Sunday, December 4, 2022

What Is Diabetic Retinopathy Screening

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Diabetic Eye Screening Programme

What is Diabetic eye screening? – Dr. Nitin Shetty

Diabetic retinopathy is an eye condition that occurs when high blood sugar levels damage the cells in the retina. The blood vessels in the retina can leak or become blocked. This condition may cause blindness or serious damage to eyesight.

For people who have diabetes, screening is important because their eyes are at risk of damage from diabetic retinopathy. Screening is a key part of diabetes care. Screening is offered every 2 years to anyone with diabetes aged 12 or over with low risk of sight loss.

People who are at high risk of sight loss should continue to receive annual or six-monthly screening.

NHS Boards ensure that the diabetic eye screening service meets the NHS Healthcare Improvement Scotland standards.

Understanding Diabetic Eye Screening Results

You will get a letter with your results from your eye screening within six weeks. When you get them you will see an ‘R’ followed by a number. The R stands for retinopathy and the number tells you how much damage, if any, has been done.

Depending on what your results say, you will have different steps to follow.

Your results

Proliferative retinopathy

You will be seen by an eye specialist quickly and taken through your treatment options

You might also see an ‘M’ which stands for maculopathy. This is when fluid builds up in part of your eye. Once again there will be a number which will tell you your result. M0 means there is no reason to worry yet and M1 means that you will need treatment for maculopathy.

If youre not sure what the results mean or have any questions about what to do next, speak to your local eye screening service. Make a note of the results and get to know what they mean – its important that you understand any changes and what you can do to prevent them getting worse.

You are more likely to reverse any eye damage if you find it early on. That is why going to regular eye screening appointment is essential.

Prepare For Your Visit

Some patients should be prepared to have their pupils dilated as this will provide a better look at the inside of the eye. The exam will likely also check for glaucoma and cataracts, both of which occur more frequently in people with diabetes and can cause vision problems. Be sure to be prepared to remove contact lenses, if applicable.

Dilation Process :

  • We will not dilate if the patient has glaucoma/family history of glaucoma, or of pregnant.

  • It is safe to dilate patients post-cataract or post Lasik.

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How Can I Access Screening

Everyone with diabetes who is 12 years old or over is invited for eye screening once a year. If its been more than a year since your last test and you have not had a letter, you can contact your GP practice or optician.

You can also book an appointment with the Essex Diabetic Eye Screening Programme. You can call them on 01245 806100, or email them at

Privacy Overview

Why Screen For Diabetic Retinopathy At All

System

One of the prime motivating factors behind the development of a screening programme for diabetic retinopathy is the efficacy of laser photocoagulation treatment in preventing visual loss. The beneficial effect of laser treatment was established by two large randomized clinical trialsthe Diabetic Retinopathy Study and the Early Treatment Diabetic Retinopathy Study . The essential findings of these trials were that, compared with no treatment, laser photocoagulation prevented visual loss in patients with proliferative diabetic retinopathy and macular oedema by about 50%., The ETDRS also served to identify points in the natural history of diabetic retinopathy at which laser photocoagulation treatment should be applied. From epidemiological data we know that patients are usually symptom-free at these threshold levels of retinopathy: retinopathy may be well advanced before visual deterioration is noticed. That patients are generally symptom-free when they should receive preventive treatment is a strong argument for establishing a screening programme.

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Automated Image Analysis: Before And After Ai

Telemedical assessment of CFP for DR screening requires a large amount of trained graders in reading centers to cope with the rising volume of images. For this and other reasons, the prospect of automated analysis of retinal images has garnered interest from ophthalmologists and computer scientists alike. The first publication analysing computer-aided detection in ophthalmology was published in 1973, focusing on the detection of contour lines of retinal vessel images.60 In 1984, a French group was the first to describe microaneurysms in fluorescein angiography.61 The development of digital photography and technical advances in computing power led to computer-aided diagnosis systems, which not only incorporate qualitative detection of features but also enable calculation of disease probability and risk stratification. To provide guidance, the American Telemedicine Association has therefore released statements on the quality,62,63 namely to validate against the gold standard ETDRS 30° seven-field stereoscopic CFP.43

In 2016, Gulshan et al published the results of a study sponsored by Google Inc, about DR detection by a CNN trained on about 128,000 CFP graded by 54 US licensed ophthalmologists and ophthalmology residents.82 Similar to IDx-DR the model could detect referrable DR with an AUC of 0.991 and 0.990 for the EyePACS-1 and MESSIDOR-2 datasets, sensitivity/specificity for EyePACS-1 were 90.3%/98.5% and 87.0%/98.% for MESSIDOR-2.

You’ll Get A Letter About The Test

If you have diabetes and you’re aged 12 or over, you’ll get a letter every year asking you to have an eye screening test.

Sometimes you may have a choice of:

  • when you have the test
  • where you have the test there may be more than 1 place to choose from in your area

Follow the instructions on the letter to book a test.

