Page 71 - NAME OF CONDITION: REFRACTIVE ERRORS

b) Investigations:

Visual acuity test: This is done as a baseline investigation. Amsler’s grid evaluation is
also useful to monitor macular disease

Fundus examination with direct and indirect ophthalmoscope. The direct
ophthalmoscope examination is essential for both community setting and general
physicians. Indirect ophthalmosopy is done in case of advanced diabetic retinopathy.

Slit lamp biomicroscopy with 78D or 90D is gold standard for diagnosis of diabetic
maculopathy.

Fundus photography and Digital Retinal Screening Programs: Systematic programs
for the early detection of eye disease including diabetic retinopathy are becoming
more common, where all people with diabetes mellitus are offered retinal screening
at least annually. This involves digital image capture and transmission of the images
to a digital reading center for evaluation and treatment referral.

Fluorescein Angiography
This is a magnified photography of the retina involving the use of an injectable dye. It
helps to classify the condition and to record changes in the retinal blood vessels. It is
also useful to rule out the ischemia of the macular region. The first angiogram is

usually done during the first evaluation. Subsequent angiograms may be done to
assess the progression of diabetic retinopathy and to decide on the mode of
treatment

C. Treatment:

Medical Care
Glucose control: One of the clinical trials, the Diabetes control and complications
trial (DCCT) has found that intensive glucose control in patients with insulin
dependent diabetes mellitus (IDDM) has decreased the incidence and progression of
diabetic retinopathy. Glycosylated hemoglobin levels of 6- 7% are ideal to prevent or
at the very least to minimize the long-term complications of DM, including DM
retinopathy.

Surgical Care

Laser photocoagulation is the standard technique for treating diabetic retinopathy.
In general, it is advised for patients with high-risk PDR, CSME, or neovascularization

of the anterior chamber angle. Either argon or diode laser can be used for
photocoagulation. Laser photocoagulation techniques can be classified as panretinal,
focal, or grid. Panretinal photocoagulation, also referred to as scatter
71