Handbook of Retinal Screening in Diabetes: Diagnosis and Management [NOOK Book]


Beginning with chapters summarizing the basics of diabetic retinopathy, this updated volume outlines the need for screening, how to screen safely and correctly, and the normal condition of the retina without diabetic retinopathy, all using excellent line and halftone illustrations. The core focus then moves on to examining each different form of retinopathy, all supported by outstanding color retinal photographs illustrating the appearance of the retina at various stages of retinopathy, plus an analysis on the ...
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Handbook of Retinal Screening in Diabetes: Diagnosis and Management

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Beginning with chapters summarizing the basics of diabetic retinopathy, this updated volume outlines the need for screening, how to screen safely and correctly, and the normal condition of the retina without diabetic retinopathy, all using excellent line and halftone illustrations. The core focus then moves on to examining each different form of retinopathy, all supported by outstanding color retinal photographs illustrating the appearance of the retina at various stages of retinopathy, plus an analysis on the best treatment for each stage. The book ends with chapters providing self-assessment questions of the type that screeners will encounter when gaining their now mandatory retinal screening qualifications, as well as a background information chapter offering advice on related UK, European, and US organizations. A website contains all the full-color retinopathy images from the book, with the option to download these into presentations.
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Editorial Reviews

Doody's Review Service
Reviewer: Ashley Rohr, MD (University of Chicago Medical Center)
Description: This is an update of a book first published in 2006 that demonstrates the algorithm used in the U.K. for retinal screening by correlating colored fundus photographs and descriptions with the retinopathy grading system used by the English National Retinopathy Screening program. It also provides background information on diabetic eye complications in addition to describing key studies in the literature that demonstrate the importance of screening and maintaining intensive blood glucose control to help prevent such complications.
Purpose: The purpose is to illustrate the diabetic retinopathy grading system used by retinal screeners in the U.K., and to provide information on treatment and when referral to an ophthalmologist is necessary. According to the authors, this book can also be used by those preparing to achieve a Diploma in Retinal Screening in the U.K. Retinal screeners are those who analyze colored fundus photographs to determine if referral to an ophthalmologist is necessary based on the grade of retinopathy. These are worthy objectives for physicians and potential retinal screeners in the U.K., but they are less applicable in the U.S. and other countries that do not use retinal screeners, but instead refer all patients to ophthalmologists for a complete ophthalmologic exam. Overall, the book meets the authors' objectives by providing colored fundus photographs with detailed descriptions and explanations as to the grade of retinopathy and when referral for treatment is indicated.
Audience: This is intended for those interested in becoming retinal screeners in the U.K., as well as physicians specializing in diabetic management and ophthalmologists. In my opinion, it is geared more towards those who are interested in achieving the diploma in retinal screening because the focus is mainly on describing fundus photographs and when to refer to an ophthalmologist, not on the complete ophthalmologic exam including indirect fundoscopy and other ancillary testing briefly described in the book, such as OCT. There is only brief mention of treatments for diabetic retinopathy and macular edema, which would be of interest to ophthalmologists. The photographs are useful to beginning ophthalmologists because of the detailed descriptions. The authors include a professor of medicine at Newcastle University and a quality assurance manager for a retinal screening service. Although they are credible authorities, I would've expected an ophthalmologist to be involved as well.
Features: The handbook provides background information on type 1 and 2 diabetes, exam findings of different stages of diabetic retinopathy, literature supporting the need for screening eye exams and good blood glucose control, methods of screening performed in the U.K. including the retinopathy grading system, and then examples of colored fundus photographs with descriptions and correlation with the grading system. The best part and most unique feature of this book is the use of colored fundus photographs with detailed descriptions and explanations why the findings correlate with a particular grade of retinopathy, which makes the information easy to comprehend. The major shortcoming is that the intended audience is primarily retinal screeners, which gives it limited application outside the U.K.
Assessment: The high-quality information in this handbook is on target for its intended audience of retinal screeners in the U.K. In addition to excellent photographic exams of different stages of diabetic retinopathy with detailed explanations, it also provides information on quality control measures used to obtain adequate fundus photographs for analysis. It is likely useful for those studying for a diploma in retinal screening, but it is less useful for readers outside of the U.K. because the retinopathy grading scheme terminology is unique to that country and, in the U.S., all patients are recommended to have a retinal exam by an ophthalmologist, not just those deemed necessary by a retinal screener based on a fundus photograph. The book does provide background information on diabetes, exam findings in diabetic retinopathy, and possible treatments similar to many other books in the field.
From the Publisher