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Early Detection For Diabetic Retinopathy Can End Preventable Blindness

Managing your diabetes through medication, diet, and physical activity is key in treating Diabetic Retinopathy. When in a mild stage, regulated blood sugar levels can typically slow the progression of the disease. Its important to work with your Endocrinologist to monitor your condition and take any additional steps necessary to help improve your diabetes. Anyone with a long history of diabetes, especially with poorly or uncontrolled blood sugar, should have regular eye exams.

Types of Diabetic Retinopathy:At your exam, our technicians will place you in a dark room to help naturally dilate your eyes. If they do not dilate on their own, drops will be placed in your eyes to open your pupils, allowing them to get a better look inside of your eye. Once your eyes have dilated, we will look for new or abnormal blood vessels, swelling, blood, or fat leaking into the retina, growth of new blood vessels or scar tissue, bleeding in the vitreous, retinal detachment, and deformities in the optic nerve.

Diabetic Retinopathy: What It Is And Why An Annual Screening Is Essential

Retinopathy Screenings for Diabetics

Diabetes can be incredibly difficult on the body. While most people understand its impact on blood sugar management, diabetes can also lead to a range of other conditions, including diabetic retinopathy.

If left undiagnosed or untreated, diabetic retinopathy can rob you of your vision, potentially permanently. If you are wondering what diabetic retinopathy is, what the symptoms of diabetic retinopathy are, and why annual screening is so critical, heres what you need to know.

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What Is Diabetic Retinopathy

Diabetic retinopathy can occur when there is damage to the small blood vessels in a part of the eye called the retina. High blood sugar levels cause this damage in people with diabetes.

Over time, high blood sugar levels cause leaking and swelling of the tiny blood vessels. Vision loss results from a lack of oxygenated blood flow to the back of the eye, as well as leaking blood vessels into the retina.

The two main types of diabetic retinopathy are:

  • Nonproliferative diabetics retinopathy : In this early-stage blood vessel damage, the blood vessels begin leaking in the retina, causing poor blood flow. Over time, less oxygenated blood can flow through these vessels, depriving the retina of the oxygen it needs to function.
  • Proliferative diabetics retinopathy : In the later stage of blood vessel damage in the eye, abnormal blood vessels grow in response to a lack of oxygenated blood flow to the retina. When the retina does not receive oxygenated blood and new, weak blood vessels begin to form, they leak and bleed into the retina. This continual leaking moves into the fluid surrounding the retina, causing it to detach and cause severe and permanent vision loss.

Damage in both phases is observable during an eye examination with your ophthalmologist or optometrist .

Preparing For Your Appointment

You may be phoned to be given specific instructions before your appointment and we may ask you to:

  • arrive as close to the appointment time as possible
  • wear a face covering during your appointment, in line with national guidance
  • wait outside the building, sometimes at a specific door and always keeping distance from other people

If you’re invited to wait inside, we’ll follow government guidance and make sure everyone is spaced apart from each other.

Remember:

  • to bring all the glasses and contact lenses you wear, along with lens solution for contact lenses
  • you may be given eye drops to get a good photo so bring sunglasses with you in case the drops make your eyes feel sensitive
  • to think about how youll get home after your appointment if you need to have eye drops which can affect your vision
  • you should not drive for a few hours after you have them

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What To Do While You Wait For Your Screening Invite

While you wait for your next screening invite, it is important to be symptom aware. If you have any problems with your vision before your next screening appointment, contact your optician or GP.

Keeping blood glucose levels, blood pressure and cholesterol within the target range is important for your eye health. More information can be accessed on the Diabetes UK website or contact your diabetes clinic.

Treatments For Diabetic Retinopathy

Flow chart of diabetic retinopathy screening.

Treatment for diabetic retinopathy is only necessary if screening detects significant problems that mean your vision is at risk.

If the condition has not reached this stage, the above advice on managing your diabetes is recommended.

The main treatments for more advanced diabetic retinopathy are:

  • laser treatment
  • injections of medication into your eyes
  • an operation to remove blood or scar tissue from your eyes

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What Happens At The Retinopathy Screening

The optician will take a photo of your retina

To do this they will need to clearly see into as much of the back of your eye as possible.

To enable them, to do this they will give you eye drops which will expand your pupils. It may take up to 20 minutes for the pupils to get large enough.

The eye drops can sting a bit so just be ready. Try to keep your eyes open as best you can to avoid having to having to have additional attempts.

The fluid needs to cover the centre of your eye to make your pupils larger.

When your pupils are sufficiently expanded the optician will sit you down in front of a machine which will take the photograph of the retina in each of your eyes.

Your eyes must be fully open for a good photograph to be achieved. Be aware that it may take a few attempts to get the photograph just right.

As well as taking a retinal photo, you will also have your sight measured.

Screening For Diabetic Retinopathy

Throughout the industrialized world the complications of diabetic retinopathy remain the major cause of preventable visual loss in persons of working age. A reduction by one-third or more in new blindness due to diabetes has been adopted as one of the key 5-year targets in the St Vincent declaration, and the best way to achieve this aim is a national strategy of screening for diabetic retinopathy. In this article we review the rationale and supporting evidence for a screening programme for diabetic retinopathy. We also debate the arguments for and against the screening modalities that are currently used in the UK.

