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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| {{Infobox_Disease
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| | Name = Diabetic retinopathy
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| | Image =
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| | Caption =
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| | DiseasesDB = 29372
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| | ICD10 = {{ICD10|H|36||h|30}} ({{ICD10|E|10|3|e|10}} {{ICD10|E|11|3|e|10}} {{ICD10|E|12|3|e|10}} {{ICD10|E|13|3|e|10}} {{ICD10|E|14|3|e|10}})
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| | ICD9 = {{ICD9|250.5}}
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| | ICDO =
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| | MedlinePlus =
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| {{Diabetic retinopathy}} | | {{Diabetic retinopathy}} |
| {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}}; [[Afsaneh Morteza|Afsaneh Morteza, MD-MPH]] [mailto:afsaneh.morteza@gmail.com] | | {{CMG}}; {{AE}} {{RBS}} [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}}; [[Afsaneh Morteza|Afsaneh Morteza, MD-MPH]] [mailto:afsaneh.morteza@gmail.com] |
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| | {{SK}} |
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| == Overview == | | ==[[Diabetic retinopathy overview|Overview]]== |
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| Diabetic retinopathy is the most severe form of the several kinds of ocular complications caused by diabetes. It is the leading cause of non traumatic blindness in adults. People with untreated diabetes are 25 times more at risk for blindness than the general population. | | ==[[Diabetic retinopathy historical perspective|Historical Perspective]]== |
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| | ==[[Diabetic retinopathy classification|Classification]]== |
| ==Historical Perspective== | |
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| Although diabetes was a well known disease since 2nd AD, no one ever linked this disorder to the eye. In 1946 Appolinaire Bouchardat firstly reported vision loss in the absence of cataract in diabetes. After the introduction of [[ophthalmoscopes]] in 1985, Edward Jaeger firstly described the diabetic macular changes in the form of yellowish spots that permeated retina. These observations were challenged as there were no proofs whether macular changes were directly related to diabetes, or they were caused by hypertension and atherosclerosis. In the beginning of the 20th century, Arthur James Ballantyne suggested that diabetic retinopathy represents a unique form of vasculopathy and his work showed for the first time the role of capillary wall alterations in the development of diabetic retinopathy.
| | ==[[Diabetic retinopathy pathophysiology|Pathophysiology]]== |
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| | ==[[Differentiating Diabetic retinopathy from other diseases|Differentiating Diabetic retinopathy from other Diseases]]== |
| == Pathophysiology== | |
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| | ==[[Diabetic retinopathy epidemiology and demographics|Epidemiology and Demographics]]== |
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| The [[retina]] is a multicellular photon sensor, a unique component of the central nervous system, which is structured on the vessels. So what is diabetic retinopathy, one disease or two?
| | ==[[Diabetic retinopathy risk factors|Risk Factors]]== |
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| Promoted by the observations that there is a selective loss of [[pericytes]] early in diabetic retinopathy, they have attracted the interests of many researchers. Pericytes are enigmatic cells, which are regular components of all human [[tissues]] and [[organs]]. In contrast to [[arteries]] and [[arterioles]] where the coverage consists of the smooth muscle cells, the capillary system is individually covered by the pericytes. Pericytes are codependent on the endothelial cells. Normal pericytes have a contractile function that helps to regulate capillary blood flow. The loss of pericytes, due to [[diabetic inflammation]], is followed by the loss of capillary [[endothelial]] cells. [[Apoptosis]] of the pericytes, leads to the disappearance of both types of cells. Since neurons in the retina have high metabolic requirements, the hypoxia that results from extensive retinal capillary cell death is a probable stimulus for the increased expression of molecules that enhance the breakdown of the [[blood–retinal barrier]] and lead to vascular proliferation or [[angiogenesis]]. Angiogenesis is a complex process, characterized by a cascade of events:
| | ==[[Diabetic retinopathy screening|Screening]]== |
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| 1: Initial [[vasodilatation]] of existing vessels
| | ==[[Diabetic retinopathy natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| 2: Increased vascular permeability and degradation of the surrounding matrix,
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| 3: [[Migration]] and tube forming of the activated and proliferating endothelial cells
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| 4: Maturation and remodeling of these new vessels takes place to form a vascular network. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the [[vitreous]]. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls, and they ultimately leak blood. Retinal damage can result from persistent [[vitreous haemorrhage]]. On the other hand, contraction of associated fibrous tissue formed by proliferative disease tissue can result in deformation of the retina and tractional retinal detachment. The detachment may tear the retina [[(rhegmatogenous) ]]or may not [[(non-rhegmatogenous)]]. The non-rhegmatogenous retinal detachment is worse and is characterized by the
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| 1: Confined retina ;
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| 2: A taut and shiny appearance ;
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| 3: Concave retina toward the pupil;
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| 4: No shifting of sub retinal fluid.
