Diabetic retinopathy questions!

I'm a type 1 diabetic (although I don't post here frequently) who actually works as a diabetic screener for diabetic retinopathy testing. I just wanted to say if anyone has any questions in regards to this/the procedure etc etc please ask me!!

CarbsRok said:

Just curious as to who actually reads the scan/photograph once taken Thank you

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Well it may be different in terms of each programmes area but in the area I work in, it works as I take the photographs and I also grade/examine the images. These are then quality assured by two different people looking at the images who work on the programme and also we have a clinical lead on ours who often reviews the images etc - again another quality assurance.
In terms of the report that gets sent out, here the results letter goes to the patient themselves and also their GP.

Roland1961 said:

Hi. Had my first retinal screening the other day. 4 nice white flashes that made my eyes run !!
I looked at the resulting images on the laptop with the chap and asked what he was looking for. Please correct my understanding if I got it wrong :
He was looking for small aneurysms which are associated with diabetes ( type 1 and type 2 I think ) and they normally refer when they see about 100 or more. We looked at mine and could not see 1 aneurysm.
How quickly do they develop and under what conditions ? What is the normal treatment ( is it really laser ) ?
Many thanks for answering these

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Hello!!
What we look for are indeed those microaneurysms which are small bleeds/swelling of blood vessels at the back of the eye and yes these occur in both type 1 and 2 diabetics.
There are general stages with diabetic retinopathy which are:

• Stage one: background retinopathy – tiny bulges (microaneurysms) appear in the blood vessels of your eye, which can leak blood.
• Stage two: pre-proliferative retinopathy –more severe and widespread changes are seen in the retina, including bleeding into the retina.
• Stage three: proliferative retinopathy – new blood vessels and scar tissue will have formed on your retina, which can cause loss of vision.
• Stage four: advanced diabetic retinopathy – this can cause either bleeding into the eye, resulting in sudden loss of vision (vitreous haemorrhage) or retinal detachment. This is when the retina pulls away from the wall of the eye and a layer of blood vessels

What causes the patient to have diabetic retinopathy is high blood sugar levels which can damage those tiny vessels that supply blood to your retina. But also even if you had background retinopathy - you may not always have it, those little bleeds can actually go away with better control of the diabetes. I also hate to say this but the longer you have had diabetes the greater the chance of developing retinopathy - I'm not trying to scare anyone one this forum as I have seen patients with Type 1 diabetes who have had it for 30+ years and have healthy/normal eyes!

Treatment usually happens when you have what we consider "sight threatening retinopathy" and yes currently this is laser treatment and also injections into the eye. The type of laser we use is called photocoagulation.

novorapidboi26 said:

how does one find themselves in a eye photographer position?................

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I actually started in an admin position so booking appointments etc for the diabetic screening - a job position came up for a screener/grader - I applied and got it! I am very passionate and interested particularly in this subject as being type 1 myself and having the test every year, I find it very interesting!

Maculopathy is "exudates" which are precipitates of lipoproteins/other proteins leaking from retinal blood vessels. This is only referrable if it is within a certain measurement of the fovea (the part of the eye used for central/sharp vision). Usually when maculopathy is present, it presents itself with at least R1 - background retinopathy if not more advanced retniopathy. Hope that makes sense!!

Roland1961 said:

Hi
Many thanks for the info.
Just a couple of remaining questions :
Are the micro-aneurysms actually visible on the image seen on the laptop or do they require enlarging to confirm ?
Is the value given to me ( about 100 ) actually a true figure that analysers work to ?
If so, why is it so high, surely the quicker the response the less chance of irrecoverable long term damage ?
Many Thanks

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With some micro-aneurysms some are indeed visible when images are taken as some can be a bit large in size but generally as a rule they are quite small/round and dark. So it does require looking at on a bigger screen to fully look at the vessels and each quadrant of the image.
Umm 100 is irrelevant as if you had a handful of micro-aneurysms and more advanced symptoms of diabetic retinopathy then it would them become referable, Having 100 micro-aneurysms (by the way I've never seen this many and nobody on my programme has ever come across that many!) on their own what not warrant a referral and as I've said I've never seen anyone with that many and I'd be surprised if anyone had!

novorapidboi26 said:

So in fact maculopathy is actually a stage further on from retinopathy rather than simply just the position of it...........

so in my case protein has been observed seeping from some of the blood vessels.....?

what will happen to this protein residue if my control and BP improves.....?

you have been very helpful, thanks.........

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Usually maculopathy has to have some laser treatment which will get rid of it, but generally if you keep your BS down and everything improves you should see less of a problem with the retinopathy!

I'm going to copy and paste a bit off the internet here as we don't actually deal with any treatment, that would be an ophthalmologist who would be doing it!
Here's what I can tell you:

"The type of laser treatment used to treat diabetic retinopathy is called photocoagulation.
A course of photocoagulation usually involves one or more visits to a laser treatment clinic. An ophthalmologist will carry out the procedure, which is usually available on an outpatient basis. This means you will not have to stay in hospital overnight.
Before the procedure, you will be given a local anaesthetic to numb the surface of your eye, as well as eye drops to widen your pupils. A special contact lens will be placed on your eye to hold your eyelids open and allow the laser beam to be focused onto your retina.
Small laser beams will be aimed at the damaged area of your retina. These will seal any blood vessels that are leaking and destroy any abnormal blood vessels that have grown in your retina.
Photocoagulation is not usually a painful procedure but you may feel a sharp pricking sensation when certain areas of your retina are being treated.
If you have had laser treatment in the past, you may experience some discomfort during the treatment. If you do, your doctor may give you stronger painkillers or a mild sedative.

After the procedure:
After laser treatment, your vision may be blurred. However, it should return to normal after a few hours.
Your eyes may also be more sensitive to light, and some people wear sunglasses until their eyes have adjusted.
You will not be able to drive after having laser surgery, so ask a friend or relative to drive you home or take public transport.
If you have had previous eye treatment, your eyes may ache afterwards. Over-the-counter painkillers, such as paracetamol, should help.
Photocoagulation can sometimes affect your night vision and peripheral vision (side vision).
Over 50% of people who have laser treatment for diabetic retinopathy notice some difficulty with their night vision, and 3% experience some loss of peripheral vision."

noblehead said:

This is a great thread McMittens

I don't know if you've seen this website before but I found it extremely useful and often post a link to it when members are wanting to know about diabetic retinopathy:

http://www.diabeticretinopathy.org.uk/Information_for_patients.html

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Great website and very useful! Cheers!!

daniT1D said:

Hello, I have just searched retinopathy following my screening and was very pleased to come across your post

The guy who did my scans said one eye was fine, the other has a swollen vessel which "should be ok unless it bursts" :O
Thanks for that! I asked if I need to go back for more regular check ups but he said no just annually.

Could you explain this for me please


Sent from the Diabetes Forum App

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Hello!
I'm not sure why the guy who saw you said "it should be ok unless it bursts"!!! It sounds like what he meant was that there's a micro-aneurysm and as long as you have a good control of your diabetes then that little micro-aneurysm won't become a retinal bleed or hemorrhage!
Also the test is indeed annually and that is standard procedure unless we see anything that needs to be referred to the hospital eye service.