Type 1 diabetes mellitus (T1DM) is characterized by the destruction of beta cells in the pancreas by an autoimmune mechanism, whereas type 2 diabetes mellitus (T2DM) is a relationship between lifestyle and genetics. Additionally, elevated hemoglobin A1c (HbA1c) levels and blood pressure are associated with increased risk of diabetic retinopathy. There are several other key risk factors for the development of diabetic retinopathy beyond years since diagnosis and type of diabetes. The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) Cohort showed that after 20 years of diabetes mellitus, 99% of patients with type 1 and 60% of patients with type 2 show some degree of retinopathy. By 2030 an estimated 191.0 million people globally will have diabetic retinopathy, and approximately 56.3 million will have vision-threatening diabetic retinopathy. As the disease progresses, associated diabetic macular edema ( DME) may also become apparent.Īmong patients aged 25-74, diabetic retinopathy is a leading cause of vision loss worldwide. It ranges from non-proliferative diabetic retinopathy (NPDR) and its stages to proliferative diabetic retinopathy (PDR). This prevalence, in concert with the associated diseases that usually coincide with (and result from) diabetes should solidify the importance of being familiar with this disease process.ĭiabetic retinopathy represents microvascular end-organ damage as a result of diabetes. ![]() An estimated 34.1 million Americans aged 18 years or older, 13.0% of all U.S. ![]() Since then, advancements in medicine have led to multiple new medication therapies and approaches to treat diabetes mellitus.ĭespite this, diabetes remains one of the top ten most prevalent and important non-infectious causes of morbidity and mortality worldwide. In 1889 Mering and Minkowski discovered the relevance of the pancreas in this disease process after inducing a severe and fatal form of diabetes in a dog following removal of the pancreas. 3.2.2 Proliferative Diabetic Retinopathyĭiabetes mellitus as a disease was identified as far back as 250-300 BC and was characterized by the sweet properties of urine.2.7.1 Macular edema with retinal hemorrhages.2.4.2 Proliferative diabetic retinopathy.2.4.1 Classification of Non-proliferative diabetic retinopathy.On fluorescein angiography, NV will often show late leakage whereas IRMAs traditionally do not leak. In severe cases, NV tends to grow along the posterior hyaloid interface especially around the optic nerve (i.e. ![]() Conversely, NV tends to be much finer and delicate in caliber, and is sometimes more focal in location depending on its severity. When compared to neovascularization (NV) in proliferative disease, IRMAs are slightly larger in caliber with a more broad arrangement and are always contained to the intraretinal layers. IRMA is one of the defining features of severe non-proliferative diabetic retinopathy based on the "4-2-1" criteria from the Early Treatment Diabetic Retinopathy Study (ETDRS). These vessels represent either new vessel growth within the retina or remodeling of pre-existing vessels through endothelial cell proliferation stimulated by hypoxia bordering areas of capillary nonperfusion. Intraretinal microvascular abnormalities (or IrMAs) are shunt vessels and appear as abnormal branching or dilation of existing blood vessels (capillaries) within the retina that act to supply areas of non-perfusion in diabetic retinopathy.
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