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| The cascade of these events causes vision loss.
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| Recent studies have also focused on the neural component of the retina and have shown that [[diabetic neuropathy]] of the neuroglial cells may play an important role in the disease.
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| ==Classification== | |
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| The disease is classified according to types of lesions detected on fundoscopy into non-proliferative diabetic retinopathy and proliferative diabetic retinopathy.
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| Non-prolifrative diabetic retinopathy is subdivided into mild, and moderate-to-severe forms.
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| Mild non-proliferative diabetic retinopathy
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| 1: [[Microaneurysms]]
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| 2: Dot and blot hemorrhages
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| 3: Hard (intra-retinal) exudate
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| Moderate-to-severe non-proliferative diabetic retinopathy
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| Is mild non-proliferative diabetic retinopathy plus:
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| 1: [[Cotton-wool]] spots
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| 2: [[Venous beading]] and loops
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| 3: Intraretinal microvascular abnormalities ( IRMA )
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| Proliferative diabetic retinopathy
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| 1: Neovascularization of the retina, [[optic disc]] or [[iris]]
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| 2: [[Fibrous tissue]] adherent to vitreous face of retina
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| 3: Retinal detachment
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| 4: Vitreous hemorrhage
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| 5: Pre-retinal hemorrhage
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| === Genetics ===
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| === Associated Conditions===
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| ===Gross Pathology===
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| ===Microscopic Pathology===
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| == Epidemiology and Demographics ==
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| The prevalence of retinopathy is strongly related to the duration of diabetes. After 20 years of diabetes, nearly all patients with type 1 diabetes and >60% of patients with type 2 diabetes have some degree of retinopathy. In the Wisconsin Epidemiologic Study of Diabetic Retinopathy, 3.6% of patients with type 1 diabetes and 1.6% of type 2 diabetes were legally blind. In the type 1 diabetes, 86% of blindness was attributable to diabetic retinopathy. The cumulative incidence of any retinopathy in type 1 diabetes was 97%. In the type 2 diabetic patients, where other eye diseases were common, one-third of the cases of legal blindness were due to diabetic retinopathy.
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| ===Age===
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| ===Gender===
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| ===Race===
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| ===Developed Countries===
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| ===Developing Countries===
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| == Risk Factors ==
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| == Screening ==
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| == Natural History, Complications and Prognosis==
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| == Diagnosis ==
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| ===History===
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| A directed history should be obtained to ascertain
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| === Symptoms ===
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| The first symptoms, is no symptoms.
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| Blurred vision and slow vision loss over time
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| Eye floaters and spots
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| Shadows or missing areas of vision (due to hemorrhage)
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| Trouble seeing at night
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| Fluctuating vision
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| Blurry and/or distorted vision
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| Double Vision
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| And other symptomes related to diabetic ocular disease
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| ===Past Medical History===
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| ===Family History===
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| ===Social History===
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| ====Occupational====
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| ====Alcohol====
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| The frequency and amount of alcohol consumption should be characterized.
