RETINOPATHY

ANATOMY OF THE EYE

1. The retina : senses light & transmits images to the brain

2. The macula : central part of the retina used to read and see fine details clearly

3. The vitreous : clear gel fills the back of the eye and sits in front of the retina

RETINAL ANATOMY

DIABETIC RETINOPATHY

Occurs when elevated blood sugar levels cause blood vessels in the eye to swell and leak into the retina.

Diabetic macula edema (swelling of the retina)

SIGN AND SYMPTOMP

1. Blurred vision2. Floaters3. Fluctuating vision4. Distorted vision 5. Dark areas in the vision6. Poor night vision7. Impaired color vision8. Partial or total loss of vision

Normal Vision

How vision may be affected by diabetic retinopathy

RISK FACTOR

Duration and severity of diabetic is a major risk factor associated with the development of retinopathy diabetic

PATHOPHYSIOLOGY

Diabetic Retinopathy is a microvasculopathy that causes:1. Retinal capillary occlusion, is caused by thickening of

capillary basement membranes, increased platelet adhesion, Increased blood viscosity

2. Retinal capillary leakage, is caused by Impairment of endothelial tight junctions, Weakening of capillary walls, elevated levels of vascular endothelial growth factor (VEGF)

TYPES OF DIABETIC RETINOPATHY

Early stage1. Non-proliferative diabetic retinopathy (NPDR)

Damaged blood vessels in the retina begin to leak fluid and small amounts of blood and cholesterol.

TYPES OF DIABETIC RETINOPATHY

Lata stage

2. Proliferative diabetic retinopathy (PDR) The retina responds by growing new abnormal vessels.3. Vitreous hemorrhage

New blood vessels bleed into vitreous cavity.4. Tractional retinal detachment

Scar tissue can shrink causing the retina to detach and result in vision loss. More severe vision loss occurs if the macula is detached.

Tractional retinal detachment

STAGE OF NPDR

1. Mild Microaneurysms only

Microaneurysms

STAGE OF DIABETIC RETINOPATHY NPDR

2. Moderate More than just microaneurysms but less than severe NPDR

Hard exudates

microaneurysm

STAGE OF DIABETIC RETINOPATHY NPDR

3. SevereDefinite venous beading in two or more quadrants Venous beading

CHARATERISTICS OF PDR

1. Neovascularization 2. Vitreous/preretinal hemorrhage

Neovascularization

NeovascularizationHard exudate

Cotton-wool spot

Blot hemorrhage

Hard exudate Cotton wool spot

DIAGNOSTIC TEST

Bassic assesment1. Visual acuity test2. Tonometry: Measures pressure inside

the eye3. Dilated eye exam

Advanced assesment4. Fluorescein angiogram: dye is

injected systemically which demonstrates retinal circulation

5. Optical coherence tomography (OCT): non-invasive imaging study that reveals retinal anatomy

Fluorescein angiogram

Optical coherencetomography (OCT)

TREATMENT

Proliferative diabetic retinopathy1. Laser surgerya. Microscopic thermal laser burns are made in the retinab. Shrinks and prevents abnormal new blood vessel

growth, and stops leaking of blood vessels Can reduce risk of further vision loss by 50%

c. Also recommended to treat macular edema

2. Intraocular (anti-VEGF) injectionsa. Reduces swelling in the retina and

causes abnormal vessels to regress

Intraocular injection

TREATMENT

TREATMENT

c. Vitrectomyd. Cloudy vitreous is removed and replaced with a clear

solution hat mimics the normal eye fluids e. Allows light rays to focus on the retina again

HYPERTENSION RETINOPATHY

Hypertensive retinopathy is retinal vascular damage caused by hypertension.

PATHOPHYSIOLOGY

Systermic chronic

hypertension

atherosclerosis

Narrowing of retinal

arterioles

Retinal Ischaemia Hypoxia

Increased capillary

permeability

Focal Retinal Oedema, retinal haemorrhage,cotton wool spots,

hard exudates

CLINICAL MANIFESTATION

1. Most patients are asymptomatic. 2. Some present with headaches and blurred

vision.3. On ophthalmoscopy :

a. Generalized arteriolar narrowingb.  Flame haemorrhagec.  Microaneurysmsd.  Exudatese.  Arteriolar macroaneurysmsf.  Cotton-wool spotsg. Optic disc swelling

CLASSIFICATION

DIAGNOSIS1. Diagnosis is made by

thorough history of the patient, ophthalmoscopy (direct or indirect) and also physical examination.

2. History a. May reveal decrease of

patient vision, occipital headache and high blood pressure.

3.  Physical examinationa. May detect elevation of

blood pressure

4. Ophthalmoscopy

a. Cotton-wool spotb. Flame haemorrhagec. Silver wire appearance of

narrowed arteriolesd. Nicking of veins where

arteries cross them (arteriovenous nicking)

e. Hard exudates “lipids deposites”

f. “Macular star”g. Flame shape haemorrhageh. Retinal oedemai. Swelling of the optic nervej. Aterial microaneurysmsk. Arteriolar macroaneurysms

 

MANAGEMENT

1. A major aim of treatment is to prevent, limit, or reverse such target organ damage by lowering the patient's high blood pressure.

2. Lifestyle changes Promote Healthy lifestyle; exercise, healthy foods

3. Advice patient to reduce the Blood Pressure a. Taking the medication accordinglyb. Referral to medical team