Ординатура / Офтальмология / Английские материалы / Handbook of Retinal Screening in Diabetes_Taylor_2006
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HANDBOOK OF
Retinal Screening
in Diabetes
Handbook of Retinal Screening in Diabetes. Roy Taylor
© 2006 John Wiley & Sons, Ltd. ISBN: 0-470-02882-3
HANDBOOK OF
Retinal Screening
in Diabetes
ROY TAYLOR
Department of Diabetes and Metabolism
The Medical School, University of Newcastle upon Tyne and Newcastle Diabetes Centre
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Library of Congress Cataloging-in-Publication Data
Taylor, Roy, 1952–
Handbook of retinal screening in diabetes / Roy Taylor. p. ; cm.
Includes bibliographical references. ISBN-13: 978-0-470-02882-7 (alk. paper) ISBN-10: 0-470-02882-3 (alk. paper)
1. Diabetic retinopathy—Diagnosis—Handbooks, manuals, etc. I. Title. [DNLM: 1. Diabetic Retinopathy—diagnosis—Handbooks. WK 39
T245h 2006] RE661.D5T35 2006 617.7′3—dc22
2006001394
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN-13 0-978-0-470-02882-7
ISBN-10 0-470-02882-3
Typeset in 10.5/13 pt Sabon
Printed in Great Britain by Scotprint, Haddington, East Lothian
This book is printed on acid-free paper responsibly manufactured from sustainable forestry in which at least two trees are planted for each one used for paper production.
Contents
Preface |
xi |
How to use this book |
xiii |
1 |
Type 1 Diabetes |
1 |
|
What causes type 1 diabetes? |
1 |
|
Who gets type 1 diabetes? |
1 |
|
How does it present? |
2 |
|
Essentials of management |
2 |
|
Insulin |
2 |
|
Food |
3 |
|
Hypoglycaemia |
6 |
|
Ketoacidosis |
6 |
|
Living with type 1 diabetes |
6 |
|
Blood glucose testing |
8 |
|
Complications |
8 |
|
History |
10 |
|
Fact file |
11 |
|
Further reading |
12 |
2 |
Type 2 Diabetes |
13 |
|
What causes type 2 diabetes? |
13 |
|
Who gets type 2 diabetes? |
13 |
|
How does it present? |
14 |
|
Management |
14 |
|
Eating |
14 |
|
Physical activity |
15 |
|
Tablets |
16 |
|
Insulin |
17 |
|
Living with type 2 diabetes |
17 |
|
Blood glucose and urine testing |
17 |
|
Complications |
17 |
|
History |
21 |
|
Further reading |
21 |
|
Fact file |
22 |
vi CONTENTS
3 The Eye in Diabetes |
23 |
|
|
Structure of the normal eye |
23 |
|
The retina |
25 |
|
Diabetic retinopathy |
26 |
|
Other diabetes-associated changes in the eye |
29 |
|
Further reading |
30 |
|
Fact file |
31 |
4 The Need to Screen |
33 |
|
|
Is blindness preventable? |
33 |
|
Can the progression of retinopathy be slowed? |
35 |
|
Detecting asymptomatic retinopathy |
37 |
|
The five principles of retinal screening |
40 |
|
Quality assurance |
41 |
|
History of the development of retinal screening by photography-based |
|
|
systems in the UK |
44 |
|
Fact file |
45 |
|
Further reading |
46 |
5 |
Practical Screening |
47 |
|
Important first steps |
47 |
|
Measuring visual acuity |
48 |
|
Interpretation of visual acuity measurement |
48 |
|
Instilling eye drops |
51 |
|
Tropicamide |
51 |
|
Other eye drops |
53 |
|
Obtaining the image |
54 |
|
Examining the image |
56 |
|
Disc |
57 |
|
Vessels |
57 |
|
Retina |
58 |
|
Explaining the results of screening |
58 |
|
Organization of a district screening system |
60 |
|
Links with your ophthalmologist |
60 |
|
Further reading |
61 |
|
Fact file |
63 |
6 |
Normal Retinal Appearances |
65 |
|
Light reflection 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 |
|
CONTENTS |
vii |
|
|
|
|
|
|
|
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) |
79 |
|
Early background (Figure 7.2) |
80 |
|
Early background (Figure 7.3) |
81 |
|
Early background (Figure 7.4) |
82 |
|
Early background (Figure 7.5) |
83 |
|
Moderate background (Figure 7.6) |
84 |
8 Severe Non-proliferative (‘Pre-proliferative’) Retinopathy |
85 |
|
|
Severe non-proliferative retinopathy (Figure 8.1) |
86 |
|
Severe non-proliferative retinopathy (Figure 8.2) |
87 |
|
Severe non-proliferative retinopathy (Figure 8.3) |
88 |
|
Severe non-proliferative retinopathy (Figure 8.4) |
89 |
9 |
Maculopathy |
91 |
|
What is maculopathy? |
91 |
|
Management of maculopathy |
92 |
|
Blood pressure control |
92 |
|
Blood glucose control |
93 |
|
Referral to ophthalmologist |
93 |
|
Exudates close to the fovea (Figure 9.1) |
94 |
|
Severe retinopathy close to the macula (Figure 9.2) |
95 |
|
Widespread exudates (Figure 9.3) |
96 |
|
Large plaque exudates (Figure 9.4) |
97 |
|
Linear exudates close to the fovea (Figure 9.5) |
98 |
|
Plaque exudates near the fovea (Figure 9.6) |
99 |
|
Circinate exudates within the arcades (Figure 9.7) |
100 |
|
Widespread exudates with circinates (Figure 9.8) |
101 |
|
Coalescent exudates in the macula region (Figure 9.9) |
102 |
10 |
Proliferative Retinopathy |
103 |
|
What is proliferative retinopathy? |
103 |
|
New vessels on the disc (Figure 10.1) |
104 |
|
Disc new vessels (Figure 10.2) |
105 |
|
New vessels on the retina (Figure 10.3) |
106 |
viii |
CONTENTS |
|
