CONTENTS
PREFACE
A. WHY DIABETIC RETINOPATHY?
1 Our National Health
2 Scottish Diabetes Framework
B. WHAT DO WE KNOW ABOUT DIABETIC RETINOPATHY?
1 SIGN Guidelines- The Evidence
C. WHAT IS DIABETES?
1 Definition
2 Classification
3 Biochemical Abnormalities
4 Symptoms
5 Diagnosis
6 Epidemiology
7 Vascular Complications
8 Metabolic Management
D.WHAT IS THE NORMAL APPEARANCE OF THE EYE?
1 External Appearance
2 Retina
3 An Overview of the Microscopic Anatomy of Blood Vessels
E.WHY DO THE FEATURES OF DIABETIC RETINOPATHY OCCUR?
1 The Effect of High Blood Sugars on the Eye
F.HOW DO WE GRADE (ASSESS) DIABETIC RETINOPATHY?
1 The Photographic Gold Standard- The Airlie House Grading System
2 The Scottish Diabetic Retinopathy Grading System
3 Historical Background
4 Ophthalmic Classification
G.HOW SHOULD WE ORGANISE SCREENING FOR DIABETIC RETINOPATHY?
1 The Health Technology Board for Scotland Advice on the Organisation of Diabetic Retinopathy Screening Programmes in Scotland 2002
H.WHAT ARE THE PRACTICAL ASPECTS OF SCREENING FOR DIABETIC RETINOPATHY?
1 Visual Acuity Measurement and Pupillary Dilation
2 Fundal Photography
3 Ophthalmoscopy for Technical Failures and Sporadic Screening
I. WHAT CAN BE DONE TO PREVENT ONSET AND PROGRESSION OF DIABETIC RETINOPATHY?
1 Tight Blood Pressure Control
2 Good Control Of Blood Sugars
3 Warning: Rapid Tightening Of Control May Cause Worsening of Diabetic Retinopathy
4 Treatment Of Hyperlipidaemia
5 Correction Of Anaemia
6 Smoking
7 Other Pharmacological Interventions
8 Special Circumstances
J. HOW DO WE TREAT SIGHT THREATENING RETINOPATHY?
1 Macular Oedema
2 Proliferative Retinopathy
3 Practical Aspects Of Laser Therapy
4 Surgery
EDITOR John Olson, Consultant in Medical Ophthalmology, Aberdeen
CONTRIBUTORS David Cline, Scottish Executive Health Department, Edinburgh
Angela Ellingford, Co-ordinator, Mobile Screening Service, Dundee
Karen Facey, Interim Director, Health Technology Assessment, NHS Quality Improvement Scotland, Glasgow
Alison Farrow, Senior Ophthalmic Photographer, University of Aberdeen, Aberdeen
Julie Freeland, Staff Nurse, Aberdeen
Keith Goatman, Bio-Medical Physicist, University of Aberdeen, Aberdeen
Graham Leese, Diabetologist, Dundee
Malcolm McPherson, Optometrist, Aberdeen
Moray Nairn, Scottish Intercollegiate Guidelines Network, Edinburgh
John Olson, Consultant in Medical Ophthalmology, Aberdeen
The Editor would like to thank the Early Treatment of Diabetic Retinopathy Study Research Group for permission to use the ETDRS standard photographs in this manual. Photographs were also kindly obtained from the department of Medical Illustration, University of Aberdeen, Malcolm McPherson, Aberdeen and John Ellis, Dundee.
Thanks also go to Deborah Broadbent, Liverpool, Simon Harding, Liverpool, David Owens, Cardiff and Peter Scanlon, Cheltenham for their support and encouragement.