DR refers to retinal changes see in patients with Diabetes Mellitus.

With increase in life expectancy of diabetics, the incidence of DR has increased.

It is the leading cause of Blindness.

Duration of Diabetes is the most important determining factor

- After 10 years, 20% of Type 1 and 25% of Type 2 diabetics develop Retinopathy
-After 20 years, 90% of Type 1 and 60% of Type 2 diabetics develop Retinopathy
-After 30 years, 95% of both Type 1 and Type 2 diabetics develop Retinopathy

Age of Onset of Diabetes also acts a risk factor

-The Risk of Retinopathy in a child with onset of diabetes at the age of 2 years is negligible for
the first 10 years. After onset of Puberty, age of onset is not a risk factor.

Sex - Incidence is more in Females than Males (4:3)

Heredity- It is transmitted as a recessive trait.

Pregnancy- may accelerate the changes of Diabetic Retinopathy.

Hypertension may also accentuate the changes of Diabetic Retinopathy.

Hyperglycemia in uncontrolled DM is the starting point for development of DR.

Microangiopathy affecting retinal pre capillary arterioles, capillaries and venules produced by
hyperglycemia is the basic pathology in DR.
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NON PROLIFERATIVE DIABETIC RETINOPATHY.

Microaneurysms are seen in the macular area. They are formed due to focal Dilation of
capillary wall following loss of pericytes. These appear as Red dots and leak fluid, proteins,
lipids.

Retinal Hemorrhages. Both Deep (Dot and blot) and Superficial (Flamed Shaped) Hemorrhages.

Retinal Oedema. Characterised BY RETINAL THICKENING IS CAUSED BY CAPILLARY LEAKAGE

Hard Exudates. Yellowish white waxy looking patches are arranged in clumps or in circinate
pattern. Commonly seen in the macular area. Composed of Leaked Lipoproteins and Lipid Filled
Macrophages.

Cotton Wool Spots are small whitish fluffy superficial lesions.

Dark blot Hemorrhages are also seen.

Risk Factors for Progression to Proliferative Diabetic Retinopathy is due to
- Multiple Increasing Intraretinal Hemorrhages.
- Venous Beading and Loops and
- Wide Spread Capillary Non-Perfusion areas.

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PROLIFERATIVE DIABETIC RETINOPATHY
Develops in more than 50% of cases after about 25 years of onset of Disease.
Therefore, it is more common in patients with juvenile onset diabetes.

Occurrence of neovascularization is characterized by proliferation of new vessels from the

capillaries in the form of Neovascularization at the optic disc and/or elsewhere in the Fundus.
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These new vessels may proliferate in the plane of retina or spread into the vitreous as vascular
fronds. Later it results in the formation of :
- Fibro vascular Epiretinal Membrane
- Vitreous Detachment and Vitreous Hemorrhage.

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DIABETIC MACULAR EDEMA.
• It is the leading cause of Legal Blindness in Diabetics.
• DME can be present at any stage of the disease, but is more common in patients with
Proliferative Diabetic Retinopathy
• DME may be asymptomatic at first.
• The macula is responsible for central vision. As the edema moves in to the fovea, the
patient will notice blurry central vision. The ability to read and recognize faces will be
compromised.

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Clinically Significant Macular Edema
• Thickening of the retina at or within 500 micron of the centre of the Fovea.
• Hard Exudates at or within 500 micron of the centre of Fovea associated with adjacent
Retinal Thickening.
• Development of a Zone of Retinal Thickening one disc diameter or larger in size, atleast
a part of which is within one disc diameter of the foveal centre.

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Advanced Diabetic Eye Disease.
It is the end result of uncontrolled proliferative diabetic retinopathy.
It is marked by complications such as –
• Persistent Vitreous Hemorrhage.
• Tractional Retinal Detachment, and
• Neovascular Glaucoma.
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MANAGEMENT

Management of DR includes its screening investigation and treatment.

A. Screening of Diabetic Retinopathy
To Prevent Visual loss occurring from DR a periodic follow up is very important for a
timely intervention. The recommendation for periodic Fundus Examination are as
follows.
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