"This handbook is an essential resource for diabetic retinopathy screeners. . . This is an excellent concise volume on the basics of retinal screening." (Diabetes Update, 1 March 2014)

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Product Details

  • ISBN-13: 9781119968559
  • Publisher: Wiley
  • Publication date: 3/14/2012
  • Sold by: Barnes & Noble
  • Format: eBook
  • Edition number: 2
  • Pages: 160
  • File size: 10 MB

Table of Contents

Preface, ix

How to use this book, x

1 Type 1 Diabetes, 1

What causes type 1 diabetes?, 1

Who gets type 1 diabetes?, 1

How does it present?, 1

Essentials of management, 2

Complications, 7

History, 8

Further reading, 9

2 Type 2 Diabetes, 10

What causes type 2 diabetes?, 10

Who gets type 2 diabetes?, 10

How does it present?, 11

Management, 11

Complications, 14

History, 15

Further reading, 17

3 The Eye in Diabetes, 18

Structure of the normal eye, 18

The retina, 21

Diabetic retinopathy, 22

Treatment of sight-threatening diabetic retinopathy, 26

Further reading, 28

4 The Need to Screen, 29

Is blindness preventable?, 29

Can the progression of retinopathy be slowed?, 32

Detecting asymptomatic retinopathy by screening, 32

The five principles of retinal screening, 35

Quality assurance, 36

Retinal screening from the patient’s perspective, 38

Retinal screening from the screener’s perspective, 39

History of the development of retinal screening by photography-based systems in the UK, 40

