Summary
Definition
Diabetic retinopathy is the retinal consequence of chronic progressive diabetic microvascular leakage and occlusion. It eventually occurs to some degree in all patients with diabetes mellitus. There are two types: non-proliferative and proliferative. Non-proliferative diabetic retinopathy (NPDR) is the early stage of the disease and is less severe. Blood vessels in the eye may leak fluid into the retina, which leads to blurred vision. Proliferative diabetic retinopathy (PDR) is the more advanced form of the disease. New blood vessels start to grow in the eye (neovascularisation), which are fragile and can haemorrhage. This may cause vision loss and scarring of the retina.
[Figure caption and citation for the preceding image starts]:
Non-proliferative diabetic retinopathy: exudate (yellow arrow), microaneurysms (red arrow), cotton wool spot (white arrow), nerve fibre layer haemorrhage (green arrow)
Courtesy of Moorfields Photographic Archive; used with permission
[Citation ends].
[Figure caption and citation for the preceding image starts]:
Proliferative diabetic retinopathy: new vessels on the optic disc (red circle)
Courtesy of Moorfields Photographic Archive; used with permission
[Citation ends].
History and exam
Other diagnostic factors
- microaneurysms
- cotton wool spots
- intraretinal haemorrhage
- lipid exudates
- floaters
- macular thickening
- vision loss
- venous beading
- intraretinal microvascular abnormalities
- optic disc neovascularisation
- retinal neovascularisation
- pre-retinal or vitreous haemorrhage
- retinal detachment
Risk factors
- young-onset diabetes
- longer duration of diabetes
- poor glycaemic control
- hypertension
- renal disease
- Pima Indians
- pregnancy
- cataract surgery
- elevated lipid levels
Diagnostic investigations
1st investigations to order
- photographs of the fundus
- optical coherence tomography scanning
- fluorescein angiography
- B scan ultrasonography
Treatment algorithm
Contributors
Authors VIEW ALL
Consultant Ophthalmic Surgeon
Moorfields Eye Hospital
London
UK
Disclosures
JD declares that he has no competing interests.
Dr Jonathan Dowler would like to gratefully acknowledge Dr Robin Hamilton, a previous contributor to this monograph. RH declares that he has no competing interests.
Peer reviewers VIEW ALL
Clinical Professor
Medicine/Endocrinology
Diabetes and Bone Disease
Mount Sinai School of Medicine
New York
NY
Disclosures
ZB declares that he has no competing interests.
Head of Department of Ophthalmology
University of Melbourne
Victoria
Australia
Disclosures
TYW declares that he has no competing interests.
Medical Director
Bascom Palmer Eye Institute
Miami
FL
Disclosures
Within the last 5 years, SS has received funding for organizing continuing medical education conferences from Alcon, Genentech, and Novartis; has owned shares in Pfizer; has received research funding from Genentech; and is co-holder of a patent pending on "Molecular targets for modulating intraocular pressure and differentiation of steroid responders versus nonresponders."
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