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Extended Screening Intervals For Those At Lowest Risk Of Sight Loss

If you had no diabetic retinopathy detected at your most recent screening tests, you are in the lowest risk group and can expect to wait longer than normal for your next screening appointment.

Evidence in recent years, endorsed by the UK National Screening Committee, has shown that is it safe for you to wait up to 24 months between screening appointments. The chance of you developing sight-threatening retinopathy between these appointments is very small.

Extending the screening interval for those people who are at lowest risk, will allow the limited appointments available at this time to be targeted to those who are at higher risk.

What Happens During Diabetic Retinopathy Screening

Diabetic Retinopathy Screening

Youll first be asked to read some letters on an eye chart. Next, drops will be put into your eyes to dilate your pupils. This allows more light to go into the eye, which makes it easier for the examiner to see the optic nerve and retina clearly and completely and to take a good photograph. The dilating eye drops may sting slightly. It should take around 15 minutes for the drops to take effect.

Once your pupils are adequately dilated, you will be asked to look into a piece of equipment that is essentially a camera. Photos will be taken of the back of your eyes. This is a non-invasive test and will not cause any pain, although there will be a bright flash when the picture is taken3.

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Causes Of Diabetic Retinopathy

The buildup of excess sugar in your blood can lead to a number of health issues. In your eyes, too much glucose can damage the tiny vessels that supply blood to your retina. Over time, this damage may block your blood flow.

Chronic damage to retinal blood vessels affects your vision. When your blood flow is diminished, your eye attempts to fix the situation by growing new blood vessels. The process of growing new blood vessels is called neovascularization. These vessels arent as effective or as strong as the original ones. They may leak or rupture, which can negatively impact your vision.

Diabetic retinopathy is a concern for anyone who has diabetes. There are additional risk factors for developing diabetic retinopathy:

Reduce Your Risk Of Diabetic Retinopathy

You can reduce your risk of developing diabetic retinopathy, or help prevent it getting worse, by:

  • controlling your blood sugar, blood pressure and cholesterol levels
  • taking your diabetes medicine as prescribed
  • attending all your screening appointments
  • getting medical advice quickly if you notice any changes to your vision

Read more about how to prevent diabetic retinopathy.

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Symptoms Of Diabetic Retinopathy

During the early stages of the condition, many people have little or no symptoms. However, as diabetic retinopathy worsens, people may have:

  • Blurry Vision
  • Darkness or Curtain-Like Shadow Over Visual Field
  • Blurred Vision

Retinal detachments can cause dramatic vision loss. Without quick action, the loss can be permanent. As a result, if you experience any of the symptoms above, its considered an emergency, and you should seek medical attention immediately.

When Will I Get My Diabetic Eye Screening Result

Diabetic Retinopathy

The results of your screening will not be available immediately and youll receive a letter with the results from your diabetic screening service. This can typically take around four to six weeks.

In diabetics, chronically high blood sugar can damage the tiny blood vessels in the retina. The clinician who reviews your comprehensive dilated eye exam will look for signs of these changes. These include microaneurysms and distortions in the blood vessels, haemorrhages, blockage of the blood supply to some parts of the retina and, in advanced stages, a proliferation of new blood vessels in response to the blockages. These new blood vessels are fragile and have a propensity to leak and bleed, which can lead to further complications such as scar formation and retinal detachment4.

You will get one of three diabetic retinopathy screening results3:

  • No retinopathy No changes are detected. Return in a year for another test.
  • Background retinopathy Small changes are detected, but your eyesight is not affected. Follow your doctors recommendations to prevent further eye damage. Return in one year for another screening.
  • Referable retinopathy Diabetes has caused damage to the eyes and your vision may be affected. You will be referred to a specialist for further advice. Screening tests may be required more often than annually, and you may need to start treatment for your eye damage.

References

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One In Three People Living With Diabetes Has Some Degree Of Diabetic Retinopathy And Every Person Who Has Diabetes Is At Risk Of Developing It

The disease usually affects both eyes, though one can be affected more than the other, and is caused when a patients blood pressure or blood sugar are too high. Over time, this can damage the blood vessels that supply blood to the retina in the eye, which coverts light into electrical signals and sends them to the brain. If the retina doesnt get the blood it needs, it cant work properly, meaning vision is affected. It can eventually cause permanent blindness.

The disease is progressive: at first, the blood vessels start to leak and eventually cause bleeding inside the eyes. There are three stages of retinopathy that mainly affect the central part of the retina and can cause permanent blindness, while a different type of the disease, called maculopathy, affects the middle of the eye.

People who have diabetes are also at higher risk of developing other eye problems, including cataracts and glaucoma.

Keeping blood sugar levels, blood pressure and cholesterol levels under control can prevent diabetes-related vision problems.

Injections and laser

If diabetic retinopathy is detected early, injections and laser treatment can stop the disease from progressing and prevent blindness.

Surgery

In the case of advanced diabetic retinopathy, surgery may be needed to remove blood and new blood vessels from the back of the eye.

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