Hypertensive Retinopathy
Hypertension may lead to multiple adverse effects to the eye. Hypertension can cause retinopathy,optic neuropathy, and choroidopathy,. This article focuses upon hypertensive retinopathy, which is the most common ocular presentation, but also includes hypertensive optic neuropathy and choroidopathy. Hypetensive retinopathy includes two disease processes. The acute effects of systemic arterial hypertension are a result of vasospasm to autoregulate perfusion [1] . The chronic effects of hypertension are caused by arteriosclerosis and predispose patients to visual loss from vascular occlusions or macroaneurysms [2] . The arteriosclerotic changes of hypertensive retinopathy are caused by chronically elevated blood pressure, defined as systolic greater than 140 mmHg and diastolic greater than 90 mmHg [2] . Hypertension is usually essential and not secondary to another disease process. Essential hypertension is a polygenic disease with multiple modifiable environmental factors contributing to the disease. However, secondary hypertension can develop in the setting of pheochromocytoma, primary hyperaldosteronism, cushings syndrome, renal parenchymal disease, renal vacular disease, coarctation of the aorta, obstructive sleep apnea, hyperparathyroidism, and hyperthyroidism [3] . Many young patients with secondary hypertension may actually present to an ophthalmologist with bilateral vision loss due to serous macular detachment, biateral optic disc edema, and exudative retinal detachment. Risk factors for essential hypertension include high salt diet, obesity, tobacco use, alcohol, family history, stress, and ethnic background. The major risk for arteriosclerotic hypertensive retinopathy is the duration of elevated blood pressure. The major risk factor for malignant hypertension i Continue reading >>
Diabetic Retinopathy
Print Overview Diabetic retinopathy (die-uh-BET-ik ret-ih-NOP-uh-thee) is a diabetes complication that affects eyes. It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). At first, diabetic retinopathy may cause no symptoms or only mild vision problems. Eventually, it can cause blindness. The condition can develop in anyone who has type 1 or type 2 diabetes. The longer you have diabetes and the less controlled your blood sugar is, the more likely you are to develop this eye complication. Symptoms You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, diabetic retinopathy symptoms may include: Spots or dark strings floating in your vision (floaters) Blurred vision Fluctuating vision Impaired color vision Dark or empty areas in your vision Vision loss Diabetic retinopathy usually affects both eyes. When to see a doctor Careful management of your diabetes is the best way to prevent vision loss. If you have diabetes, see your eye doctor for a yearly eye exam with dilation — even if your vision seems fine. Pregnancy may worsen diabetic retinopathy, so if you're pregnant, your eye doctor may recommend additional eye exams throughout your pregnancy. Contact your eye doctor right away if your vision changes suddenly or becomes blurry, spotty or hazy. Causes Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don't develop properly and can leak easily. There are two types of diabetic retinopathy: Early diabetic retinopathy. In this more common form — called nonproliferative diabetic retinopathy (NPDR) Continue reading >>
Risk Factors For Retinopathy And Dme In Type 2 Diabetesresults From The German/austrian Dpv Database
Risk Factors for Retinopathy and DME in Type 2 DiabetesResults from the German/Austrian DPV Database Affiliation 5th Medical Department, University Medical Center, University of Heidelberg, Mannheim, Germany Affiliation Department of Internal Medicine, Knappschafts-Krankenhaus, Bottrop, Germany Affiliation Centre for Diabetes and Nutrition Ludwigshafen, Ludwigshafen, Germany Affiliation Specialized Diabetes Practice, Saaldorf, Germany Affiliation Department of Internal Medicine, St. Josefs Hospital, Heidelberg, Germany Affiliation Institute of Epidemiology and Medical Biometry, University Medical Centre, Ulm, Germany Membership of the DPV consortium is listed in the Acknowledgments. Risk Factors for Retinopathy and DME in Type 2 DiabetesResults from the German/Austrian DPV Database DPV InitiativeGerman BMBF Competence Network Diabetes Mellitus To assess the prevalence and risk factors for early and severe diabetic retinopathy and macular edema in a large cohort of patients with type 2 diabetes Retinopathy grading (any retinopathy, severe retinopathy, diabetic macular edema) and risk factors of 64784 were prospectively recorded between January 2000 and March 2013 and analyzed by KaplanMeier analysis and logistic regression. Retinopathy was present in 20.12% of subjects, maculopathy was found in 0.77%. HbA1c > 8%, microalbuminuria, hypertension, BMI > 35 kg/m2 and male sex were significantly associated with any retinopathy, while HbA1c and micro- and macroalbuminuria were the strongest risk predictors for severe retinopathy. Presence of macroalbuminuria increased the risk for DME by 177%. Retinopathy remains a significant clinical problem in patients with type 2 diabetes. Metabolic control and blood pressure are relevant factors amenable to treatment. Concomitant kidney Continue reading >>
