Screening for
Diabetic Retinopathy
This presentation lasts approximately 10 minutes.
Diabetic Retinopathy
• Diabetic retinopathy is damage to blood
vessels and tissue in the retina (the
layer at the back of the eye) caused by
diabetes.
• Diabetic retinopathy can affect anyone
with diabetes, whether they have type 1
or type 2.
• The condition can be well advanced
before any reduction of vision is
experienced.
• Diabetic retinopathy is the main cause of
blindness in the16 - 65 year old age
group.
• Early detection and regular monitoring
are essential to reduce the risk of
progression and improve the chances of
successful laser treatment.
Good blood sugar and
blood pressure control
can reduce the risk of
diabetic retinopathy and
other complications of
diabetes.
The Retina
• The retina is the innermost layer of the
eye.
• The retina contains photoreceptor cells
(rods and cones) these cells work like
the film in a camera by recording light
which enters through the pupil.
• This light information is sent from the
retina, along the optic nerve and into the
brain where the image is formed.
Main Features of the Retina
OPTIC NERVE
(OPTIC DISC 1.5mm)
FOVEA
MACULA
• Optic Nerve (Optic Disc) - The nerve which
connects the eye to the brain, and brings the
retina its main blood supply.
• Macula - Responsible for fine detail central
vision (reading, writing etc.) and colour vision.
• Fovea - The centre of the macula which
provides the sharpest point of human vision.
Screening for Diabetic
Retinopathy
Using a Digital Camera
• Regular screening for diabetic retinopathy is
the best way to reduce the risk of visual
impairment caused by diabetes.
• ***** PCT/Hospital provide annual screening
for anyone with diabetes registered with a
local GP.
• The screening service uses a digital fundus
camera (camera used to photograph the
inside of the eye) which produces instant
pictures. These can be shown to the patient
during their appointment.
Your Screening Appointment
• When you arrive you will have to check in
at reception.
• You will be asked to take a seat in the
waiting area until the nurse or screening
assistant calls your name.
First, your vision will be tested using a standard
wall chart, the same sort that you use when you
visit your optician.
Eye drops are then inserted into your eyes which
dilate your pupils and allow a clear view for photography.
This may sting at first.
IT IS NOT ADVISABLE TO
DRIVE FOR UP TO 4 HOURS
AFTER THE EXAMINATION AS
THE EYE DROPS CAN CAUSE
TEMPORARY BLURRING OF
VISION AND SENSITIVITY TO
BRIGHT LIGHT!
It is advisable to bring sunglasses with you to
wear when you leave.
When your pupils are dilated (after about 15 mins)
the screener will take 4 photographs,
2 in each eye.
The screener will then show you the photographs
and point out any signs of diabetic retinopathy.
The results will be sent to your GP.
A letter outlining the
results of the screening
appointment and any
further action required
will be sent to you
within 4 weeks of your
appointment.
Signs of Diabetic
Retinopathy.
Micro aneurysms Are small red spots.
These are caused by
a swelling of very
small capillary vessels in
the retina, they are an
early sign of diabetic
retinopathy.
Micro aneurysms should be monitored every 12 months.
superficial flame shaped
haemorrhage
deep round
haemorrhage
Small blot
haemorrhages
Haemorrhages - Are red blots varying in size and shape.
These are small bleeds within the retina or near the
surface. There are several types .
Haemorrhages should be monitored every 3, 6 or 12 months depending on severity.
Some Other Signs of Diabetic Retinopathy
Hard exudates Shiny pale white
or yellow sharp
edged features.
These are fatty
deposits caused
by leaking fluid.
Cotton wool spot White and fluffy
patches.
These are scarred
nerve fibres near the
surface of the retina.
Venous loop A loop in a blood
vessel, caused by
poor flow of blood.
These signs should be assessed by an ophthalmologist.
New blood vessels These appear wispy and
fragile. New blood
vessels form as a result of
existing vessel damage.
These vessels are
extremely weak and tend
to rupture very easily.
This causes scarring and a
build up of blood within the
eye.
New vessels require laser treatment.
Maculopathy This applies to most of the signs we have
already looked at when they occur on
the macula, close to the fovea.
Hard exudates
Haemorrhages
Micro aneurysms
Early maculopathy requires close monitoring. With hard exudates laser treatment is needed.
Laser Treatment
• Laser treatment uses an intense beam
of light directed onto the retina.
• The treatment is given by an
Ophthalmologist and is given as an
outpatient.
• There are three main types of laser
treatment.
Pan-Retinal Photocoagulation
This is used to treat proliferative
retinopathy (lesions which affect most of the
retina with the exception of the macula). The
laser is pointed at the outer part of the
retina to reduce the risk of bleeding and
scarring from repeated haemorrhages.
This may take several sessions of laser
treatment.
Panretinal Photocoagulation (PRP) - applied to
treat proliferative diabetic retinopathy.
Focal Laser Treatment
Damaged blood vessels in the macula can leak
fluid and exudates (fatty deposits) which
damage your central vision. Focal laser
treatment (often in combination with grid laser
treatment) involves pointing the beam at the
leaking blood vessels to prevent further leakage.
This leakage and the resulting retention of fluid
is known as Macular Oedema.
Grid Laser Treatment
This treatment applies low power laser
burns to the retina in a grid pattern. This
process removes the fluid from the back of
the eye to improve sight by stimulating the
cells that normally drain fluid away from
the retina.
Grid laser treatment - applied for moderate macular
oedema.
After laser treatment
After laser treatment you will be followed
up by the Ophthalmologist for several
months. When the Ophthalmologist is
happy that the condition has stabilised you
will be returned to the screening service
for regular monitoring.
PLEASE CONTACT THE
SCREENING SERVICE ON
*** **** ****
IF YOU HAVE ANY QUERIES OR
CONCERNS REGARDING
DIABETIC RETINOPATHY.
THANK YOU FOR
YOUR ATTENTION.