Eye Screening for Individuals with Diabetes

This page discusses eye screening for individuals with diabetes.

 

Each individual over the age of 12 years who has diabetes mellitus should receive eye screening annually. Eye screening reduces the risk of sight loss by the early detection and treatment if required, of diabetic retinopathy and maculopathy. 

 All individuals with Type 1 and Type 2 diabetes are at risk and this risk is increased by 

  • Length of time diagnosed with diabetes
  • Poor blood sugar control
  • High blood pressure
  • High fats in the blood

Retinopathy is damage to the retina, the part of the back of the eye that converts light into electrical signals. Your brain interprets these signals to produce the images that you see.

Blood vessels bring oxygen and nutrients to your retina. High blood sugar and blood pressure affect damage these blood vessels.  

 As with other complications, the best way of avoiding these is through control of risk factors, namely:

  • Blood Glucose
  • Blood Pressure
  • Cholesterol
  • Smoking

What happens at screening visit?

Treatment Options and what you can do to help prevent further changes.

Stages of Retinopathy

There are various stages of retinopathy as described below:

Background retinopathy is the earliest stage of changes to the retina caused by diabetes. The small blood vessels have been affected and they may bulge slightly (microaneurysms), leak blood (retinal haemorrhages) and/or leak fluid (exudates).

Pre-proliferative retinopathy is when changes to the retina are more extensive than background retinopathy. This means additional monitoring is required because of the increased risk to loss of sight.

Proliferative retinopathy occurs when retinopathy progresses further and large areas of the retina are starved of sufficient blood supply.  New fragile blood vessels can appear and potentially bleed. Treatment reduces risk of sight loss if provided prior to vision being affected.

Maculopathy is when diabetic retinopathy occurs near the macula. The Macula is the small central part of the retina that you use to see things clearly. It is the most used area of the retina.

Here are some example images of the retina (back of the eye) demonstrating a normal retina with no damage and then some example images displaying complications. 

A normal Retinal Image

Examples of Diabetic Retinopathy 

 

The Official Grading System Used for Diabetic Retinopathy and Maculopathy in Scotland with the Advice given dependant on the stage of retinopathy/maculopathy is shown below.

Retinopathy

Description

Outcome

R0 (no visible retinopathy)

No diabetic retinopathy anywhere

Rescreen 12 months

R1 (mild)

Background diabetic retinopathy BDR – mild

The presence of at least one of any of the following features anywhere:

·         Dot haemorrhages

·         Microaneurysms

·         Hard exudates >2DD

·         Cotton wool spots

·         Blot haemorrhages

·         Superficial/flame shaped haemorrhages

Rescreen 12 months

R2 (observable background)

Background diabetic retinopathy BDR – observable

Four or more blot haemorrhages in one hemi-field only

 (Inferior and superior hemi-fields delineated by a line passing through the centre of the fovea and optic disc)

Rescreen 6 months (or refer to ophthalmology if this is not feasible)

R3 (referable background)

Background diabetic retinopathy BDR - referable

Any of the following features:

·         Four or more blot haemorrhages in both inferior and             superior hemi-fields

·         Venous bleeding

·         IRMA

Refer ophthalmology

These patients may be kept under surveillance and will not necessarily receive immediate laser treatment

R4 (proliferative)

Proliferative diabetic retinopathy PDR

Any of the following features:

·         Active new vessels

·         Vitreous haemorrhage

Refer ophthalmology

There patients are likely to receive laser treatment or another intervention

R1-R4 describes degrees of retinopathy. This relates to disease affecting the whole of the retina.

Retinopathy

Description

Outcome

M1 (Observable)

Lesions as specified below within a radius of >1 but ≤2 disc diameters the centre of the fovea

·         Any hard exudates

Rescreen 6 months

(or refer to ophthalmology if this is not feasible)

M2 (Referable)

Lesions as specified below within a radius of <1 disc diameter of the centre of the fovea

·         Any blot haemorrhages

·         Any hard exudates

Refer ophthalmology

These patients may be kept under surveillance and will not necessarily receive immediate laser treatment

M1 and M2 described stages of maculopathy- this relates to disease in the area of the eye most important for fine vision (the macula).

Treatments 

If complications such as retinal bleeding, or new blood vessels growth occurs, you will be referred to a specialist eye doctor who may recommend laser treatment, injections or even surgery to treat the back of the eye.

 

Retinal Image showing Laser Scars

 

Rate this page