Diabetic retinopathy (167/1700)

A 45yo T1DM had an annual check up. Ophthalmoscopy showed dot and blot hemorrhage +
hard exudate and multiple cotton wool spots. What is the next step in management?

a. Reassurance and annual screening only
b. Urgent referral to ophthalmologist
c. Laser therapy
d. Non-urgent referral to ophthalmologist
e. Nothing can be done


























answer: D
here we have hard exudate, soft exudate cotton wool spots, blot hemorrhages = pre-proliferative or u can say non proliferative d retinopathy (retinal neovascularization)..... non urgent, referral to outpatient appointment with an ophthalmologist




Diabetic retinopathy

Traditional classification	New classification
Background retinopathy microaneurysms (dots) blot haemorrhages (<=3) hard exudates Pre-proliferative retinopathy cotton wool spots (soft exudates; ischaemic nerve fibres) > 3 blot haemorrhages venous beading/looping deep/dark cluster haemorrhages more common in Type I DM, treat with laser photocoagulation	Mild NPDR 1 or more microaneurysm Moderate NPDR microaneurysms blot haemorrhages hard exudates cotton wool spots, venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR Severe NPDR blot haemorrhages and microaneurysms in 4 quadrants venous beading in at least 2 quadrants IRMA in at least 1 quadrant

Proliferative retinopathy retinal neovascularisation - may lead to vitrous haemorrhage fibrous tissue forming anterior to retinal disc more common in Type I DM, 50% blind in 5 years Maculopathy based on location rather than severity, anything is potentially serious hard exudates and other 'background' changes on macula check visual acuity more common in Type II DM