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| ====Drug Use====
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| ====Smoking====
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| ===Allergies===
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| === Physical Examination ===
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| ==== Appearance of the Patient ====
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| ====Vital Signs====
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| ====Skin====
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| ====Head====
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| ==== Eyes ====
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| ==== Ear ====
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| ====Nose====
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| ====Throat ====
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| ==== Heart ====
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| ==== Lungs ====
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| ==== Abdomen ====
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| ==== Extremities ====
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| ==== Neurologic ====
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| ====Genitals====
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| ==== Other ====
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| === Laboratory Findings ===
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| ==== Electrolyte and Biomarker Studies ====
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| ==== Electrocardiogram ====
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| ==== Chest X Ray ====
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| ====CT ====
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| ==== MRI ====
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| ==== Echocardiography or Ultrasound ====
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| ==== Other Imaging Findings ====
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| === Other Diagnostic Studies ===
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| == Treatment ==
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| === Pharmacotherapy ===
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| ==== Acute Pharmacotherapies ====
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| ==== Chronic Pharmacotherapies ====
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| === Surgery and Device Based Therapy ===
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| ==== Indications for Surgery ====
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| ==== Pre-Operative Assessment ====
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| ==== Post-Operative Management ====
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| ==== Transplantation ====
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| === Primary Prevention ===
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| === Secondary Prevention ===
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| === Cost-Effectiveness of Therapy ===
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| === Future or Investigational Therapies ===
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| ==References==
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| {{reflist|2}}
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| {{WikiDoc Help Menu}}
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| {{WikiDoc Sources}}
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| [[Category:Disease]]
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| ==[[Diabetic retinopathy overview|Overview]]==
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| ==[[Diabetic retinopathy pathophysiology |Pathophysiology]]==
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| ==[[Diabetic retinopathy differential diagnosis|Differentiating Diabetic retinopathy from other Diseases]]==
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| ==[[Diabetic retinopathy epidemiology and demographics|Epidemiology and Demographics]]==
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| ==[[Diabetic retinopathy risk factors|Risk Factors]]==
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| ==[[Diabetic retinopathy screening|Screening]]==
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| ==[[Diabetic retinopathy natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
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| ==Diagnosis== | | ==Diagnosis== |
| [[Diabetic retinopathy history and symptoms|History and Symptoms]] | [[Diabetic retinopathy physical examination|Physical Examination]] | [[Diabetic retinopathy laboratory findings|Laboratory Findings]] | [[Diabetic retinopathy ultrasound|Ultrasound]] | [[Diabetic retinopathy other imaging findings|Other Imaging Findings]] | [[Diabetic retinopathy other diagnostic studies|Other Diagnostic Studies]] | | [[Diabetic retinopathy history and symptoms|History and Symptoms]] | [[Diabetic retinopathy physical examination|Physical Examination]] | [[Diabetic retinopathy laboratory findings|Laboratory Findings]] | [[Diabetic retinopathy electrocardiogram|Electrocardiogram]] | [[Hashiomoto's thyroiditis chest x ray|Chest X Ray]] | [[Diabetic retinopathy CT|CT]] | [[Diabetic retinopathy MRI|MRI]] | [[Diabetic retinopathy echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Diabetic retinopathy other imaging findings|Other Imaging Findings]] | [[Diabetic retinopathy other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
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| [[Diabetic retinopathy medical therapy|Medical Therapy]] | [[Diabetic retinopathy surgery|Surgery]] | [[Diabetic retinopathy primary prevention|Primary Prevention]] | [[Diabetic retinopathy secondary prevention|Secondary Prevention]] | [[Diabetic retinopathy cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Diabetic retinopathy future or investigational therapies|Future or Investigational Therapies]] | | [[Diabetic retinopathy medical therapy|Medical Therapy]] | [[Diabetic retinopathy surgery|Surgery]] | [[Diabetic retinopathy primary prevention|Primary Prevention]] | [[Diabetic retinopathy secondary prevention|Secondary Prevention]] | [[Diabetic retinopathy cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Diabetic retinopathy future or investigational therapies|Future or Investigational Therapies]] |
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| ==Case Studies== | | ==Case Studies== |
| :[[Diabetic retinopathy case study one|Case #1]]
| | [[Diabetic retinopathy case study one|Case #1]] |
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| ==Related chapters== | | ==Related chapters== |
| *[[List of terms associated with diabetes]] | | *[[List of terms associated with diabetes]] |
| ==External links== | | *[[Diabetic neuropathy]] |
| | *[[Diabetes]] |
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| | ==External Links== |
| *[http://www.nei.nih.gov/health/diabetic/retinopathy.asp Diabetic Retinopathy] Resource Guide from the National Eye Institute (NEI). | | *[http://www.nei.nih.gov/health/diabetic/retinopathy.asp Diabetic Retinopathy] Resource Guide from the National Eye Institute (NEI). |
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| [[Category:Ophthalmology]] | | [[Category:Ophthalmology]] |
| [[Category:Diabetes]] | | [[Category:Pediatrics]] |
| [[Category:Blindness]]
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| [[Category:Endocrinology]] | | [[Category:Endocrinology]] |
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