Diabetes: Diabetic retinopathy Olga Brochner Ophthalmology, ADHB

Plan The eyeThe eye Diabetic retinopathyDiabetic retinopathy (D.R.) (D.R.) Influencing factorsInfluencing factors Signs & stagesSigns & stages ManagementManagement QuestionsQuestions

D.M. & eye Lens changes - cataract, refraction changesLens changes - cataract, refraction changes Iris changes - diminished pupillary responses, rubeosis, anterior synechiaeIris changes - diminished pupillary responses, rubeosis, anterior synechiae Optic neuropathyOptic neuropathy Extraocular muscle palsyExtraocular muscle palsy

Posterior segment ScleraSclera ChoroidChoroid Optic discOptic disc VitreousVitreous RetinaRetina MaculaMacula ScleraSclera ChoroidChoroid Optic discOptic disc VitreousVitreous RetinaRetina MaculaMacula

Retinopathy Abnormal, pathological processes in retinaAbnormal, pathological processes in retina D.R. = microvascularD.R. = microvascular AsymptomaticAsymptomatic until BAD until BAD Prevention / monitorPrevention / monitor T here is no cure

Influencing Factors Length of timeLength of time Diabetic controlDiabetic control HypertensionHypertension Lipids (?)Lipids (?)

HbA1c Small difference in HbA1c = significant reduction on rate of complications

Diabetic retinopathy Leading cause of blindness in working age group (Western World)Leading cause of blindness in working age group (Western World) Retinopathy universal diabetic related complicationRetinopathy universal diabetic related complication AsymptomaticAsymptomatic Stages of DRStages of DR Diabetes epidemicDiabetes epidemic

D.R. stages / signs NilNil Non- proliferative = Mild – severeNon- proliferative = Mild – severe Proliferative DRProliferative DR Maculopathy (any time)Maculopathy (any time)

Visual loss 2 pathways: IschaemiaIschaemia Leakage /Leakage / oedema oedema

Pathogenesis Structural changesStructural changes  vascular permeability  vascular permeability IschaemiaIschaemia Angiogenic factorsAngiogenic factors NeovascularisationNeovascularisation Vit haem & traction detachmentsVit haem & traction detachments Loss of vision / blindness Ischaemia Ischaemia Leakage Leakage

Signs Structural changes capillary wallsStructural changes capillary walls Microaneurysm (MA)Microaneurysm (MA) HaemorrhagesHaemorrhages Increased permeabilityIncreased permeability = “hard” exudates = “hard” exudates Retinal oedemaRetinal oedema IRMAIRMA New vesselsNew vessels Cotton wool spotsCotton wool spots

Proliferative D.R. Intra-retinal microvascular abnormalities (IRMA)Intra-retinal microvascular abnormalities (IRMA) New vessels (neovascularisaton)New vessels (neovascularisaton) Vitreous haemorrhagesVitreous haemorrhages Fibrous tissueFibrous tissue Traction detachmentsTraction detachments ( & rhegmatogenous)

Maculopathy Results in visual lossResults in visual loss Retinal thickening / exudate within maculaRetinal thickening / exudate within macula Soggy groundSoggy ground = soggy vision = soggy vision OCTOCT

EducationEducation DietDiet LifestyleLifestyle MonitoringMonitoring MedicationsMedications LASER treatmentLASER treatment Surgery (ret det)Surgery (ret det) What to do???

Photoscreen

Eye Clinic review DilateDilate TimeTime Driving ….Driving ….

LASER Application of light energy to retinaApplication of light energy to retina Focal / grid laserFocal / grid laser PRP = pan retinal photocoagulationPRP = pan retinal photocoagulation

Via Silt-lamp

Intravitreal Triamcinolone / Avastin Intravitreal = steroid / anti VEGF 1.Prevent further VA loss 2.Complications 3.Repeat & with laser

VR surgery

Outcomes Retina is vital for sightRetina is vital for sight Anxiety of vision lossAnxiety of vision loss Macula involved???Macula involved??? Chronic conditionChronic condition Long term follow-upLong term follow-up = huge demand = huge demand

Summarise No visual symptoms untilNo visual symptoms until well advanced well advanced Regular checksRegular checks Early treatment always more effective & long-term better resultEarly treatment always more effective & long-term better result Can not improve sight – aims to stop worseningCan not improve sight – aims to stop worsening

Questions? Thank you