1. Diabetic Retinopathy and Diabetic Retinal Screening service
Fiona Heggie
Clinical Nurse Co-ordinator - DRS
NHS Greater Glasgow & Clyde

2. Diabetic Retinopathy
DIABETIC RETINOPATHY IS ONE OF THE LEADING CAUSES OF BLINDNESS IN THE WORKING AGE POPULATION.
DIABETIC RETINOPATHY IS A DISEASE PRIMARILY AFFECTING THE BLOOD VESSELS SUPPLYING THE RETINA.

3. INCREASED BLOOD SUGAR ALTERS THE PROPERTY OF BLOOD (BECOMES MORE STICKY AND VISCOUS).
CAPILLARY OCCLUSION
DECREASES OXYGEN AND NUTRIENT SUPPLY TO RETINAL TISSUE.
ISCHAEMIC AREAS.

4. Retinopathy changes BACKGROUND MICROANUERYSMS DOT/BLOT HAEMORRHAGES
COTTON WOOL SPOTS
HARD EXUDATES/OEDEMA
VENOUS DILATION / BEADING
IRMA (INTRA RETINAL MICROVASCULAR ABNORMALITIES
PROLIFERATIVE
NEW VESSELS (AT DISC OR ELSWHERE)

5. Anatomy of Eye

6. Normal Fundus

7. What is retinopathy?

8. Microanuerysms

9. Microanuerysms

10. Dots/ Blot haemorrhages

11. Cotton wool spots

12. Hard Exudates

13. Circinate of Exudates

14. Venous Beading

15. NVE -New vessels elsewhere

16. NVD- New vessels at disc

17. NVD, CWS and Flame Haems

18. Pre retinal Haemorrhage

19. IRMA Intra Retinal Microvascular Abnormality

20. IRMA

21. Epiretinal membrane

22. Superior retinal detachment

24. End stage retinopathy DETACHED RETINA RUBEOSIS IRIDIS
(BLIND, PAINFUL EYE)

25. Rubeosis Iridis

26. Treatment IMPROVING GLYCAEMIC CONTROL LASER THERAPY (PRP OR FOCAL)
VITRECTOMY

27. PRP- Pan Retinal Photocoagulation

28. What is Maculopathy?

29. AREA BETWEEN SUPERIOR AND INFERIOR RETINAL VEINS.
MACULOPATHY
“ANY OF THE COMPLICATIONS OF RETINOPATHY OCCURRING IN THE AREA OF THE MACULA”.
AREA BETWEEN SUPERIOR AND INFERIOR RETINAL VEINS.
THE MACULA IS THE AREA BETWEEN THE SUPERIOR AND INFERIOR RETINAL VEIN. TYPE 2 MORE PRONE TO MAC OEDEMA
MACULA
OPTIC NERVE
FOVEA

30. More prevelant in type2

31. Laser treatment

32. Is it preventable? GOOD GLYCAEMIC CONTROL – (NOT TOO INTENSIVE)
TIGHT BP CONTROL
LOWER BLOOD CHOLESTEROL LEVELS
CORRECTION OF ANAEMIA
REGULAR EYE SCREENING -
EARLY DETECTION OF SIGHT THREATENING CHANGES WITH APPROPRIATE AND TIMELY TREATMENT
SMOKING CESSATION

34. Digital photography HIGH QUALITY INSTANT IMAGE CAPTURE/REVIEW
COLOUR ENHANCE/RED FREE/ENLARGEMENT
IMAGE TRANSFER/VIEW
STORAGE/RETRIEVAL
LOWER FLASH INTENSITY
AUDITABLE
HTBS COMPLIANT (BEST SCREENING TOOL)

35. Screening process DISTANCE V A check
DEMOGRAPHY DETAILS, MEDICAL HISTORY AND MEDICATION
STANDARD 45 degree IMAGE of BOTH EYES
DIALTE/SMALL PUPIL MODE G. PROXYMETACAINE 0.5% + G.TROPICAMIDE 1%
ADVICE / INFORMATION
RESULT LETTERS – Pt , GP

36. 3 TIER GRADING
PRIMARY – NURSES. SECONDARY - OPTOMETRISTS

38. maculopathy

39. OTHER PATHOLOGY DRUSEN CUPPED DISCS (GLAUCOMA) HYPERTENSIVE VESSELS
EMBOLI
FLAME HAEMORRHAGES
ASTEROID HYALOSIS
MACULAR HOLES
RETINAL TEARS
RETINITIS PIGMENTOSA
RETINAL VEIN/ARTERY OCCLUSION
ARMD
TUMOUR/LESION

40. Drusen
Gross drusen – soft and calcified (from early DRS pictures)

41. Asteroid Hyalosis
Asteroid hyalosis – calcified soaps in the vitreous. Annoying for us, but usually not too bad for the patient. Commoner in diabetics – usually unilateral, and does not signify anything about underlying retinopathy

42. Pre retinal Haem & pigmented laser scar

43. Technical Failures
Not all pts suitable for photography e.g clinical -Cataracts, asteroid hyalosis or
non- clinical – mobility issues, wheelchair bound
In house clinics for slit lamp examination
Both fixed slit lamps and portable

44. Outcomes
None (R0) or mild background retinopathy (R1), no maculopathy (M0) – 12 month recall
Moderate retinopathy (R2) or observable maculopathy (M1) – 6 month recall
Severe referable retinopathy (R3), Proliferative (R4) or Referable maculopathy (M2) – refer to Ophthalmology

45. New Development - OCT
Specialised OCT clinics (optical Coherence Tomography) For patients with M2 – faint hard exudates, single blot haemorrhages at macula
Piloted in 1 clinic (Vic) Jan 2012 – June 2012 with Slit lamp examination to corroborate OCT findings
116pts identified by Level 3 grader as M2
31 pts required follow up treatment (27%)
45 pts suitable for re screening in OCT or 6/12 photography clinics
40 pts returned to annual photo screening
15 pts were non attenders
OCT clinics have been rolled out to further sites at SGH, GRI

46. Summary DRS service current register of 63,000+ patients
Diabetes numbers increasing yearly (current prevelance is 5.8% of glasgow pop 1,217,025)
Current Type 2 figures 88.5%
Current referral rate to ophthalmology is 5%