Navigating the Complexities of Diabetic Retinopathy

Navigating the Complexities of
Diabetic Retinopathy

1. Navigating the Complexities of Diabetic Retinopathy Mohamed ELShafie Lecturer of ophthalmology Harvard Medical School Almuni Director of training unit

2. Diabetic Retinopathy Classification

3. Reproducible , Well validated , and are Robust in Prediction of important outcomes Limitations • Rely only on 7 standard field photographs (30% of the retina) • DR classification system prognosticates the risk of progression to PDR and does not effectively predict the incidence of DME (most common cause of visual impairment) • Does not include functional data • Does not include evaluation of the neural retina or diabetic retinal neurodegeneration • Does not record the regression of degree of retinopathy or resolution of retinal neovascularization.

4. Ultra-Wide Field Imaging ü Images of up to 200º of the retina (80%). ü Screening • May not require mydriasis • 133º-200º with 1 single image (vs. 30º-50º standard cameras). ü UWF imaging vs 7 ETDRS fields à 15% greater DR stage ü Predominantly peripheral lesions • >50% of lesions outside 7 ETDRS fields • X 3.2 progression of 2 steps DR • X 4.7 progression into PROLIFERATIVE DR

5. Diabetic Maculopathy Classification

6. DISORGANIZATION OF INTERNAL RETINAL LAYERS D R I L

7. DISORGANIZATION OF OUTER RETINAL LAYERS D R O L

8. OCT /OCTA Imaging Fluid: Intra or subretinal Hyperreflective material Confluent cystic spaces

9. S uspended S cattering P article s I n M otion ( SSPiM )

10. OCT/OCTA Imaging Microaneurysm: • Hyperreflective contour & Continuous .. No leakage • Loss of continuity … leakage

11. • OCT delineate the capsular structure, hyperreflective spots, and location of microaneurysms • Microaneurysms with the ring sign were positively correlated with exudation

12. OCT /OCTA Imaging Hard Exudate Hyperreflective foci leading to exudation When central involvement, severe vision loss

13. Cotton Wool Spot Paracentral Acute Middle Maculopathy (PAMM)

14. OCT /OCTA Imaging Proliferation Surgical planning New vessels vs IRMA