DIABETIC RETINOPATHY
It refers to retinal changes seen in patients with diabetes mellitus. With increase in the life expectancy of diabetics, the incidence of diabetic retinopathy has increased. In Western countries, it is the leading cause of blindness.
1. Duration of diabetes is the most important determining factor. Roughly 50 percent of patients develop DR after 10 years, 70 percent after 20 years and 90 percent after 30 years of onset of the disease.
2. Sex. Incidence is more in females than males (4:3).
3. Poor metabolic control is less important than duration, but is nevertheless relevant to the development and progression of DR.
4. Heredity. It is transmitted as a recessive trait,without sex linkage. The effect of heredity is more on the proliferative retinopathy.
5. Pregnancy may accelerate the changes of diabetic retinopathy.
6. Hypertension, when associated, may also accentuate the changes of diabetic retinopathy.
7. Other risk factors include smoking, obesity and hyperlipidemia.
Diabetic retinopathy has been variously classified. Presently followed classification is as follows:
I. Non-proliferative diabetic retinopathy (NPDR)
II. Proliferative diabetic retinopathy (PDR)
III. Diabetic maculopathy
IV. Advanced diabetic eye disease (ADED)
Urine examination,
Blood sugar estimation.
Fundus fluorescein angiography should be carried
I. Screening for diabetic retinopathy. To prevent visual loss occurring from diabetic retinopathy a periodic follow-up is very important for a timely intervention. The recommendations for periodic fundus examination are as follows:
Every year, till there is no diabetic retinopathy or there is mild NPDR.
Every 6 months, in moderate NPDR.
Every 3 months, in severe NPDR.
Every 2 months, in PDR with no high risk
II. Medical treatment. Besides laser and surgery to the eyes (as indicated and described below), the medical treatment also plays an essential role. Medical treatment for diabetic retinopathy can be discussed
as:
It refers to retinal changes seen in patients with diabetes mellitus. With increase in the life expectancy of diabetics, the incidence of diabetic retinopathy has increased. In Western countries, it is the leading cause of blindness.
Etiopathogenesis
1. Duration of diabetes is the most important determining factor. Roughly 50 percent of patients develop DR after 10 years, 70 percent after 20 years and 90 percent after 30 years of onset of the disease.
2. Sex. Incidence is more in females than males (4:3).
3. Poor metabolic control is less important than duration, but is nevertheless relevant to the development and progression of DR.
4. Heredity. It is transmitted as a recessive trait,without sex linkage. The effect of heredity is more on the proliferative retinopathy.
5. Pregnancy may accelerate the changes of diabetic retinopathy.
6. Hypertension, when associated, may also accentuate the changes of diabetic retinopathy.
7. Other risk factors include smoking, obesity and hyperlipidemia.
Classification
Diabetic retinopathy has been variously classified. Presently followed classification is as follows:
I. Non-proliferative diabetic retinopathy (NPDR)
- Mild NPDR
- Moderate NPDR
- Severe NPDR
- Very severe NPDR
II. Proliferative diabetic retinopathy (PDR)
III. Diabetic maculopathy
IV. Advanced diabetic eye disease (ADED)
Investigations
Urine examination,
Blood sugar estimation.
Fundus fluorescein angiography should be carried
Management
I. Screening for diabetic retinopathy. To prevent visual loss occurring from diabetic retinopathy a periodic follow-up is very important for a timely intervention. The recommendations for periodic fundus examination are as follows:
Every year, till there is no diabetic retinopathy or there is mild NPDR.
Every 6 months, in moderate NPDR.
Every 3 months, in severe NPDR.
Every 2 months, in PDR with no high risk
characteristic.
II. Medical treatment. Besides laser and surgery to the eyes (as indicated and described below), the medical treatment also plays an essential role. Medical treatment for diabetic retinopathy can be discussed
as:
1. Control of systemic risk factors is known to influence the occurrence, progression and effect of laser treatment on DR. The systemic risk factors which need attention are.
Strict metabolic control of blood sugar,
Lipid reduction,
Control of associated anaemia, and
Control of associated hypoproteinemia
2. Role of pharmacological modulation. Pharmacological inhibition of certain biochemical pathways involved in the pathogenesis of retinal changes in diabetes is being evaluated These include:
Protein kinase C (PKC) inhbitors,
Vascular endothelial growth factors (VEGF) inhibitors,
Aldose reductase and ACE inhibitors, and
Antioxidants such as vitamin E
3. Role of intravitreal steroids in reducing diabetic macular oedema is also being stressed recently by following modes of administration:
Flucinolone acetonide intravitreal implant and Intravitreal injection of triamcinolone
DIABETIC RETINOPATHY
Slit lamp examination Pinguecula
Retinal deatachment Corneal examination
Duochrome test Corneal Opacity
Photo-Ophthalmia Epilation of eye
Tags:
eye disease