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Diabetes Mellitus: Non-proliferative (Background) Retinopathy

Non-proliferative retinopathy

Hard exudates
These yellow flecks lie deep in the retina and reflect leakage of incompetent pre-capillary retinal arterioles.

They are proteolipid residues; the more soluble transudate has been absorbed. Do not mistake them for other yellow-white spots in the retina (Yellow-White Things in the Retina).

Hemorrhages
These red dots lie deep in the retina and reflect mini-blowouts of diseased pre-capillary arterioles.

Their round shape distinguishes them from other hemorrhages in or near the retina (Retinal Hemorrhages).

Diabetic retinopathy
Diabetes mellitus is the commonest cause of microvascular retinopathy.

This early stage, marked by leakage, is called nonproliferative diabetic reinopathy, or background diabetic retinopathy, because there are as yet no new blood vessels (neovascularization). About 25% of diabetics will show nonproliferative signs 15 years after diagnosis. But they will not notice any disturbance of vision unless the macular region fills with fluid (diabetic macular edema). Vision-reducing diabetic macular edema is present in about 10% of diabetics 15 years after diagnosis.

What to do?
Refer all newly diagnosed diabetics for ophthalmologic examination at the time of diagnosis. The schedule of periodic examinations thereafter should be set by the ophthalmologist.

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