- Diabetic Retinopathy Exam
Performing the Test
- Check the patient's visual acuity using a Snellen eye chart
- To properly examine the macula and peripheral retina, mydriatic drops should be used; however, in family practice this is often not available
- Patients with sight-threatening diabetic retinopathy should be assessed by a general ophthalmologist or retinal specialist
- Perform ophthalmoscope examination
- Focus on the optic disc and retina for pathologic changes:
- Nonproliferative retinopathy
- Microaneurysms - Red round spots at the end of small arteries
- Dot haemorrhages - Larger red dots with sharp borders
- Blot haemorrhages - Larger red dots with indistinct borders
- Hard exudates - Small, white or yellowish deposits with sharp margins that have a waxy or glistening appearance
- Soft “cotton wool” exudates - White patches with ill defined feathery edges
- Venous beading - Veins resemble a string of beads
- Intraretinal microvascular abnormalities(IRMA)
- Proliferative retinopathy (new vessel formation)
- Neovascularlization of the disc (NVD) - New small vessels that often resemble a wagon wheel
- Neovascularization elsewhere (NVE) - New small vessels at least one disc diameter away from the disc
- Macular edema (may accompany any stage of nonproliferative or proliferative retinopathy)
- Difficult to visualize, but clues are rings of hard exudates and diminished visual acuity
- Bickley L, Szilagyi P. BATES’ Guide to Physical Examination and History Taking. 9th edition. Lipincott Williams & Wilkins; 2007.
- McGee, S. Evidence Based Physical Diagnosis. St. Louis Missouri. Saunders Elsevier. 2007.
- Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2008; 32(suppl 1): S1-S201.
- Gardner D, Shoback D. Greenspan’s Basic & Clinical Endocrinology. 8th Edition. USA. McGraw-Hill. 2007