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Diabetic Retinopathy (DR) . Ayesha S Abdullah 28.12.2012. Learning outcomes. By the end of the lecture the students would be able to; Describe the epidemiology of DR Correlate the pathogenesis of DR with the clinical presentation Identify signs of DR in a given fundus photograph

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diabetic retinopathy dr

Diabetic Retinopathy (DR)

Ayesha S Abdullah


learning outcomes
Learning outcomes

By the end of the lecture the students would be able to;

  • Describe the epidemiology of DR
  • Correlate the pathogenesis of DR with the clinical presentation
  • Identify signs of DR in a given fundusphotograph
  • Identify the signs of proliferative DR and high risk Non-proliferative DR on a given fundus photograph
  • Outline the management for DR
diabetes mellitus dm
Diabetes Mellitus (DM)
  • Metabolic syndrome characterized by hyperglycaemia & insulin deficiency
  • Type 1 and type 2 & Gestational Diabetes Mellitus
  • Type 2 is more common than type 1
  • A micro & macrovasculopathy
epidemiology of dm and dr
Epidemiology of DM and DR
  • We are having a “global epidemic of DM”.
  • The prevalence of DM is estimated to rise from 2.8% (2000) to 4.4% (2030)
  • Most of this increase will occur as a result of a 150% rise in developing countries.
  • The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030.
  • The prevalence is estimated to be 10% in Pakistan
  • With over 5.2 million people with DM , it is the 6th country with the largest population of people with DM.
  • With growing obesity, sedentary life style and increased aging population, the prevalence is estimated to rise further.

Wild S, Roglic G, Green A, Sicree R, King H. Global Prevalence of Diabetes- Estimates for the year 2000 and projections for 2030. Diabetes Care 27:1047–1053, 2004

diabetic retinopathy
Diabetic retinopathy
  • Is a microvascular complication of DM
  • The prevalence is highest among type 1 DM (40%)
  • Patients with DR are 25% more likely to go blind than non-diabetics
  • In UK 1000 individuals are registered blind each year due to diabetic eye disease
  • It is the leading cause of blindness in 20-64 year age group in USA
pathogenesis of diabetic retinopathy
Pathogenesis of Diabetic Retinopathy

DR is a microangiopathy resulting in

Microvascular occlusion

Microvascular leakage

microvascular occlusion
Microvascular Occlusion

Factors responsible for occlusion

  • Thickening of capillary basement membrane
  • Capillary endothelial cell damage and proliferation
  • Changes in R.B.Cs
  • Increased stickiness and aggregation of platelets

Pathogenesis of Diabetic Retinopathy

Microvascular occlusion

Retinal capillary non-perfusion

Retinal ischaemia & Hypoxia, ischaemia of the nerve fibres- soft exudates

Arteriovenousshunts - IRMA(intra-retinal microvascualr abnormalities), venous changes, stagnation of blood and more hypoxia

microvascular leakage
Microvascular Leakage

Breakdown of inner blood-retinal barrier

  • Retinal haemorrhages
  • Retinal oedema
    • Diffuse edema
    • Hard exudates
  • Microaneurysims

What is inner and outer blood-retinal barrier?

Schematic of the retinal fundus illustrating the potential involvement of the components of the kallikrein–kinin system(KKS) found in the vitreous in diabetic retinopathy changes. Red lines indicate arteries and blue lines indicate veins. FXII, factor XII; FXIIa, factor XIIa; HK, high-molecular-weight kininogen; Kal, kallikrein; PK, prekallikrein; KKS, kallikrein–kinin system.
classification of diabetic retinopathy
Classification of diabetic retinopathy
  • Non-proliferative (NPDR)
  • Proliferative (PDR)
  • Diabetic Maculopathy
signs of dr
Signs of DR
  • Microaneurysms (MA)
  • Hard exudates (HE)
  • Haemorrrhages (H)
  • Retinal oedema- macular oedema(CSME)
  • Cotton wool spots (CWS)
  • Intra-retinal microvasuclarabnormalities(IRMA)
  • Venous changes
  • Fibrovascualr proliferation –Neovascularization
stages of dr1
Stages of DR

1. Mild NonproliferativeRetinopathy

Signs: MA & HE

2. Moderate NonproliferativeRetinopathy

Signs:Haemorrhages, microaneurysms, Soft exudates, IRMA

3. Severe Nonproliferative Retinopathy..

Signs: Along with microaneurysms, haemorrhages, IRMA and venous changes are also seen

4. Proliferative Retinopathy.

Signs: NVE & NVD, vitreous haemorrhage, tractional RD

management of dr
Management of DR


  • PDR
  • Clinically significant macular oedema

Principles & modes

  • Metabolic control
  • Control of risk factors
  • Laser therapy- photocoagulation
  • Anti-VEGF agents
  • Vitreoretinalsurgery

Home work

List the risk factors for DR

How does diabetic retinopathy cause vision loss?