Scribe Guide Quiz 1
Diabetic Retinopathy Knowledge Quiz
Test your knowledge on diabetic retinopathy and its impact on vision. This quiz covers the mechanisms, signs, treatment options, and more related to this critical diabetes complication.
- Multiple-choice questions
- Focus on ocular health and diabetic implications
- Designed for healthcare professionals and students
What is diabetic retinopathy, and by what mechanism does it occur?
This is retinal changes that cause the patient to have the retina break off from the wall of the eye causing vision loss.
This is when the retina shows no signs of diabetes
This is large spikes of blood sugar and intermediate spikes of low sugars
This is retinal bleeding, edema, ischemia, and ultimately neovascularization caused by diabetic damage to the retinal blood vessels.
What are the retinal signs of diabetic retinopathy. How do they compare to, say, hypertensive retinopathy.
Diabetic retinopathy will manifest with sudden vision loss, In the eye you will see large dark areas of non perfusion.
With diabetic retinopathy you typically see a lot of dot-blot hemorrhages, cotton-wool spots, and hard exudates. Hypertension usually has more flame hemorrhages and vascular changes such as arterial-venous nicking and copper/silver wiring.
Diabetes contains drusen or yellow deposits where hypertension has large areas of retinal hemorrhage and poor circulation
Diabetic Retinopathy will typically manifest with many hemorrhages but no signs of edema, while hypertension shows signs of edema and hemorrhaging.
How are angiogenic molecules involved with diabetic retinas?
VEGF production by areas of ischemic retina leads to neovascularization. These new vessels are bad as they can cause traction, bleeding, detachments, etc..
Anti-VEGF antibodies are released causing the body to respond in the form of inflammation called edema or subretinal fluid
The body has large deposits of glucose which when released travel to the vessels of the eye and cause bleeding and decay.
The retina produces new blood vessels that become engorged with plasma and begin to leak into the retina thus producing VEGF which causes bleeding and tractional detachments.
How do we categorize diabetic retinopathy?
Neovascular and Age Related dependent on the amount of years with the condition
NPDR (nonproliferative diabetic retinopathy) or PDR (proliferative diabetic retinopathy) depending upon the presence of neovascularization.
Either Non Perfussion Retinopathy and Perfussion Retinopathy dependent on the amount of circulation evident
Insulin Dependent and Non Insulin Dependent, this stems from patients level of insulin production internally
What are some mechanisms in diabetic retinopathy that might lead to decreased vision? What causes the majority of vision loss in diabetic patients?
Drusen, Tractional Detachments and Retinal Hemorrhage
Macular edema (probably the leading cause of vision loss) Vitreous hemorrhage Retinal detachment
Sub-Retinal Fluid, Vitreous Hyalosis, and Neovascular Glaucoma
Large Retinal Hemorrhage, Lesions in the RPE and Retinal Detachment
How do we treat Proliferative diabetic retinopathy?
This disease stage is untreatable as the retinal ischemia at this point is too far progressed.
This stage of diabetic retinopathy can only be treated with surgery (Vitrectomy to remove Neovascularization)
Proliferative diabetic retinopathy is treated with PRP (pan retinal photocoagulation). By ablating the peripheral ischemic retina with a laser, we decrease VEGF production and thus decrease neovascularization.
PDR is usually treated with Anti-VEGF injections done every 4-6 weeks along with Steroid Injections done every 3 months.
A 35 year old man with bad type-1 diabetes presents with a pressure of 65. His anterior chamber is deep but you find neovascularization everywhere – in the retina and on the iris. What do you think is causing the pressure rise, and how do you treat it?
The pressure is up because of a vitreous hemorrhage caused by the blood vessels developing atrophy and leaking into the retina and this is treated with an injection of steroid to release the pressure caused by the hemorrhage.
The pressure is up because of neovascularization of the iris angle with blood vessels clogging up the trabecular drain. You treat neovascularization by PRP lasering the peripheral retina to decrease VEGF production. NVA (neovascularization of the angle) is hard to manage and this patient will probably require a surgical drainage procedure in the near future.
The pressure is up due to new areas of VEGF developing causing the retina to have an immune response and raise the pressure, this is treated with laser photocoagulation and is done in 3 sessions of 500 burns.
The Pressure is up because the neovascularization of the blood vessels causes neovascular glaucoma which leads to and increase in retinal hemorrhages and pressure. This is treated with surgery to implant a stent and remove the blood.
Which of the following OCT scans shows macular edema?
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