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retinopathy (diabetes mellitus)

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Diabetic retinopathy (DR) is a chronic progressive, potentially sight-threatening disease of the retinal microvasculature associated with the prolonged hyperglycaemia and other conditions linked to diabetes mellitus such as hypertension (1).

  • DR is the most common eye problem associated with diabetes
    • other ocular complications of diabetes may include:
      • specific to progression of the ocular disease e.g. - cataract, rubeosis ridis
      • non-specific recognised associations of diabetes in the eye e.g. - glaucoma, retinal vein occlusion/optic disc swelling (1)
  • it is a microangiopathy affecting the retinal precapillary arterioles, the capillaries and the venules

The risk of developing diabetic retinopathy is greater with longer duration of diabetes

  • large longitudinal studies of patients with diabetes in Wisconsin reported that
    • retinopathy develops within five years of diagnosis of diabetes in about
      • 25% of people with type 1 diabetes
      • 40% of people with type 2 diabetes who are taking insulin and 24% of people with type 2 diabetes who are not taking insulin
      • the 25 year cumulative rate of progression to
        • diabetic retinopathy was 83%
        • diabetic macular oedema was 29%
        • clinically relevant macular oedema was 17% 
  • in addition to duration of diabetes, poor glycaemic control and uncontrolled hypertension is also associated with greater risk of DR (when compared to patients with good control of these factors)  (2)

A change in the vision in DR has two basic mechanisms:

  • retinopathy - diabetes related damage to the whole retina
  • maculopathy - specific diabetes related damage to the central fovea (3).

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