diabetic retinopathy screening. stages of diabetic retinopathy
Post on 20-Jan-2016
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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) Intraretinal microvascular
abnormalities (IRMA) Large blot haemorrhages Venous beading and looping
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
Panretinal photocoagulation
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
Diabetic maculopathy
Exudative maculopathy Ischaemic maculopathy Mixed form
All progress to macular oedema and then visual loss (central & colour)
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
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
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
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
NSC Grading Protocol
Retinopathy – R
1. Level 0 – None
2. Level 1 – Background
3. Level 2 – Pre-proliferative
4. Level 3 - Proliferative
NSC grading
Maculopathy – M Photocoagulation – P Unclassifiable - U
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
Useful websites for patients
www.retinalscreening.nhs.uk www.retinopathyscreening.co.uk
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