13.1

Non-Proliferative Diabetic Retinopathy

Introduction:

Diabetic retinopathy (DR) is the most common cause of new onset blindness in people between the ages of 20 and 74 years in developed countries. DR is estimated to eventually affect one-third of patients with diabetes. The prevalence and severity are affected by the duration of diabetes, glycemic control, and the presence of concurrent hypertension. It is estimated that in 2005–2008, 4.2 million (28.5%) people with diabetes aged 40 years or older had DR, and of these, almost 0.7 million (4.4% of those with diabetes) had advanced DR

Clinical Features:

In the early stages, non-proliferative diabetic retinopathy (NPDR) is typically asymptomatic. Retinal manifestations of DR are caused by a microangiopathy that manifests itself as microaneurysms; the hallmarks of NPDR are intraretinal hemorrhages, cotton wool spots, hard exudates, and, in some eyes, macular edema (Fig. 13.1.1). Venous beading and intraretinal microvascular abnormalities may happen in severe NPDR. NPDR is sub-classified as mild, moderate or severe based on the presence and severity of these findings.

Figure 13.1.1 Color fundus photograph showing intraretinal hemorrhages, microaneurysms, cotton wool spots and hard exudates in a patient with NPDR. The red free photo is especially useful in evaluating for microaneurysms.

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