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EYE & FEET EXAMINATION

EYE & FEET EXAMINATION. E is for . EYE EXAMINATION. Clinical risk factors for retinopathy. Poor Glycaemic Control Hypertension Duration of Diabetes Pregnancy Diabetic Nephropathy Smoking. Non-proliferative retinopathy. Microaneurysms Haemorrhages Hard exudates

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EYE & FEET EXAMINATION

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  1. EYE & FEET EXAMINATION

  2. E is for ... EYE EXAMINATION

  3. Clinical risk factors for retinopathy • Poor Glycaemic Control • Hypertension • Duration of Diabetes • Pregnancy • Diabetic Nephropathy • Smoking

  4. Non-proliferative retinopathy • Microaneurysms • Haemorrhages • Hard exudates • Few cotton wool spots • Treatment: address clinical risk factors: BP, HbA1c%, lipids, aspirin, ACE-inhibitors

  5. Maculopathy • Impaired visual acuity • Haemorrhages and/or hard exudates within one disc diameter of the macula, with or without visual loss • Treatment: address clinical risk factors and focal laser photocoagulation

  6. Pre-proliferative retinopathy • Venous irregularities • Multiple haemorrhages • Multiple cotton wool spots • Intra retinal microvascular abnormalities (IRMA) • Treatment: address clinical risk factors: BP, HbA1c%, lipids, aspirin, ACE-inhibitors

  7. Proliferative retinopathy • New vessels on the optic disc or elsewhere in the retina • Pre-retinal haemorrhage • Fibrous tissue • Treatment: address clinical risk factors and urgent pan-retinal laser photocoagulation

  8. Advanced diabetic eye disease • Vitreous haemorrhage • Fibrous tissue proliferation • Recent retinal detachment • Rubeosis iridis • Severe maculopathy • Treatment: laser photocoagulation, vitrectomy, often futile leading to blindness

  9. F is for ... FEET EXAMINATION

  10. Foot Screening • Annual review essential - by GP, Practice Nurse, Diabetes Nurse or, ideally, podiatrist. • Examination should include: inspection, foot pulses, capillary refill, 10g monofilament testing, vibration sense. • If evidence of neuropathy or ischaemia refer to podiatrist since risk of ulceration is high. If ulceration present refer urgently to foot at risk clinic • Amputations can be reduced by 75%

  11. The Alphabet Strategy • Advice Smoking , diet , exercise • Blood pressure < 140/80 • Cholesterol TC ≤ 4.0 mmol/l , LDL ≤ 2.0 mmol/l HDL > 1.0 mmol/l, TGs < 1.7 mmol/l • Diabetes control HbA1c ≤ 7% • Eye examination Annual examination • Feet examination Annual examination • Guardian drugs Aspirin, ACEI, ARB, statins

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