Further reading, 41

5 Practical Screening, 42

Important first steps, 42

Measuring visual acuity, 43

Instilling eyedrops, 47

Obtaining the image, 50

Examining the image, 51

Grading the image, 54

Explaining the results of screening, 57

Success of the screening visit, 59

Organization of a district screening system, 59

Links with your ophthalmologist, 62

Further reading, 64

6 Normal Retinal Appearances, 65

Light refl ection artefact (Figure 6.1), 66

Light reflection artefact (Figure 6.2), 67

Tortuous vessels (Figure 6.3), 68

Tiger striping (Figure 6.4), 69

Tiger striping (Figure 6.5), 70

Myelinated fibres (Figure 6.6), 71

Myopic crescent (Figure 6.7), 72

Pigmented image (Figure 6.8), 73

Asteroid hyalosis (Figure 6.9), 74

Choroidal circulation (Figure 6.10), 75

Eyelash artefact (Figure 6.11), 76

7 Background Retinopathy, 77

What is background retinopathy?, 77

Lesions, 77

Early background (Figure 7.1), 78

Early background (Figure 7.2a), 79

Early background (red-free version of Figure 7.2a) (Figure 7.2b), 80

Early background (Figure 7.3), 81

Early background (Figure 7.4), 82

Early background (Figure 7.5), 83

Early background (Figure 7.6), 84

Moderate background (Figure 7.7a), 85

Moderate background (red-free version of Figure 7.7a) (Figure 7.7b), 86

8 Maculopathy, 87

What is maculopathy?, 87

Management of maculopathy, 88

Exudates close to the fovea (Figure 8.1), 90

Severe retinopathy close to the macula (Figure 8.2), 91

Widespread exudates (Figure 8.3), 92

Large plaque exudates (Figure 8.4), 93

Linear exudates close to the fovea (Figure 8.5), 94

Plaque exudates near the fovea (Figure 8.6), 95

Circinate exudates within the arcades (Figure 8.7), 96

Widespread exudates with circinates (Figure 8.8), 97

Coalescent exudates in the macular region (Figure 8.9), 98

9 Severe Non-proliferative (‘Pre-proliferative’) Retinopathy, 99

Management of severe, non-proliferative retinopathy, 99

Severe non-proliferative retinopathy (Figure 9.1), 100

Severe non-proliferative retinopathy (Figure 9.2), 101

Severe non-proliferative retinopathy (Figure 9.3), 102

Severe non-proliferative (Figure 9.4), 103

10 Proliferative Retinopathy, 104

What is proliferative retinopathy?, 104

Management of proliferative retinopathy, 104

New vessels on the disc (Figure 10.1), 105

Disc new vessels (Figure 10.2), 106

Retinal new vessels (Figure 10.3a), 107

Retinal new vessels – red-free image of Figure 10.3a (Figure 10.3b), 108

New vessels on the retina (Figure 10.4), 109

New vessels on the retina (Figure 10.5), 110

New vessels on the retina (Figure 10.6), 111

New vessels on the retina (Figure 10.7a), 112

New vessels on the retina – red-free version of Figure 10.7a (Figure 10.7b), 113

Old panretinal laser scars (Figure 10.8), 114

Panretinal laser scars (Figure 10.9), 115

Disc and retinal new vessels, with exudative maculopathy (Figure 10.10a), 116

Disc and retinal new vessels, with exudative maculopathy (red-free version of Figure 10.10a) (Figure 10.10b), 117

11 Advanced Diabetic Eye Disease, 118

What is advanced?, 118

Management of advanced diabetic eye disease, 118

Early fi brosis (Figure 11.1), 119

Fibrosis (Figure 11.2), 120

Fibrovascular membrane (Figure 11.3), 121

Preretinal haemorrhage (Figure 11.4), 122

Preretinal haemorrhage (Figure 11.5), 123

Severe exudative maculopathy (Figure 11.6), 124

Preretinal haemorrhage and persisting new vessel formation (Figure 11.7), 125

Preretinal haemorrhage (Figure 11.8), 126

Fibrous band and heavy laser scars (Figure 11.9), 127

12 Non-diabetic Eye Disease, 128

What other diseases are common?, 128

Other eye diseases, 128

Drusen (Figure 12.1), 131

Drusen (Figure 12.2), 132

Atrophic chorioretinital scars (Figure 12.3), 133

Old chorioretinitis (Figure 12.4), 134

Papilloedema (Figure 12.5), 135

One year later – same eye as shown in Figure 12.5 (Figure 12.6), 136

Papilloedema (Figure 12.7), 137

Pigment epithelial hypertrophy (Figure 12.8), 138

Cholesterol embolus (Figure 12.9), 139

Branch retinal vein occlusion (Figure 12.10), 140

Central retinal vein occlusion (Figure 12.11), 141

Branch retinal artery occlusion (Figure 12.12), 142

Glaucomatous disc (Figure 12.13), 143

Macular hole (Figure 12.14), 144

13 Background Information, 145

The UK Retinal Screening Diploma, 145

Working towards the full Diploma, 146

Driving and diabetes, 146

Pregnancy, 147

Insurance and diabetes, 147

Employment and diabetes, 147

Prescription charges, 148

British Association of Retinal Screening, 148

Diabetes UK, 148

National Retinopathy Screening Systems, 149

Patient leaflets, 149

Ophthalmoscopy, 150

14 Self-assessment Questions, 152

Chapter 1, 152

Chapter 2, 153

Chapter 3, 154

Chapter 4, 154

Chapter 5, 155

Chapters 6–12, 157

15 Answers to Self-assessment Questions, 158

Chapter 1, 158

Chapter 2, 159

Chapter 3, 160

Chapter 4, 160

Chapter 5, 161

16 Glossary of terms, 163

Index, 167

Companion website

This book is accompanied by a companion website: wiley.com/go/taylor/retinalscreening

The website features:

• PowerPoints of all fi gures from the book for downloading

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