Diabetic retinopathy presentation intended to refresh the knowledge of ophthalmic nurses, ophthalmic clinical officers and other mid level ophthalmic personnel, and read initially for the self-support diabetes patients group.

1. Diabetic Retinopathy
FOR MID LEVEL HEALTHCARE WORKERS DR ANTON

3. Diabetes
 Vascular disease
 Involves eyes and other organs
 Related to glucose metabolism
 One of the leading causes of
blindness

4. Diabetes Epidemiology
 About 8% of world populations is
suffering from diabetes
 About 75% of involved persons will have
diabetic retinopathy after 20 years of
disease course
 About 80% of diabetic patients live in
low to middle income countries

5. Diabetes Epidemiology
 Five to ten percent of all diabetic
patients have diabetes type 1 (use
insulin injections)
 90-95% is for diabetes type 2 (being
treated with diet, or tablets, or injections)

6. Diabetes Epidemiology
 About 5% of world blindness is due to
diabetes
 Every diabetic patient is twenty times
more likely to go blind than the general
population

7. Diabetes Signs
 Frequent urination
 Excessive thirst
 Unexplained weight loss
 Extreme hunger
 Sudden vision changes
 Tingling or numbness in the hands or feet
 Sores that are slow to heal

8. Diabetes Ocular Features
 Cataract (mostly posterior subcapsular
or posterior cortical)
 Diabetic Retinopathy
 Primary open angle glaucoma
(increased risk)
 Hypermetropia or myopia due to lens
swelling

9. Diabetes Signs: Diabetic Feet

10. Diabetes Signs: Obesity

11. Diabetic Retinopathy
 Damage to the walls of the vessels of the fundus
 Causes irreversible blindness
 Blindness can be prevented
 Easily screened for
 Treated well

12. Normal fundus

13. Diabetic Retinopathy
 Can be divided into two types:
* Non-proliferative DR (95%)
* Proliferative DR

14. Non-proliferative DR
Fundus features:
 Microaneurisms
 Dot-and-blot hemorrhages
 Cotton-wool spots
 +/- Macular edema

15. Non-proliferative DR: Mild stage

16. Non-proliferative DR: Severe Stage

17. Proliferative DR
Fundus features:
 Microaneurisms
 Dot-and-blot hemorrhages
 Cotton-wool spots
 Intraretinal Microvascular Anomalies
 +/- Macular edema
 Neovascularization of the disc or retina

18. Proliferative DR
Other Ocular Features:
• Neovascularization of Pupil margin
• Neovascularization of Iris stroma
• Neovascularization of the AC Angle
• Highly raised IOP with secondary neovascular
glaucoma and finally painful blind eye
• Vitreous Hemorrhage
• Tractional retinal detachment

19. Proliferative DR – Neovascularization of the Disc

20. Proliferative DR – Tractional RD

21. Proliferative DR – Vitreous Hemorrhage

22. Macular Edema
Complication due to leaking from damaged
vessels. Can occur in both types of DR. Usually hard
exudates are seen in the margin of edema.

23. Macular Edema

24. When to refer?
Every diabetic patient has to be screened by
ophthalmic personnel at least once annually,
depending on the severity of diabetes and severity
of diabetic retinopathy

25. Initial diagnostics
1) Fundoscopy
2) Fasting Blood Sugar
3) Amsler Grid Test for Macular Edema

26. Amsler Grid in Macular Edema

27. How to treat?
1) Control BP
2) Normalize blood glucose and HbA1c
3) Follow the diet
4) Get medicines in time
5) Laser treatment for certain complications
6) Anti-VEGF treatment for certain complications
7) Vitrectomy for certaincomplications
8) Cataract surgery for diabetic cataract
9) Glasses for refractive error

28. Thank you