Handbook of Retinal Screening in Diabetes

Roy Taylor, Prof of Medicine and Metabolism, University of Newcastle upon Tyne and Newcastle Diabetes Centre. Professor Taylor is a member of the Project Advisory Group of the National Screening Programme for sight-threatening diabetic retinopathy and President of The British Association of Retinal Screeners. Professor Taylor started the first mobile retinal camera service in 1986 and upgraded this to a digital screening system using high resolution equipment in 2000. He coordinates the data collection and analysis for 11 centres throughout the UK and is acclaimed as a leading expert on screening for sight-threatening diabetic retinopathy.

Preface. How to use this book. 1 Type 1 Diabetes. What causes type 1 diabetes? Who gets type 1 diabetes? How does it present? Essentials of management. Insulin. Food. Hypoglycaemia. Ketoacidosis. Living with type 1 diabetes. Blood glucose testing. Complications. History. Fact file. Further reading. 2 Type 2 Diabetes. What causes type 2 diabetes? Who gets type 2 diabetes? How does it present? Management. Eating. Physical activity. Tablets. Insulin. Living with type 2 diabetes. Blood glucose and urine testing. Complications. History. Further reading. Fact file. 3 The Eye in Diabetes. Structure of the normal eye. The retina. Diabetic retinopathy. Other diabetes-associated changes in the eye. Further reading. Fact file. 4 The Need to Screen. Is blindness preventable? Can the progression of retinopathy be slowed? Detecting asymptomatic retinopathy. The five principles of retinal screening. Quality assurance. History of the development of retinal screening by photography-based systems in the UK. Fact file. Further reading. 5 Practical Screening. Important first steps. Measuring visual acuity. Interpretation of visual acuity measurement. Instilling eye drops. Tropicamide. Other eye drops. Obtaining the image. Examining the image. Disc. Vessels. Retina. Explaining the results of screening. Organization of a district screening system. Links with your ophthalmologist. Further reading. Fact file. 6 Normal Retinal Appearances. Light reflection artefact (Figure 6.1). Light reflection artefact (Figure 6.2). Tortuous vessels (Figure 6.3). Tiger striping (Figure 6.4). Tiger striping (Figure 6.5). Myelinated fibres (Figure 6.6). Myopic crescent (Figure 6.7). Pigmented image (Figure 6.8). Asteroid hyalosis (Figure 6.9). Choroidal circulation (Figure 6.10). Eyelash artefact (Figure 6.11). 7 Background Retinopathy. What is background retinopathy? Lesions. Early background (Figure 7.1). Early background (Figure 7.2). Early background (Figure 7.3). Early background (Figure 7.4). Early background (Figure 7.5). Moderate background (Figure 7.6). 8 Severe Non-proliferative ('Pre-proliferative') Retinopathy. Severe non-proliferative retinopathy (Figure 8.1). Severe non-proliferative retinopathy (Figure 8.2). Severe non-proliferative retinopathy (Figure 8.3). Severe non-proliferative retinopathy (Figure 8.4). 9 Maculopathy. What is maculopathy? Management of maculopathy. Blood pressure control. Blood glucose control. Referral to ophthalmologist. Exudates close to the fovea (Figure 9.1). Severe retinopathy close to the macula (Figure 9.2). Widespread exudates (Figure 9.3). Large plaque exudates (Figure 9.4). Linear exudates close to the fovea (Figure 9.5). Plaque exudates near the fovea (Figure 9.6). Circinate exudates within the arcades (Figure 9.7). Widespread exudates with circinates (Figure 9.8). Coalescent exudates in the macula region (Figure 9.9). 10 Proliferative Retinopathy. What is proliferative retinopathy? New vessels on the disc (Figure 10.1). Disc new vessels (Figure 10.2). New vessels on the retina (Figure 10.3). Disc new vessels (Figure 10.4). New vessels on the retina (Figure 10.5). New vessels on the retina (Figure 10.6). Old pan-retinal laser scars (Figure 10.7). Pan-retinal laser scars (Figure 10.8). 11 Advanced Diabetic Eye Disease. What is advanced? Early fibrosis (Figure 11.1). Fibrosis (Figure 11.2). Fibro-vascular membrane (Figure 11.3). Pre-retinal haemorrhage (Figure 11.4). Pre-retinal haemorrhage (Figure 11.5). Severe exudative maculopathy (Figure 11.6). Pre-retinal haemorrhage and persisting new vessel formation (Figure 11.7). Pre-retinal haemorrhages (Figure 11.8). Fibrous band and heavy laser scars (Figure 11.9). 12 Non-diabetic Eye Disease. What other diseases are common? Other eye diseases. Glaucoma. Conjunctivitis. Sub-conjunctival haemorrhage. Uveitis. Drusen (Figure 12.1). Drusen (Figure 12.2). Atrophic chorioretinital scars (Figure 12.3). Old chorioretinitis (Figure 12.4). Papilloedema (Figure 12.5). One year later - same eye as Figure 12.5 (Figure 12.6). Papilloedema (Figure 12.7). Pigment epithelial hypertrophy (Figure 12.8). Cholesterol embolus (Figure 12.9). Branch retinal vein occlusion (Figure 12.10). Branch retinal artery occlusion (Figure 12.11). Glaucomatous disc (Figure 12.12). Macular hole (Figure 12.13). 13 Self-assessment Questions. Chapter 1. Chapter 2. Chapter 3. Chapter 4. Chapter 5. Chapters 6-12. 14 Background Information. Driving and diabetes. Insurance and diabetes. Employment and diabetes. Prescription charges. British Association of Retinal Screeners (BARS). Diabetes UK. National Retinopathy Screening Systems. Laser therapy. Vitrectomy. Ophthalmoscopy. 15 Answers to Self-assessment Questions. Chapter 1. Chapter 2. Chapter 3. Chapter 4. Chapter 5. 16 Glossary of Terms. Index.