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