PATHOLOGY

Diabetic retinopathy is a microangiopathy affecting retinal pre-capillary arterioles, capillaries and venules.

It results from retinal capillary micro aneurysms, extensive vascular permeability, vascular occlusion, Neo-vascularisation, contraction of fibrovascular proliferations.

Slit lamp findings: cotton wool spots, blot haemorrhages, flame-shaped haemorrhages, hard exudates, retinal thickening and oedema

Importance of optimising glucose, BP and lipids to minimise risk of progression of diabetic eye disease.

SYMPTOMS?

None (can present without affecting vision)
Acuity decrease, floaters, dimmer vision, struggling to see in the dark

AIM?

Detect early stage diabetic retinopathy, before changes in vision occur, to enable treatment to prevent retinopathy progressing.

More than 1,700 people have their sight seriously affected by their diabetes every year in the UK.

GP practices are responsible for referring eligible patients with diabetes for diabetic eye screening, however, 5-% of adverse events in National DES programme related to incomplete data extraction from general practice (for example, poor coding of diabetes).

WHO?

Everyone living with type 1 or type 2 diabetes over the age of 12 will get an invite to a regular ANNUAL eye screening.
Patient diagnosed with diabetes that has since gone into ‘remission’ still need screening as they remain at risk of retinopathy.

Frequency of screening is one year, unless,

• they require more frequent screening

• require additional screening in pregnancy (routine at booking, routine at 28w, indicated extra test at 16-20w), excluding women with gestational diabetes

From 2019, some people who have two negative screens will only need to be screened once every 2 years.

WHAT IS THE SCREENING TEST?

• Visual Acuity

• Retinal photography (following pupil dilatation)

EXPLAINING THE RESULTS?

R0M0, R1M1 one eye, R1M1 both eyes

'R' followed by a number. The R stands for retinopathy

No retinopathy (R0)-no concern
Background changes (R1)-You may be asked to return sooner
Non-proliferative retinopathy (R2)-More regular eye screenings
Proliferative retinopathy (R3)-You will be seen by an eye specialist quickly and taken through your treatment options

'M' which stands for maculopathy.
M0 no concern
M1 need treatment for maculopathy.

DIABETES PREDISPOSES TO OTHER EYE DISEASE

Cataract
Glaucoma