Handbook of Retinal Screening in Diabetes: Diagnosis and Management, 2nd Edition

Beginning with chapters summarizing the basics of diabetic retinopathy, this updated volume outlines the need for screening, how to screen safely and correctly, and the normal condition of the retina without diabetic retinopathy, all using excellent line and halftone illustrations. The core focus then moves on to examining each different form of retinopathy, all supported by outstanding color retinal photographs illustrating the appearance of the retina at various stages of retinopathy, plus an analysis on the best treatment for each stage. The book ends with chapters providing self-assessment questions of the type that screeners will encounter when gaining their now mandatory retinal screening qualifications, as well as a background information chapter offering advice on related UK, European, and US organizations. A website contains all the full-color retinopathy images from the book, with the option to download these into presentations.

Preface, ix

How to use this book, x

1 Type 1 Diabetes, 1

What causes type 1 diabetes?, 1

Who gets type 1 diabetes?, 1

How does it present?, 1

Essentials of management, 2

Complications, 7

History, 8

Further reading, 9

2 Type 2 Diabetes, 10

What causes type 2 diabetes?, 10

Who gets type 2 diabetes?, 10

How does it present?, 11

Management, 11

Complications, 14

History, 15

Further reading, 17

3 The Eye in Diabetes, 18

Structure of the normal eye, 18

The retina, 21

Diabetic retinopathy, 22

Treatment of sight-threatening diabetic retinopathy, 26

Further reading, 28

4 The Need to Screen, 29

Is blindness preventable?, 29

Can the progression of retinopathy be slowed?, 32

Detecting asymptomatic retinopathy by screening, 32

The five principles of retinal screening, 35

Quality assurance, 36

Retinal screening from the patient’s perspective, 38

Retinal screening from the screener’s perspective, 39

History of the development of retinal screening by photography-based systems in the UK, 40

Further reading, 41

5 Practical Screening, 42

Important first steps, 42

Measuring visual acuity, 43

Instilling eyedrops, 47

Obtaining the image, 50

Examining the image, 51

Grading the image, 54

Explaining the results of screening, 57

Success of the screening visit, 59

Organization of a district screening system, 59

Links with your ophthalmologist, 62

Further reading, 64

6 Normal Retinal Appearances, 65

Light refl ection artefact (Figure 6.1), 66

Light reflection artefact (Figure 6.2), 67

Tortuous vessels (Figure 6.3), 68

Tiger striping (Figure 6.4), 69

Tiger striping (Figure 6.5), 70

Myelinated fibres (Figure 6.6), 71

Myopic crescent (Figure 6.7), 72

Pigmented image (Figure 6.8), 73

Asteroid hyalosis (Figure 6.9), 74

Choroidal circulation (Figure 6.10), 75

Eyelash artefact (Figure 6.11), 76

7 Background Retinopathy, 77

What is background retinopathy?, 77

Lesions, 77

Early background (Figure 7.1), 78

Early background (Figure 7.2a), 79

Early background (red-free version of Figure 7.2a) (Figure 7.2b), 80

Early background (Figure 7.3), 81

Early background (Figure 7.4), 82

Early background (Figure 7.5), 83

Early background (Figure 7.6), 84

Moderate background (Figure 7.7a), 85

Moderate background (red-free version of Figure 7.7a) (Figure 7.7b), 86

8 Maculopathy, 87

What is maculopathy?, 87

Management of maculopathy, 88

Exudates close to the fovea (Figure 8.1), 90

Severe retinopathy close to the macula (Figure 8.2), 91

Widespread exudates (Figure 8.3), 92

Large plaque exudates (Figure 8.4), 93

Linear exudates close to the fovea (Figure 8.5), 94

Plaque exudates near the fovea (Figure 8.6), 95

Circinate exudates within the arcades (Figure 8.7), 96

Widespread exudates with circinates (Figure 8.8), 97

Coalescent exudates in the macular region (Figure 8.9), 98

9 Severe Non-proliferative (‘Pre-proliferative’) Retinopathy, 99

Management of severe, non-proliferative retinopathy, 99

Severe non-proliferative retinopathy (Figure 9.1), 100

Severe non-proliferative retinopathy (Figure 9.2), 101

Severe non-proliferative retinopathy (Figure 9.3), 102

Severe non-proliferative (Figure 9.4), 103

10 Proliferative Retinopathy, 104

What is proliferative retinopathy?, 104

Management of proliferative retinopathy, 104

New vessels on the disc (Figure 10.1), 105

Disc new vessels (Figure 10.2), 106

Retinal new vessels (Figure 10.3a), 107

Retinal new vessels – red-free image of Figure 10.3a (Figure 10.3b), 108

New vessels on the retina (Figure 10.4), 109

New vessels on the retina (Figure 10.5), 110

New vessels on the retina (Figure 10.6), 111

New vessels on the retina (Figure 10.7a), 112

New vessels on the retina – red-free version of Figure 10.7a (Figure 10.7b), 113

Old panretinal laser scars (Figure 10.8), 114

Panretinal laser scars (Figure 10.9), 115

Disc and retinal new vessels, with exudative maculopathy (Figure 10.10a), 116

Disc and retinal new vessels, with exudative maculopathy (red-free version of Figure 10.10a) (Figure 10.10b), 117

11 Advanced Diabetic Eye Disease, 118

What is advanced?, 118

Management of advanced diabetic eye disease, 118

Early fi brosis (Figure 11.1), 119

Fibrosis (Figure 11.2), 120

Fibrovascular membrane (Figure 11.3), 121

Preretinal haemorrhage (Figure 11.4), 122

Preretinal haemorrhage (Figure 11.5), 123

Severe exudative maculopathy (Figure 11.6), 124

Preretinal haemorrhage and persisting new vessel formation (Figure 11.7), 125

Preretinal haemorrhage (Figure 11.8), 126

Fibrous band and heavy laser scars (Figure 11.9), 127

12 Non-diabetic Eye Disease, 128

What other diseases are common?, 128

Other eye diseases, 128

Drusen (Figure 12.1), 131

Drusen (Figure 12.2), 132

Atrophic chorioretinital scars (Figure 12.3), 133

Old chorioretinitis (Figure 12.4), 134

Papilloedema (Figure 12.5), 135

One year later – same eye as shown in Figure 12.5 (Figure 12.6), 136

Papilloedema (Figure 12.7), 137

Pigment epithelial hypertrophy (Figure 12.8), 138

Cholesterol embolus (Figure 12.9), 139

Branch retinal vein occlusion (Figure 12.10), 140

Central retinal vein occlusion (Figure 12.11), 141

Branch retinal artery occlusion (Figure 12.12), 142

Glaucomatous disc (Figure 12.13), 143

Macular hole (Figure 12.14), 144

13 Background Information, 145

The UK Retinal Screening Diploma, 145

Working towards the full Diploma, 146

Driving and diabetes, 146

Pregnancy, 147

Insurance and diabetes, 147

Employment and diabetes, 147

Prescription charges, 148

British Association of Retinal Screening, 148

Diabetes UK, 148

National Retinopathy Screening Systems, 149

Patient leaflets, 149

Ophthalmoscopy, 150

14 Self-assessment Questions, 152

Chapter 1, 152

Chapter 2, 153

Chapter 3, 154

Chapter 4, 154

Chapter 5, 155

Chapters 6–12, 157

15 Answers to Self-assessment Questions, 158

Chapter 1, 158

Chapter 2, 159

Chapter 3, 160

Chapter 4, 160

Chapter 5, 161

16 Glossary of terms, 163

Index, 167