Management of diabetic retinopathy

Abstract

Sub-Saharan Africa faces an epidemic of diabetes. Visual loss from diabetic retinopathy (DR) is both preventable and treatable. This article reviews the epidemiology and clinical features of DR and current evidence-based interventions in three areas: primary prevention of retinopathy by optimum medical management, early detection of pre-symptomatic disease and management of established retinopathy to prevent or mitigate visual loss. There are significant challenges to DR care in resource poor environments. Appropriate provision of effective interventions by health services can reduce social and economic costs associated with patient care.

Figure 1

Normal retinal anatomy. The retinal vasculature radiates from the optic disc. The macula is bordered by the vascular arcades. Light is focused on the fovea which is responsible for sharp, central, colour vision.

Figure 2

Non-proliferative diabetic retinopathy. Colour fundus photograph showing haemorrhages (H), Cotton wool spots (CWS) and intraretinal microvascular abnormalities (IRMA).

Figure 3

Proliferative diabetic retinopathy. Colour fundus photograph showing (A) new vessels, (B) fibrovascular tissue and (C) a central retinal hole secondary to traction from fibrovascular tissue.

Figure 4

Colour fundus photograph showing extensive exudates some of which are grouped in ‘circinates’ surrounding clusters of microaneurysms (labelled C in image).

Figure 5

Imaging of diabetic macular oedema. Mid (a) and late (b) phase fluorescein angiogram images showing leaking microaneurysms and pooling of dye in intraretinal spaces.

Figure 6

(a) Red free image (left) showing location of scan on optical coherence tomography (OCT). OCT (right) shows intraretinal fluid cysts with thickening of the retina and a detached hyaloid face. (b) Normal OCT image of the central macula for comparison