Diabetic Retinopathy

Category	Nonproliferative diabetic retinopathy (NPDR)	Proliferative diabetic retinopathy (PDR)
Mechanism	🔹 Retinal vessel microangiopathy → blood leaks → retinal hemorrhages	🔹 Retinal vessel microangiopathy → chronic retinal hypoxia → abnormal proliferation of blood vessels → traction on retina → retinal detachment
Examination findings	🔹 Microaneurysms
🔹 Intraretinal hemorrhage
🔹 Hard exudates
🔹 Retinal edema
🔹 Cotton-wool spots
🔹 Intraretinal microvascular abnormalities (IRMA)	🔹 Findings of nonproliferative retinopathy are usually present
🔹 **Neovascularization is the hallmark of PDR
🔹 Fibrovascular proliferation → vitreous hemorrhage, traction retinal detachment**
🔹 Rubeosis iridis (pathological neovascularization of the iris)→ secondary glaucoma
Vision loss	🔹 May result from macular edema	🔹 May result from vitreous hemorrhage, retinal detachment, or neovascular glaucoma

Associated with DM1 and DM2
Nonproliferative
- Microaneurysms
- Hemorrhages
- Exudates
- Cotton wool spots
Proliferative
- Neovascularization
  - Can lead to vitreous hemorrhage or retinal detachment
Generally asymptomatic until late stage

Onset
- Type 1 DM → within 5 years of the onset of disease
- Type 2 DM → at the time of diagnosis
Interval → every year

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Management for all patients

Optimization of diabetes treatment
Managing risk factors for atherosclerotic cardiovascular disease (ASCVD) </aside>
Glycemic control
- Hgb A1c less than 7%
Blood pressure control
Proliferative & Severe non - proliferative
- Photocoagulation
- Anti-VEGF

Proliferative Diabetic Retinopathy

Proliferative Diabetic Retinopathy

Hypertensive Retinopathy

Cotton-wool spots
Flame hemorrhages
Microaneurysms
AV nicking
- Associated with advanced hypertensive retinopathy.
- Definition
Arterial wall thickening
Hard Exudates
Optic disc edema
Papilledema → indicate a hypertensive crisis

AMD is the leading cause of blindness in individuals > 65 years in developed countries.

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Most common cause of blindness in developed countries
AMD is characterized by progressive degenerative changes in the central part of the retina (macula) → visual impairment

Presents with central vision loss
- Scotomas (blind spot)
- Metamorphopsia
  - Linear distortion

Dry (∼ 90%)
- Atrophy and degeneration of the central retina
- Drusen deposition
- Slow progressive
Wet (∼ 10%)
- Leakage of serous fluid or blood with neovascularization
- Subretinal and intraretinal hemorrhage and/or exudate

Dry AMD

Amsler grid → detection of metamorphopsias and scotomas
Fundoscopy
- Dry
  - Drusen
  - Areas of retinal atrophy
- Wet
  - Hemorrhage
  - Grayish-green depigmentation
  - Neovascularization
  - Edema

Amsler grid
(a) Healthy individual will perceive a grid of straight lines
(b) Metamorphopsia
(c) Central scotoma

Amsler grid (a) Healthy individual will perceive a grid of straight lines (b) Metamorphopsia (c) Central scotoma

Dry
- Supportive
- Eye vitamins → Vitamins A, C, and E, beta-carotene, zinc
- Quit smoking
Wet
- First line → Anti-VEGF injections
  - Ranibizumab
  - Bevacizumab