An overview of the eye in diabetes

Abstract

The three papers in this symposium are based on presentations to an RSM meeting on the Diabetic Eye, held on 9 April 2003. The matter is particularly topical because the National Service Framework for Diabetes calls for a high-quality retinal screening programme. After a review of the various ophthalmic conditions likely to be encountered in diabetic patients (A Negi, S A Vernon) we proceed to the most important, diabetic retinopathy, with a discussion of screening methods (D M Squirrell, J F Talbot) and an account of laser treatments (J G F Dowler). Colour versions of the clinical photographs are available online [www.jrsm.org]. Publication was coordinated by Professor Susan Lightman, of Moorfields Eye Hospital, London, UK.

Figure 1

Common eye abnormalities in diabetes. RCES=recurrent corneal erosion syndrome, BRVO=branch retinal vein occlusion, CRVO=central retinal vein occlusion, NAION=non-arteritic ischaemic optic neuropathy, OHT=ocular hypertension, POAG=primary open-angle glaucoma, ACG=angle-closure glaucoma

Figure 2

Sight-threatening maculopathy with normal acuity. Note the microaneurysms nasal to the fovea, the dot and blot haemorrhages, and the hard exudates in relation to the microvascular abnormalities. Colour version available on [www.jrsm.org]

Figure 3

Preproliferative retinopathy with multiple cotton-wool spots and a flame-shaped haemorrhage below the disc. Normal acuity. Colour version available on [www.jrsm.org]

Figure 4

Proliferative retinopathy. A gliotic neovascular tuft is seen arising from the vein running directly upwards from the disc. There is severe beading of the superotemporal vein (this sign is often followed by rapid progression to proliferation). Disc new vessels are also present. Colour version available on [www.jrsm.org]

Figure 5

Proliferative retinopathy with disc vessels, gliosis and traction retinal detachment superiorly. The acuity is still 6/6 in this patient, who presented with a few floaters. Colour version available on [www.jrsm.org]

Figure 6

Iris rubeosis. Note new vessels around the pupil margin and in the iris periphery. Cornea is clear but intraocular pressure was raised. Colour version available on [www.jrsm.org]

Figure 7

Oral fluorescein digitally enhanced angiographic image of cystoid macular oedema