1. Diabetic Retinopathy david.kinshuck@goodhope.nhs.uk 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

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

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

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

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

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

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

9. Retinopathy is a ‘preventable’ chronic disease

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

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

12. Features microaneurysms

13. Features New vessels (also get tortuous vessels and haemorhages)