Overview of Diabetic retinopathy. Will go over epidemiology, basic anatomy, pathophysiology, symptomatology, diagnostic approach, management and complications.

0:15 - Epidemiology
2:40 - Basic anatomy of the eye
4:14 - Pathophysiology
10:33 - Clinical presentation
10:56 - Diagnostic approach
12:15 - Management

Complication of Diabetes mellitus - diabetic retinopathy. These patients are at very high risk of developing blindness. It is split into two stages - non-proliferative diabetic retinopathy and proliferative diabetic retinopathy. The majority of the patients are asymptomatic until later stages where the disease state is irreversible. Therefore, patient education is the key here!

Basic anatomy - Retina, retinal arteries and veins, optic nerve, macula, fovea, vitreous body, aqueous humor, iris, pupil, lens.

Pathophysiology - Non-proliferative and proliferative
1. Non-proliferative - Micro-aneurysm, intraretinal hemorrhages, nerve fiber layer infarcts and hard exudates
2. Proliferative - neovascularization

Pericytes - provide structural support to the capillaries.
In DR, there structures are destroyed which results in micro-aneurysms, and intraretinal hemorrhages.

Blood retinal barrier is also compromised due to damage to the endothelial cells and basement membranes resulting in hard exudates

Low-grade inflammation that occurs during hyperglycemic states can cause leukostasis, occlusion, and eventual ischemia. This will show up as the cotton wool spots 2/2 infarcted nerve fiber endings.

Ischemic states cause the release of VEGF (Vascular endothelial growth factor)
- VEGF causes neovascularization and increases vascular permeability
- Vessels formed through this process are very weak therefore they rupture easily resulting in retinal hemorrhages and macular edema (this occurs due to increased permeability)

Complications of Neovascularization - 1. Vitreous hemorrhage 2. Retinal detachment 3. Acute glaucoma

The most common cause of vision loss in DR is thru macular edema

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