COMPLICATIONS: RETINOPATHY

    ; Diabetic retinopathy is the commonest cause of blindness in the 30-

    65 age group in the UK at the present time.

    ; Development or progression of retinopathy can be prevented by good

    glycaemic control, management of hypertension and avoidance of

    smoking.

; It is reasonable to aim for a target HbA1c of < 7.0% to limit

    development and progression of microvascular complications,

    including retinopathy

    ; Laser treatment is indicated for proliferative diabetic retinopathy and

    maculopathy. It is more likely to be effective if applied at an early stage

    when the patient is more likely to be asymptomatic; therefore screening for

    retinopathy is vital.

; Laser therapy is not always effective in all patients

    ; Retinopathy may be present in up to a third of newly diagnosed type 2

    diabetic patients.

    ; Some degree of retinopathy will also be present in the majority of patients

    who have had diabetes for more than 20 years, and a significant number,

    particularly if poorly controlled, will develop retinopathy at an earlier stage.

    ; All patients over the age of 12 years should have an annual eye

    examination. This will be retinal photography performed by an Optometrist

    or other qualified screener

    ; Patients with proliferative retinopathy, maculopathy, unexplained loss in

    visual activity, cataract affecting vision, or where the doctor has other

    concern should be referred to an Optometrist or Ophthalmologist

    All patients should have their eyes examined at least annually

    for detection of diabetic retinopathy

HOW TO PERFORM RETINAL ASSESSMENT IN DIABETES

    ; Examine visual acuity on Snellen Chart with the patient wearing

    spectacles if appropriate.

    ; If acuity is reduced, check if it corrects with a pinhole.

    ; Examine near vision with patient’s reading glasses. This is more sensitive

    for detecting maculopathy.

; Warn patient that drops may blur his/her vision for a few hours and that it

    is preferable that he/she should not drive a car during this time.

; Dilate pupils with 1% Tropicamide.

    WESTERN ISLES NHS

    ANNUAL EYE SCREENING

    PROGRAMME

     OPTOMETRIST

    Normal Retina or Diabetic Retinopathy/Maculopathy or other Minimal Background Pathology Diabetic Retinopathy

    Annual Routine

    Screen

    Direct Referral to Repeat Referral to GP Ophthalmologist Examination at

    Optometrist