Good morning everybody. With my respects for the eminent dignitaries with whom I have the opportunity to share this dias, I thank Dr. Nitinbhai for the trust he put in me for the subject and the role of a moderator. I would like to perform both the duties simultaneously to save more time for the panel discussion and hence I would like to request our convener Dr. Mrs. Ushaben to be little considerate about my timings.
long standing hyperglycemia leads to many situations, out of which these three are important in order of their frequency. They have a close association and detection of one should compel the concerned specialist to look for others. Ophthalmoscopic examination is the only &quot;visible&quot; and documentable indicator and hence the role of ophthalmologist is very valuable.
The classification, we all know, and so important for post graduates, needs fast brushing up before we go to the practical aspects. The retinopathy does go through all the stages and some signs need need special attention from prognostic and treatment point of view. It is imperative to look for signs of vision threatening macular edema at any stage of the disease and not wait for loss of visual acuity. This is where an ophthalmologist with good ophthalmoscopy experience can help tremendously in preventing diabetic blindness.
NOT SEEN EVEN WITH 90D FFA REVEALS THEM
INCREASE IN SNUMBER OF SOFT AND HARD EXUDATES WITH RETINAL THICKENING IN MACULAR REGION
NUMBER OF SOFT EXUDATES IS A DIRECT POINTER TO THE DEGREE OF ISCHEMIA AND IT'S OCCURANCE SHOULD LEAD ONE TO LOOK FOR FURTHER EVIDENCES LIKE, VENOUS BEADS, BLOT HEMORRHAGES, IRMA, and evidence of advancing retinopathy.
Intraretinal microvascular abnormalities, capillary non perfusions are best diagnosed by FFA . VENOUS DILATATIONS, TORTUOSITY, BEADING, LOUPING ARE SIGNS OF INCREASING DEGREE OF STASIS AND INDICATORS OF ISCHEMIA.
NVE, IN EARLY STAGES CAN BE CONFUSED WITH IRMA BUT FFA CAN CLEAR THE DOUBTS FAST. VENOUS STASIS INDICATED BY SACULAR DILATATIONAS AND BEADING SHOULD WARN THE OBSERVER AND JUSTIFY EARLY INITIATION OF PRP IN CERTAIN CASES.
NVD AND SUBHYALOID/VITREOUS HEMORHHAGE ARE THE AGE OLD FEATURES OF 'HIGH RISK' GROUP NEEDING PROMPT PRP.
SOMETIMES VISION LOSS IS NOT ENTIRELY DUE TO MACULAR EDEMA AND WE NEED TO ADD DIFFERENTIAL DIAGNOSIS, NOT TREATABLE BY FOCAL LASER. THEY ARE, MACULAR EDEMA, ISCHEMIA, ARMD, ERM ETC.
Diabetic Retinopathy Presentation and Classification Dr Anand Sudhalkar