|
|
|
|
|
|
|
Disc new vessels (Figure 10.4) |
107 |
|
New vessels on the retina (Figure 10.5) |
108 |
|
New vessels on the retina (Figure 10.6) |
109 |
|
Old pan-retinal laser scars (Figure 10.7) |
110 |
|
Pan-retinal laser scars (Figure 10.8) |
111 |
11 Advanced Diabetic Eye Disease |
113 |
|
|
What is advanced? |
113 |
|
Early fibrosis (Figure 11.1) |
114 |
|
Fibrosis (Figure 11.2) |
115 |
|
Fibro-vascular membrane (Figure 11.3) |
116 |
|
Pre-retinal haemorrhage (Figure 11.4) |
117 |
|
Pre-retinal haemorrhage (Figure 11.5) |
118 |
|
Severe exudative maculopathy (Figure 11.6) |
119 |
|
Pre-retinal haemorrhage and persisting new vessel formation (Figure 11.7) |
120 |
|
Pre-retinal haemorrhages (Figure 11.8) |
121 |
|
Fibrous band and heavy laser scars (Figure 11.9) |
122 |
12 |
Non-diabetic Eye Disease |
123 |
|
What other diseases are common? |
123 |
|
Other eye diseases |
124 |
|
Glaucoma |
124 |
|
Conjunctivitis |
125 |
|
Sub-conjunctival haemorrhage |
125 |
|
Uveitis |
125 |
|
Drusen (Figure 12.1) |
127 |
|
Drusen (Figure 12.2) |
128 |
|
Atrophic chorioretinital scars (Figure 12.3) |
129 |
|
Old chorioretinitis (Figure 12.4) |
130 |
|
Papilloedema (Figure 12.5) |
131 |
|
One year later – same eye as Figure 12.5 (Figure 12.6) |
132 |
|
Papilloedema (Figure 12.7) |
133 |
|
Pigment epithelial hypertrophy (Figure 12.8) |
134 |
|
Cholesterol embolus (Figure 12.9) |
135 |
|
Branch retinal vein occlusion (Figure 12.10) |
136 |
|
Branch retinal artery occlusion (Figure 12.11) |
137 |
|
Glaucomatous disc (Figure 12.12) |
138 |
|
Macular hole (Figure 12.13) |
139 |
13 |
Self-assessment Questions |
141 |
|
Chapter 1 |
141 |
|
Chapter 2 |
143 |
|
Chapter 3 |
144 |
|
Chapter 4 |
145 |
|
CONTENTS |
ix |
|
|
|
|
|
|
|
Chapter 5 |
146 |
|
Chapters 6–12 |
148 |
14 |
Background Information |
149 |
|
Driving and diabetes |
149 |
|
Insurance and diabetes |
150 |
|
Employment and diabetes |
150 |
|
Prescription charges |
150 |
|
British Association of Retinal Screeners (BARS) |
151 |
|
Diabetes UK |
151 |
|
National Retinopathy Screening Systems |
152 |
|
Laser therapy |
152 |
|
Vitrectomy |
153 |
|
Ophthalmoscopy |
153 |
15 Answers to Self-assessment Questions |
157 |
|
|
Chapter 1 |
157 |
|
Chapter 2 |
159 |
|
Chapter 3 |
160 |
|
Chapter 4 |
160 |
|
Chapter 5 |
161 |
16 |
Glossary of Terms |
165 |
|
Index |
169 |
Preface
This book has been written mainly for retinal screeners, but should be of interest to others including optometrists, medical students, nurses, diabetologists and ophthalmologists. It describes diabetes from the perspective of the patient, acknowledging the day to day difficulties which are often unknown to those who do not themselves have diabetes. The book also covers the basic anatomy of the eye, visual function and the practicalities of screening individuals and populations. However, the most important chapters describe retinal images to allow acquisition of the vital skill of recognizing different degrees of severity of retinopathy.
Retinal screening is part of diabetes care, and retinal screeners play a vital role in the diabetes care team which delivers the service to individuals with diabetes. Although the book is intended primarily as a practical handbook, it should be useful for those preparing to take the new UK National Diploma in diabetes retinal screening.
All images were taken using Canon CR-6 cameras with either JVC or Canon D60 digital imagers. The images in this book have all been taken during routine screening in busy sessions. Experts on eyes or photographs may feel that their technical quality is not optimal. However, this is a book about practical screening in diabetes and deals with the reality of image interpretation in day to day work. It is not a textbook of ophthalmology. The level of resolution obtained is easily sufficient to detect treatable retinopathy and prevent diabetes blindness. Indeed, the major fall in rates of blindness in Newcastle upon Tyne was achieved using lower resolution Polaroid retinal photographs.
The self-assessment chapter has been organized so that you may test yourself after each chapter. The retinal images are also obtainable from the web, and the website can be used as a further self-assessment tool.
xii |
PREFACE |
This book could not have been put together without the expert input of the Newcastle retinal screening team – Denise Young, Deborah Batey, Maureen Shotton, Diane Mitchie and Dianne Mitchell. I am most grateful to each of them, and this book is an attempt to clone them. Dr C.S. Arun helped to identify representative images and Dr Ayad Al-Bermani, Medical Ophthalmologist, proof read the book. Photographs were taken by Jodie Batey and line drawings were created by James Corris. My knowledge about diabetic retinopathy has been acquired by close and much appreciated collaboration over many years with Mr Kevin Stannard, Consultant Ophthalmologist.
Roy Taylor