Diabetic Retinopathy Overview

Impairment in the Working Age Person

• Impairment in the working age person is discussed
• Various eye conditions are described, including their causes, symptoms and treatments

Diabetic Retinopathy

• Non-proliferative diabetic retinopathy: Characterized by microaneurysms, intraretinal hemorrhages, hard exudates, cotton wool spots and macular edema
• Proliferative diabetic retinopathy: Includes microaneurysms, retinal hemorrhages, hard exudates, cotton wool spots and macular edema, and neovascularization (new blood vessel growth).
• Severity of Diabetic retinopathy is graded, with stages having different features, such as leakage, masked hemorrhages and exudates

Grading of Diabetic Retinopathy Stages

• Stage one: Mild non-proliferative diabetic retinopathy with small microaneurysms.
• Stage two: Moderate non-proliferative diabetic retinopathy showing microaneurysms, bleeding, and deposits.
• Stage three: Severe non-proliferative diabetic retinopathy with increased microaneurysms, bleeding, and blood vessel abnormalities.
• Stage four: Proliferative diabetic retinopathy featuring new, abnormal blood vessels (neovascularization) which can lead to scar tissue and retinal detachment.

Prevalence of Diabetic Retinopathy in Type 1

• First 5 years: No retinopathy
• 5-10 years: 27% have diabetic retinopathy
• 10+ years: 71% with diabetic retinopathy
• After 30 years: Incidence rises to 90% with 30% having PDR (Proliferative Diabetic retinopathy)

Prevalence of Diabetic Retinopathy in Type 2

• Maculopathy can be presenting feature
• Diabetes may be undiagnosed for years
• Severe damage to retinal capillaries

Management of Diabetic Retinopathy

• Blood sugar control is crucial
• Anti-VEGF treatments
• Laser photocoagulation
• Vitrectomy is also a procedure

Pathological Myopia

• Choroidal neovascular membranes (CNVMs): Occur in some cases of myopia (nearsightedness)
• Myopia: Eye is longer/increased curvature compared with normal, causing difficulty focusing.

Management of Pathological Myopia

• Non Surgical Management: Eyeglasses, contact lenses
• Pharmacological treatments. Steroids
• Laser treatments for Intravitreal neovascularization.
• Surgical interventions

Acute Optic Neuritis

• Inflammation of the optic nerve, often causing pain and vision loss.
• Often unilateral (one eye)
• Symptoms include gradual blurring of vision, pain, and partial/full vision loss
• USA: 46 per 100,000; England and Wales: 93 per 100,000
• Treatment includes oral prednisolone and intravenous methylprednisolone

Treatment of Acute Optic Neuritis

• Oral prednisolone, oral placebo, intravenous methylprednisolone, followed by oral.
• Red desaturation is used to assess progression

Posterior Uveitis

• Inflammation of the uveal tract (iris, ciliary body, choroid)
• Incidence: 15-40 per 100,000
• Causes include infective (e.g., toxoplasmosis) as well as non-infective conditions.
• Treatments include anti-infective agents, immunosuppressive agents

Management of Posterior Uveitis

• Improved visual prognosis
• Quality of life improves
• Long-term medication often required

Toxoplasmosis Retinochoroiditis

• Infection causing inflammation in the retina and choroid (middle layer of eye).
• Characterized by presence of white, smooth and elevated retinochoroidal lesions
• Causative agent is Toxoplasma gondii
• Usually occurs in individuals with compromised immune systems.
• Transmission occurs via cat feces.
• Treatment includes clindamycin and corticosteroids or pyrimethamine, sulfonamides, folinic acid, and steroids

Punctate Inner Choroidopathy

• Bilateral inflammatory condition in young adults (often women)
• Symptoms include blurred vision, photopsia (light flashes) and scotoma (blind spots)
• Findings include multiple yellow-white lesions in the inner choroid and retina
• Treatments options include laser photocoagulation, photodynamic therapy, steroids, but role of steroids is contentious

Serpiginous Chorioretinitis

• Bilateral progressive inflammatory eye disease affecting the inner choroid, retina, and retinal pigment epithelium (RPE).
• Location is peripapillary area
• Lesions spread centrifugally, often appearing as a jigsaw-like pattern.
• Lesions are often circumscribed and gray-white in appearance.

Cytomegalovirus (CMV) Retinitis

• CMV retinitis occurs more commonly when the patient has a weakened immune system due to existing illnesses or treatments.
• Incidence of the condition has increased in the past decade
• Symptoms include retinal necrosis and intraretinal hemorrhage. Can appear as a "tomato ketchup and mayonnaise" retinopathy
• Treatment and Management includes intravenous therapy, and intravitreal implants
• Patients often have reduced T-cell function

Impact of HIV CMV Retinitis

• HIV patients experience progressive T-cell function loss, increasing susceptibility to CMV retinitis.
• HAART (Highly Active Antiretroviral Therapy) has significantly reduced CMV retinitis incidence

Trauma as a Cause of Bilateral Blindness

• Trauma can cause bilateral blindness, due to issues like road accidents, electrocution, or self-inflicted injuries, or chemical injuries.

Prevention and Reduction of Trauma

• Health and safety education at home and work
• Eye care professionals have role in promoting safety awareness

Table 3.3 Fundal Changes in the Inflammatory Retinopathies

• Table summarising different inflammatory retinopathies and features such as anterior uveitis, vitreous cells/vitritis, chorioretinal scars in various conditions like Punctate inner choroidopathy, acquired toxoplasmosis etc

Explore the various stages and conditions of diabetic retinopathy, including non-proliferative and proliferative types. Learn about the implications of these conditions on working-age individuals, their symptoms, causes, and treatments. This quiz provides insights into the grading of diabetic retinopathy stages.