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Diabetic retinopathy screening

Diabetic retinopathy screening. Stages of diabetic retinopathy. Background retinopathy. Asymptomatic First sign of diabetic retinopathy Micro aneurysms Dot retinal haemorrhages Hard yellow exudates. Pre-proliferative retinopathy. Asymptomatic Cotton wool spots(>5)

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Diabetic retinopathy screening

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  1. Diabetic retinopathy screening

  2. Stages of diabetic retinopathy

  3. Background retinopathy • Asymptomatic • First sign of diabetic retinopathy • Micro aneurysms • Dot retinal haemorrhages • Hard yellow exudates

  4. Pre-proliferative retinopathy • Asymptomatic • Cotton wool spots(>5) • Intraretinal microvascular abnormalities (IRMA) • Large blot haemorrhages • Venous beading and looping

  5. Proliferative diabetic retinopathy • Asymptomatic initially • Growth of new vessels on optic disc, iris, retina and into vitreous cavity • Fragile blood vessels • Vitreous haemorrhage • Tractional retinal haemorrhage

  6. Panretinal photocoagulation

  7. Laser treatment • Treatment of proliferative retinopathy • Destroys ischaemic retina, macula sparing • Stops release of vasoproliferative factors • New vessels regress • REDUCES peripheral & night vision- may have to stop driving

  8. Diabetic maculopathy • Exudative maculopathy • Ischaemic maculopathy • Mixed form • All progress to macular oedema and then visual loss (central & colour)

  9. Diabetic retinopathy • Commonest cause of blindness in the working population in western world • 30% of type 2 diabetics have DR at diagnosis, rising to 60 % after 15 years • 90% of type 1 diabetics will have DR after 20 years • Can be treated if caught early

  10. National Screening program • Following NSF report in 2006 • PCTs to commission systematic screening program for their region • Compile a dynamic list of all patients with diabetes • Provide yearly retinal screening for these patients • Manage DNA’s, suspend files • Early referral to HES

  11. Aims and objectives of screening program • Aims of the screening program is early detection of diabetic retinopathy changes, early referral for treatment to prevent blindness • All diabetics over the age of 12 years get annual retinal screening for life

  12. Screening program • GP practices & hospital refer all diabetic patients to the local screening program to be added to the list • Yearly invites for retinal screening • Images graded • Results sent back to GP and patient • Direct referral to HES if abnormal

  13. NSC Grading Protocol • Retinopathy – R • Level 0 – None • Level 1 – Background • Level 2 – Pre-proliferative • Level 3 - Proliferative

  14. NSC grading • Maculopathy – M • Photocoagulation – P • Unclassifiable - U

  15. Management • R0 – Annual screening • R1 – Annual screening • R2 – Refer to HES • R3 – Fast track referral to HES • M – Refer to HES • P – If on new screen, refer to HES • P – If quiescent, annual screening • U – Refer to HES

  16. Useful websites for patients • www.retinalscreening.nhs.uk • www.retinopathyscreening.co.uk

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