Handbook of Retinal Screening in Diabetes

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. Table of Contents 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