Diagnosis of Diabetic Retinopathy

Diagnostic Test list for Diabetic Retinopathy:

The list of medical tests mentioned in various sources as used in the diagnosis of Diabetic Retinopathy includes:

• Ordinary doctor eye exam - not fully adequate; may not detect non-advanced cases.
• Dilated eye exam - best performed by eye specialist
• Eye test (vision test) - not useful; only detects very advanced cases of retinopathy.
• Dye test (fluorescein angiogram) - This is a special eye that that shows retinal circulation.
• Amsler grid - A special test that helps you identify what parts of your visual field are damaged.
• Slit lamp examination - Often done as part of a dilated eye exam. This test examines front or back of eye.
• Color Fundus Photography exam (dilated) - A form of photography of the retina.
• Eye ultrasound test (ultrasonography) - A rarely used test that is mainly used when there is a vitreous hemorrhage or cataract that makes a visual dilated eye checkup not possible.
• Non-mydriatic camera - A new form of retinal examination for retinopathy that does not require pupil dilation. Not widely available yet.

Diabetic Retinopathy Diagnosis: Book Excerpts

• Differential Diagnosis - Retinal Hemorrhage
• Diagnosis - Retinal detachment
• Diagnosis - Vascular retinopathies
• Differential Overview - Retinal Phenomena
• Diagnosis - Retinal detachment
• Diagnosis - Vascular retinopathies

Tests and diagnosis discussion for Diabetic Retinopathy:

Keep your eyes healthy: NIDDK (Excerpt)

Have an eye doctor examine your eyes once a year. Have this exam even if your vision is OK. The eye doctor will use drops to make the black part of your eyes (pupils) bigger. This is called dilating (DY-lay-ting) your pupil, which allows the doctor to see your retina. Finding eye problems early and getting treatment right away will help prevent more serious problems later on. (Source: excerpt from Keep your eyes healthy: NIDDK)

Are You at Risk for Diabetic Eye Disease: NEI (Excerpt)

If you have diabetes, you should have your eyes examined at least once a year. Your eyes should be dilated during the exam. That means eyedrops are used to enlarge your pupils. This allows the eye care professional to see more of the inside of your eyes to check for signs of the disease. (Source: excerpt from Are You at Risk for Diabetic Eye Disease: NEI)

Facts About Diabetic Retinopathy: NEI (Excerpt)

Diabetic retinopathy is detected during an eye examination that includes:

Your eye care professional will look at your retina for early signs of the disease, such as: (1) leaking blood vessels, (2) retinal swelling, such as macular edema, (3) pale, fatty deposits on the retina--signs of leaking blood vessels, (4) damaged nerve tissue, and (5) any changes in the blood vessels.

Should your doctor suspect that you need treatment for macular edema, he or she may ask you to have a test called fluorescein angiography.

In this test, a special dye is injected into your arm. Pictures are then taken as the dye passes through the blood vessels in the retina. This test allows your doctor to find the leaking blood vessels. (Source: excerpt from Facts About Diabetic Retinopathy: NEI)

Diagnostic Tests for Diabetic Retinopathy: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Diabetic Retinopathy.

Retinal Hemorrhage: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• It is critical to realize that hemorrhages do not progress but represent altered structure, and as such may affect acuity
• Nonaccidental trauma must be the first etiology considered
• Pigmented lesions of the retina including choroidal nevi, congenital hypertrophy of the retinal pigment epithelium, retinal pigment epithelial hyperplasia
• Diabetic retinopathy is characterized by dot/blot, flame, preretinal, vitreous hemorrhages
• Hypertensive retinopathy is typically accompanied by signs of hypoxia, e.g., cotton wool spots and optic disc swelling
• May be associated with any systemic vascular disease or collagen vascular disease (e.g., systemic lupus erythematosus)
• Vein occlusion
  –Occlusion of a central vein may involve the entire retina, occlusion of one branch vein involves a section of the retina
• Peripheral retinal hemorrhaging may be associated with vascular insufficiency due to carotid stenosis
• May be associated with optic disc swelling
• Traumatic truncal injury may create intraretinal hemorrhages called Purtscher lesions
• Intracranial hemorrhage may dissect forward to surround optic nerve (Terson phenomenon)
• Blood dyscrasias, anemias, leukemias, sickle cell, ocular sarcoidosis, Behçet disease, Eales disease may cause retinopathy
• If sudden loss of vision is associated, wet macular degeneration, macular hemorrhage of histoplasmosis, preretinal hemorrhage, or vitreous hemorrhage may be the etiology
• Retinal vascular tumors, which may have an associated neurologic aneurysm
• HIV retinopathy presents with hemorrhage as first sign but may progress to involve and destroy vision

Workup and Diagnosis

• History
  –Evaluate status of known systemic diseases; e.g., hypertension, diabetes
  –Investigate for undiagnosed systemic disease: Hypertension, diabetes, carotid occlusion, cardiac anomalies, blood disorders, HIV

• Physical exam
  –Visual acuity: Acuity is compromised if the hemorrhage lies within the foveal area
  –Pupillary evaluation: Look for Marcus Gunn pupil
  –Extraocular muscle evaluation for diplopia (may be associated with diabetes)
  –Confrontation visual fields are indicated in all cases
  –Perform a dilated fundus evaluation
• Labs
  –CBC, differential, lipid profile, ANA, sickle cell, ACE, serum calcium

• Studies
  –Ultrasonography, fluorescein angiography, ocular CT may be performed in conjunction with an ophthalmology consultation
  –If secondary to a retinal vascular tumor, orbital and brain imaging with and without contrast is indicated with a neurologic consultation

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Retinal detachment: Diagnosis
(Professional Guide to Diseases (Eighth Edition))

Confirming diagnosis  Diagnosis depends on ophthalmoscopy after full pupil dilation. Examination shows the usually transparent retina as gray and opaque; in severe detachment, it reveals folds in the retina and ballooning out of the area. Indirect ophthalmoscopy is used to search for retinal tears. Ultrasound is performed if the lens is opaque.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Vascular retinopathies: Diagnosis
(Professional Guide to Diseases (Eighth Edition))

Check visual acuity and then vital signs, including blood pressure. Diagnosis is made on fundal examination with an ophthalmoscope. Determine if female patients are pregnant; hypertensive retinopathy may be an early sign of preeclampsia. (See Diagnostic tests for vascular retinopathies.)

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Retinal Phenomena: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Hypertension

❑ Diabetic retinopathy

❑ Glaucoma

❑ Cholesterol emboli

❑ Papilledema

❑ Pigmented crescent

❑ Macular degeneration

❑ Retinal detachment

❑ Acute optic neuritis

❑ Optic atrophy

❑ Retinal hemorrhage

❑ Chorioretinal exudates

❑ Lipemia retinalis

❑ Central retinal artery occlusion

❑ Central retinal vein occlusion

❑ Angioid streaks

❑ Hyperviscosity

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Retinal detachment: Diagnosis
(Handbook of Diseases)

Ophthalmoscopy after full pupil dilation allows diagnosis. Examination shows the usually transparent retina as gray and opaque; with severe detachment, it reveals folds in the retina and a ballooning out of the area. Indirect ophthalmoscopy is used to search for retinal tears. Ultrasonography is performed if the lens is opaque.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Vascular retinopathies: Diagnosis
(Handbook of Diseases)

Appropriate diagnostic tests depend on the type of vascular retinopathy. (See Diagnosing of vascular retinopathies.) Always include determination of visual acuity and ophthalmoscopic examination.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

 » Next page: Signs of Diabetic Retinopathy

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