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INTRODUCTION

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American
adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, blood
vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina.
The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision. If you
have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy
can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.
Diabetic retinopathy has four stages:
Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of
balloon-like swelling in the retinas tiny blood vessels.
Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the
retina are blocked.
evere Nonproliferative Retinopathy. !any more blood vessels are blocked, depriving several areas of the
retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for
nourishment.
!roliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the
growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are
abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the
inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. "owever, they
have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.
igns and y"pto"s
As the condition progresses, diabetic retinopathy symptoms may include#
$pots or dark strings floating in your vision %floaters&
Blurred vision
'luctuating vision
Dark or empty areas in your vision
(ision loss
Difficulty with color perception
Diabetic retinopathy usually affects both eyes.
Diabetic retinopathy may be classified as early or advanced, depending on your signs and symptoms.
#OD$
The procedure
The patient is escorted by the ophthalmic nurse and positioned appropriately and as comfortably as possible at
the slit-lamp to face the retinal camera. A brief e)planation of the procedure is given again as the patient*s
cooperation during the process is key to securing +uality digital images of the retina. The patient is asked not to
blink during the photography and to fi)ate on a green light when looking at the retinal camera. This ma)imises
the clarity of the retinal images. ,hotographs are taken of the optic disc and the macula in each eye. This takes
-.--/ seconds. Two colour photographs are taken of each eye. 0rading is the ne)t stage undertaken in this
process. This involves grading the photographs to determine whether any diabetic retinopathy is present and, if
so, to assess the stage reached. 0rading also involves e)amining the lens, vitreous, optic disc and the
remainder of the retina. The senior ophthalmic nurse will shortly become responsible for this stage. 1urrently,
however, it is performed by an associate specialist in the diabetic clinic.
%fter the procedure
'or those patients in the early stage of diabetic retinopathy laser therapy is given to preserve the remaining level
of sight. It is important to e)plain to the patient that this treatment will not restore sight already lost. These
patients will also be encouraged to achieve the best possible diabetic control in order to increase the likelihood
of preserving their vision in the longer term. ,atients with no retinopathy or with mild background changes are
given an appointment for a re-e)amination every 2- months. Those patients with a deteriorating background
retinopathy will be e)amined every si) months. Importantly, depending on the stage of the diabetic retinopathy
and the degree of visual loss, advice is given about the services provided by the 34IB in helping and supporting
patients to manage visual impairment. ,atients are also advised to visit their optician annually. Appropriate
referral to members of the multidisciplinary team such as the social worker should also be made in order to
ensure that ongoing needs are met.
CONC&UION
The scope of clinical practice for senior ophthalmic nurse practitioners in the outpatient department has been
e)tended by enabling them to undertake diabetic retinal screening for patients with diabetes. They have
increased their knowledge of diabetes and diabetic eye disease and have enhanced their technical skills.
1onse+uently, they are delivering +uality care underpinned by an evidence-based approach to health education.
They are also using technical e+uipment to perform retinal screening procedures such as slit-lamp
biomicroscopy and digital photography.
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