes with medicocre control Longer with good control, very much longer with very good control Healthy retinal capillaries Diabetic capillaries: non-perfused areas

Identifying progession of retinopathy Exudates/oedema = leakage  New Vessels  An ‘early’ sign = haemorrhages

Retinopathy is linked to HbA1c: 1% HbA1c = 37% progression rate (UKPDS & DCCT)

Retinopathy is linked to blood pressure 1mmHg = 1.1% progression rate

Retinopathy is linked to genes Genetic = 25% Retinopathy Family history heart disease, stroke, blood pressure (may be mediated through blood pressure)

Retinopathy is linked to smoking Smoking 20/day = 300% progression rate Passive smoker gets 25% of the smoke

Retinopathy is linked to lipids Statin reduces progression by 25-50% (estimate) Treat even if normal, especially if there are exudates

Retinopathy is a ‘preventable’ chronic disease

Tight control of diabetes is a balancing act Resources motivation learning disability the wrong time or an unenthusiastic patient

Cases Case 14 (severe++) 0.6mb online & folderonlinefolder Case 3 (new vessels) online & folderonlinefolder

Features microaneurysms

Features New vessels (also get tortuous vessels and haemorhages)