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Diabetic retinopathy screening. Stages of diabetic retinopathy.

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Diabetic retinopathy screening
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Page 1: Diabetic retinopathy screening. Stages of diabetic retinopathy.

Diabetic retinopathy screening

Page 2: Diabetic retinopathy screening. Stages of diabetic retinopathy.

Stages of diabetic retinopathy

Page 3: Diabetic retinopathy screening. Stages of diabetic retinopathy.
Page 4: Diabetic retinopathy screening. Stages of diabetic retinopathy.

Background retinopathy

Asymptomatic First sign of diabetic retinopathy Micro aneurysms Dot retinal haemorrhages Hard yellow exudates

Page 5: Diabetic retinopathy screening. Stages of diabetic retinopathy.
Page 6: Diabetic retinopathy screening. Stages of diabetic retinopathy.
Page 7: Diabetic retinopathy screening. Stages of diabetic retinopathy.

Pre-proliferative retinopathy

Asymptomatic Cotton wool spots(>5) Intraretinal microvascular

abnormalities (IRMA) Large blot haemorrhages Venous beading and looping

Page 8: Diabetic retinopathy screening. Stages of diabetic retinopathy.
Page 9: Diabetic retinopathy screening. Stages of diabetic retinopathy.

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

Page 10: Diabetic retinopathy screening. Stages of diabetic retinopathy.

Panretinal photocoagulation

Page 11: Diabetic retinopathy screening. Stages of diabetic retinopathy.

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

Page 12: Diabetic retinopathy screening. Stages of diabetic retinopathy.
Page 13: Diabetic retinopathy screening. Stages of diabetic retinopathy.

Diabetic maculopathy

Exudative maculopathy Ischaemic maculopathy Mixed form

All progress to macular oedema and then visual loss (central & colour)

Page 14: Diabetic retinopathy screening. Stages of diabetic retinopathy.

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

Page 15: Diabetic retinopathy screening. Stages of diabetic retinopathy.

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

Page 16: Diabetic retinopathy screening. Stages of diabetic retinopathy.

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

Page 17: Diabetic retinopathy screening. Stages of diabetic retinopathy.

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

Page 18: Diabetic retinopathy screening. Stages of diabetic retinopathy.

NSC Grading Protocol

Retinopathy – R

1. Level 0 – None

2. Level 1 – Background

3. Level 2 – Pre-proliferative

4. Level 3 - Proliferative

Page 19: Diabetic retinopathy screening. Stages of diabetic retinopathy.

NSC grading

Maculopathy – M Photocoagulation – P Unclassifiable - U

Page 20: Diabetic retinopathy screening. Stages of diabetic retinopathy.

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

Page 21: Diabetic retinopathy screening. Stages of diabetic retinopathy.

Useful websites for patients

www.retinalscreening.nhs.uk www.retinopathyscreening.co.uk


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