Diabetic Retinopathy

Clinical features

• Non-proliferative diabetic retinopathy (NPDR)
  • No neovascularization
  • Mild
    • ≥ 1 microaneurysms
  • Moderate
    • Soft exudates (cotton wool spots) – nerve fibre layer infarction
    • Hard exudates – lipid deposition
    • Haemorrhages (dot or blot)
    • Venous beading
  • Severe
    • Venous beading in at least two quadrants
• Proliferative diabetic retinopathy (PDR)
  • Neovascularization from the disc or retinal vessels
  • May arise in the absence of NPDR
  • Early
    • New vessels
  • High-risk
    • Macula involved
  • Complications
    • Vitreous haemorrhage
    • Retinal detachment
• Macula oedema
  • May occur at any stage of DR
  • Retinal thickening
  • Seen with fluorescein angiography
• DR is usually asymptomatic until very late
  • Usually not reversible by symptomatic stage
  • Require regular screening

Exacerbating factors

• Pregnancy
• Poor glycaemic control
• Hypertension
• Diabetic nephropathy
• Thigh glycaemic control in patients with previously poor glycaemic control

Ocular manifestations of diabetes

• Central retinal artery occlusion
• Central retinal vein occlusion
• Mononeuritis multiplex
• Vitreous haemorrhage
• Retinal detachment
• Cataracts

 Indications for urgent referral (within 2 weeks)

• Proliferative diabetic retinopathy
• Macular involvement
• CRAO / CRVO
• Retinal detachment
• Vitreous haemorrhage