This document discusses diabetic retinopathy, its causes, stages, treatments, and prevention. It is progressive retinal vessel dysfunction caused by long-term hyperglycemia. Key factors that contribute to its development include hypertension, hyperlipidemia, female sex, pregnancy, smoking, obesity, and poor metabolic control. Stages include non-proliferative and proliferative retinopathy. Treatments include anti-VEGF drugs, laser photocoagulation, vitrectomy, and strict control of blood sugar and blood pressure to prevent its progression.

4. Progressive dysfunction of the
retinal blood vessels caused by
chronic hyperglycaemia.

5. 1. Hyperglycaemia
Duration of diabetes
- 50% develop DR after 10 yrs
- 70 % after 20 yrs
- 90 % after 30 yrs
2. Hypertension
3. Hyperlipidaemia
4. More in females than males
5. Pregnancy may accelerate DR
6. Smoking, Obesity, Anaemia
7. Poor metabolic control
8. Hereditary – more on proliferative DR

11. • Non-proliferative diabetic retinopathy
I. Mild nonproliferative retinopathy
II. Moderate nonproliferative retinopathy
III. Severe nonproliferative retinopathy
IV.Very severe nonproliferative retinopathy
• Proliferative diabetic retinopathy
• Diabetic maculopathy
• Advanced diabetic eye disease

12. No retinopathy

13. I. Mild nonproliferative retinopathy
• Atleast one microaneurysm or intraretinal
haemorrhage
• Hard/ Soft exduates may or may not be
present

15. II. Moderate nonproliferative retinopathy
• Micro aneurysms / intraretinal haemorrhages in
2 or 3 quadrants
• Early mild IRMA Intra retinal Microvascular
abnormalities
• Hard / Soft exudates may or may not be
present

18. III. Severe nonproliferative retinopathy
Any one of the following :
• Four quadrants of severe micro aneurysms /
intraretinal haemorrhages
• Two quadrants of venous bleeding
• One quadrant of IRMA changes

21. IV. Very severe nonproliferative retinopathy
Any two of the following :
• Four quadrants of severe micro aneurysms /
intraretinal haemorrhages
• Two quadrants of venous bleeding
• One quadrant of IRMA changes

22. Proliferative diabetic retinopathy
PDR
PDR without HRC PDR with HRC
NVD ¼ to 1/3 of disc area
with or without VH or PRH
NVD < ¼ disc area
with VH or PRH
NVD < ¼ disc area
with VH or PRH

24. Extensive vitreous haemorrhage obscuring most of fundus
(white circle)

29. Diabetic Maculopathy
On Slit lamp examination with 90D lens :
1. Thickening of retina at or within 500 micron of the centre of
fovea
2. Hard exudates at or within 500 micron of the centre of fovea
associated with adjacent retinal thickening
3. Development of a zone of retinal thickening one disc diameter
or larger in size, at least a part of which is within one disc
diameter of foveal centre.

31. Maculopathy within 1 disc diameter of the fovea.

32. Advanced diabetic eye disease
1. Persistent vitreous haemorrhage
2. Tractional retinal detachment
3. Neovascular glaucoma

34. Investigations
1. Urine examination
2. Blood sugar estimation
3. 24 hour urinary protein
4. Renal function tests
5. Lipid profile
6. Haemogram
7. Glycosylated Haemoglobin (HbA1C)
8. Fundus Fluorescein angiography – to
elucidate areas of neovascularisation,
leakage and capillary nonperfusion
9. Optical Coherence Tomography to study
detailed structural changes in diabetic
maculopathy

35. Prevention
1. Primary Prevention –
Strict glycemic control,
Blood pressure control,
correction of dyslipidaemia,
control of associated anaemia,
control of hypoproteinemia
2.Secondary Prevention – Annual eye exams
3. Tertiary Prevention – Retinal laser
photocoagulation ,
Vitrectomy

36. Treatment of Diabetic Retinopathy
1. Anti – vascular endothelial growth factors
2. Others under evaluation – Protein Kinase C
inhibitors, Aldose reductase, ACE inhibitors,
Antioxidants such as vitamin E
3. Role of intravitreal steroids – Flucinolone
acetonide intravitreal implant, Inj.
Triamcinolone intravitreal

37. Laser Photocoagulation

40. Vitrectomy

42. Latest Treatment modalities for Diabetic Retinopathy
September 16, 2014
Eylea Granted Breakthrough Therapy for Diabetic Retinopathy
Food and Drug Administration (FDA) has granted Eylea (afilbercept)
Injection Breakthrough Therapy designation for the treatment of
diabetic retinopathy in patients with diabetic macular edema
(DME).
Eylea is a vascular endothelial growth factor (VEGF) inhibitor designed
to block the growth of new blood vessels and decreases vascular
permeability in the eye by blocking VEGF-A and placental growth
factor (PlGF), two growth factors involved in angiogenesis.
Eylea helps prevent VEGF-A and PlGF from interacting with their natural
VEGF receptors as shown in preclinical studies.
Eylea is already approved for the treatment of neovascular (wet) age-related
macular degeneration (AMD) and macular edema following
central retinal vein occlusion (CRVO).

43. Human trials begin for promising diabetic retinopathy
treatment
Fri, 05 Sep 2014
Human trials are set to begin for a new medication, currently called KVD001,
which treats diabetic macular edema, a form of diabetic retinopathy.
KVD001 is an intravitreal plasma kallikrein inhibitor drug that is given
byinjection into the eye. Whilst injections into the eye may sound painful, in
practice they are not as eye-watering as they sound.
There is currently only one medication, Lucentis, has been officially licensed for
treatment of diabetic macular edema. Having another medication such as
KVD001 would give doctors more choice over which treatment to give and,
because it works in a different way to Lucentis, it means that it could help save
thesight of people for whom Lucentis is not effective.
KVD001 has been developed by KalVista Pharmaceuticals, a company in
Hampshire. The clinical trials, which will be run across five different centres within
the United States, are being funded by the type 1 diabetes charity, the JDRF.

44. Conclusion
Diabetic Retinopathy is preventable through
strict glycemic control and annual dialated
eye exams by an opthalmologist.