Diabetic retinopathy for the non-ophthalmologist

Abstract

Diabetic retinopathy is a microangiopathy resulting from the chronic effects of diabetes mellitus. Healthcare professionals often work in isolation to deliver highly specialised care efficiently and effectively for people living with diabetes. It is not uncommon for people with diabetes to be making frequent visits to community and hospital clinics to see a variety of specialists and healthcare professionals, with seemingly little opportunity for coordination of this complex health management programme between the wider team. In a field that is so diverse and rapidly changing, healthcare professionals of all specialties need to be aware of developments across all aspects of diabetes management. In this article, we discuss the epidemiology and natural history of diabetic retinopathy and describe an approach to its assessment and diagnosis. We provide an overview of the principles of diabetic retinopathy management and outline possible future treatments for diabetic retinopathy.

Keywords: diabetic macular oedema; diabetic retinopathy; intravitreal injections; laser photocoagulation; vitrectomy.

Fig 1.

Colour fundus photography of diabetic retinopathy lesions. a) A photograph of an eye with severe non-proliferative diabetic retinopathy showing dot (white arrowheads) and blot (white arrow) haemorrhages, exudates (black arrowheads) and intraretinal microvascular abnormalities (segments of dilated and tortuous retinal vasculature amid retinal vessels; black arrow). b) A close-up photograph of an eye with diabetic macular oedema showing exudates (black arrows) and microaneurysms (white arrows) at the macula, a cotton wool spot is shown just outside the inferotemporal vascular arcade (white arrowhead).

Fig 2.

Ultra-widefield fundus photography of an eye with active proliferative diabetic retinopathy showing laser photocoagulation scars (black arrows), new vessels elsewhere (white arrows) and a vitreous haemorrhage (white arrowheads).

Fig 3

Ultra-widefield fundus photography of an eye with advanced proliferative diabetic retinopathy showing fibrovascular proliferations (white arrows), new vessels elsewhere (black arrowhead), subhyaloid haemorrhage (black arrow) and tractional retinal detachment (within area of the white arrowheads) involving the macula.