Diabetic and Hypertensive Retinopathy

Definition | Diabetic Retinopathy | Hypertensive Retinopathy | References

Definition

Retinopathy refers to damage to the retina, the light-sensitive layer at the back of the eye, often resulting from systemic diseases such as diabetes and hypertension. Diabetic retinopathy is caused by high blood sugar levels, while hypertensive retinopathy is caused by high blood pressure.

Diabetic Retinopathy

Definition: Diabetic retinopathy is a complication of diabetes that affects the blood vessels of the retina, potentially leading to vision loss if not properly managed.

Aetiology: Caused by prolonged high blood glucose levels leading to damage of retinal blood vessels.

Pathophysiology: Chronic hyperglycaemia leads to damage to the retinal microvasculature, causing microaneurysms, haemorrhages, and exudates. This can progress to proliferative diabetic retinopathy, characterised by neovascularisation and risk of vitreous haemorrhage and retinal detachment.

Risk Factors: Duration of diabetes, poor glycaemic control, hypertension, hyperlipidaemia, pregnancy.

Signs and Symptoms:

• Often asymptomatic in early stages
• Blurred vision
• Floaters
• Distorted vision
• Sudden vision loss in advanced stages

Investigations:

• Comprehensive eye examination including visual acuity test
• Fundoscopy to examine the retina
• Optical coherence tomography (OCT) to assess retinal thickness and macular oedema
• Fluorescein angiography to evaluate retinal blood flow

Management:

Primary Care Management

• Regular screening: Annual retinal screening for diabetic patients
• Glycaemic control: Optimise blood glucose levels to reduce progression (target HbA1c as recommended by NICE guidelines)
• Blood pressure control: Maintain blood pressure within recommended targets
• Lipid management: Treat dyslipidaemia to reduce cardiovascular risk
• Referral to an ophthalmologist for further management if retinopathy is detected

Specialist Management

• Laser photocoagulation: To treat proliferative diabetic retinopathy and macular oedema
• Intravitreal injections: Anti-VEGF agents (e.g., ranibizumab, aflibercept) or corticosteroids for macular oedema
• Vitrectomy: For advanced proliferative diabetic retinopathy with vitreous haemorrhage or retinal detachment

Hypertensive Retinopathy

Definition: Hypertensive retinopathy is retinal vascular damage caused by chronic high blood pressure.

Aetiology: Prolonged elevated blood pressure leads to damage of retinal blood vessels.

Pathophysiology: High blood pressure causes changes in the retinal vasculature, including arteriolar narrowing, arteriosclerosis, haemorrhages, and exudates. Severe hypertension can lead to optic disc swelling (papilloedema).

Risk Factors: Chronic hypertension, poor blood pressure control, smoking, diabetes, hyperlipidaemia.

Signs and Symptoms:

• Often asymptomatic in early stages
• Blurred vision
• Headaches
• Visual field defects
• Sudden vision loss in severe cases

Investigations:

• Comprehensive eye examination including visual acuity test
• Fundoscopy to examine the retina
• Optical coherence tomography (OCT) to assess retinal thickness
• Blood pressure measurement
• Blood tests to assess cardiovascular risk factors

Management:

Primary Care Management

• Blood pressure control: Maintain blood pressure within recommended targets (e.g., <130/80 mmHg for most patients)
• Lifestyle modifications: Diet, exercise, weight management, smoking cessation
• Regular monitoring: Regular follow-up to monitor blood pressure and retinal changes
• Referral to an ophthalmologist if hypertensive retinopathy is detected

Specialist Management

• Management of complications: Such as retinal haemorrhages or macular oedema
• Laser photocoagulation: In cases of severe retinopathy with complications
• Regular follow-up with both a cardiologist and an ophthalmologist to manage blood pressure and retinal health

References

1. NICE. (2024). Diabetic Retinopathy: Diagnosis and Management. Retrieved from NICE
2. NICE. (2024). Hypertension in Adults: Diagnosis and Management. Retrieved from NICE
3. NHS. (2023). Diabetic Retinopathy. Retrieved from NHS
4. NHS. (2023). Hypertensive Retinopathy. Retrieved from NHS
5. British Medical Journal (BMJ). (2022). Retinopathy: Diagnosis and Management. Retrieved from BMJ
6. American Academy of Ophthalmology (AAO). (2021). Clinical Practice Guidelines: Retinopathy. Retrieved from AAO

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