Diabetic Retinopathy Grading amp Burden

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Hamid on Mar 31, 2011 Says :

Thats great.thanks

ali on Mar 11, 2011 Says :

thats great. very thanks

ashim on Oct 06, 2009 Says :

useful ,looking forward for more slides

dmoin on Oct 02, 2009 Says :

useful lec.

vivek on Sep 26, 2009 Says :

really useful. expecting more downloadable slides...............

dr.enayar rezaei on Sep 19, 2009 Says :

diabetic retinopathy

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Slide 1 :

Diabetic Retinopathy Grading & Burden Dr John A. Olson MD FRCP Consultant Medical Ophthalmology Aberdeen Royal Infirmary (Please use Notes Page view)

Slide 2 :

Classification of Diabetic Retinopathy Non-Proliferative Proliferative Maculopathy

Slide 3 :

Manual Grading Classical 2

Slide 4 :

How Did We Get Here? DRS - does laser work ? ETDRS - when should it be applied ? But: Pre- HBA1c Pre- Home glc monitoring

Slide 5 :

Grading Today ETDRS EURODIAB 2 X 50° fields per eye = Interim ETDRS grading Aldington 1995

Slide 6 :

% of Patients Developing PDR by severity of Microaneurysms/Haemorrhage

Slide 7 :

Cotton Wool Spots & Exudates CWS in isolation, same risk of severe visual loss as exudates

Slide 8 :

% of Patients Developing PDR by severity of Venous Beading Retinal pallor indicating areas of extensive capillary occlusion either side of beading IRMA, see later

Slide 9 :

% of Patients Developing PDR by severity of IRMA CWS a b

Slide 10 :

New Vessels Presence Site Size Vitreous Haemorrhage ? 3 = High Risk PDR

Slide 11 :

Advanced DR Persistent Vitreous Haemorrhage Traction Retinal Detachment Rubeotic Glaucoma

Slide 12 :

ETDRS Final Retinopathy Severity Scale

Slide 13 :

Practical Retinopathy Severity Scale

Slide 14 :

Risk of High Risk PDR

Slide 15 :

Maculopathy Clinically Significant Macular Oedema (CSMO) ((grey patches) tide mark of exudates

Slide 16 :

20/20 Vision CSMO ETDRS Geometric Centre NOT involved Geometric Centre INVOLVED

Slide 17 :

Grading Options For Screening Interim ETDRS DCCT WESDR EURODIAB Final ETDRS All current drug trials New Grading system Empirical Redefine

Slide 18 :

Image Quality

Slide 19 :

Red-free vs Colour Red-free Better contrast Haemorrhages IRMA VB NV

Slide 20 :

The “Burden” Digital Camera Trained Graders Sensitivity 81-100 % Specificity 97-100 %

Slide 21 :

21st Century Solution Automated grading will reduce the workload by 50 %

Slide 22 :

The Advantages of being the Professor Queen’s Anniversary Prize for Medical Imaging

Slide 23 :

The Eye Clinic may not be the best place 3 step deterioration in retinopathy Cumulative incidence of laser

Slide 24 :

Anyone can measure blood pressure

Slide 25 :

Triage No/ Mild NPDR Annual review Mod/ Mod severe NPDR 6 monthly photography Dedicated Diabetes clinic ? Severe NPDR Ophthalmology referral

Slide 26 :

Resources UK National Screening Committee's recommendations: Preservation of Sight in Diabetes; a risk reduction programme Health Authority 600,000 2.5% diagnosed with diabetes 85% initially attend 8% referred first year ( ? “pre-proliferative”) 3% by year 4 Ad hoc schemes already reach 60% but sensitivity ?

Slide 27 :

Ophthalmology Manpower 600,000 2.5% 15,000 to screen 1020 new visits year 1 2 clinics a week 4 return clinics a week 420 year 4 1 clinic a week Nurse, Photographer, Optician,Secretary, Reception

Slide 28 :

Laser Sessions 6 patients per session 5 % of 12,000 250 sessions year 1 6 clinics a week ! 117 year 4 2 clinics a week One WTE Ophthalmologist

Slide 29 :

Only if carefully planned. Yes, but let’s make sure its the right difference.

Slide 30 :

Will it be enough ? Will it make a difference ?

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