Hypertensive Retinopathy
Hypertensive retinopathy is retinal vascular damage caused by hypertension. Signs usually develop late in the disease. Funduscopic examination shows arteriolar constriction, arteriovenous nicking, vascular wall changes, flame-shaped hemorrhages, cotton-wool spots, yellow hard exudates, and optic disk edema. Treatment is directed at controlling BP and, when vision loss occurs, treating the retina. Acute BP elevation typically causes reversible vasoconstriction in retinal blood vessels, and hypertensive crisis may cause optic disk edema. More prolonged or severe hypertension leads to exudative vascular changes, a consequence of endothelial damage and necrosis. Other changes (eg, arteriole wall thickening, arteriovenous nicking) typically require years of elevated BP to develop. Smoking compounds the adverse effects of hypertensive retinopathy. Hypertension is a major risk factor for other retinal disorders (eg, retinal artery or vein occlusion, diabetic retinopathy). Also, hypertension combined with diabetes greatly increases risk of vision loss. Patients with hypertensive retinopathy are at high risk of hypertensive damage to other end organs. Symptoms usually do not develop until late in the disease and include blurred vision or visual field defects. In the early stages, funduscopy identifies arteriolar constriction, with a decrease in the ratio of the width of the retinal arterioles to the retinal venules. Chronic, poorly controlled hypertension causes the following: Arteriovenous crossing abnormalities (arteriovenous nicking) Arteriosclerosis with moderate vascular wall changes (copper wiring) to more severe vascular wall hyperplasia and thickening (silver wiring) Sometimes total vascular occlusion occurs. Arteriovenous nicking is a major predisposing factor to the d Continue reading >>
Update On Hypertensive Retinopathy
To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video Published by Abraham Chambers Modified over 2 years ago Presentation on theme: "Update on Hypertensive Retinopathy" Presentation transcript: 2 Introduction First described in the late 1800s Used to predict risk of stroke, cardiovascular disease, and even mortality Epidemiology HR in 3% to 14% of nondiabetic adults age 40. 10 year cumulative incidence is 16%. spectrum of retinal vascular signs caused by elevated blood pressure. Autoregulation of the vasculature breakdown of autoregulation pathways and atherosclerosis Arteriolosclerosis - irreversibleopacification, compression of venules. BRB disruptionexudative stage Malignant stage optic disc and macular oedema due to raised intracranial pressure. Grade Features 1 Mild generalized retinal arteriolar narrowing 2 Definite focal narrowing and arteriovenous nipping 3 Signs of grade 2 retinopathy plus retinal hemorrhages, exudates, and cotton wool spots 4 Severe grade 3 retinopathy plus papilloedema -Poor reliability and reproducibility -Grades do not correlate with severity of hypertension -Not sequential in nature -Grades do not correlate with prognosis, cardiovascular events, and mortality. Grade Features Mild ( retinal arteriolar signs) Generalized arteriolar narrowing, focal arteriolar narrowing, arteriovenous nicking, opacity (copper wiring) of arteriolar wall, or a combination of these signs Moderate (retinopath y-like lesions) Retinal hemorrhages (blot-shaped, dot-shaped, or fiame-shaped), microaneurysms, cotton wool spots, hard exudates, or a combination of these signs Malignant Signs of moderate retinopathy plus optic disk swelling -Good reliability and reproducibility. -Predicted the long-term risk of st Continue reading >>
Hypertensive Retinopathy - Carbon.materialwitness.co
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Diabetic Retinopathy
Diabetic retinopathy is a condition that occurs in people who have diabetes. It causes progressive damage to the retina, the light-sensitive lining at the back of the eye. Diabetic retinopathy is a serious sight-threatening complication of diabetes. Diabetes interferes with the body's ability to use and store sugar (glucose). The disease is characterized by too much sugar in the blood, which can cause damage throughout the body, including the eyes. Over time, diabetes damages the blood vessels in the retina. Diabetic retinopathy occurs when these tiny blood vessels leak blood and other fluids. This causes the retinal tissue to swell, resulting in cloudy or blurred vision. The condition usually affects both eyes. The longer a person has diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness. Symptoms of diabetic retinopathy include: Seeing spots or floaters Blurred vision Having a dark or empty spot in the center of your vision Difficulty seeing well at night When people with diabetes experience long periods of high blood sugar, fluid can accumulate in the lens inside the eye that controls focusing. This changes the curvature of the lens, leading to blurred vision. However, once blood sugar levels are controlled, blurred distance vision will improve. Patients with diabetes who can better control their blood sugar levels will slow the onset and progression of diabetic retinopathy. Often the early stages of diabetic retinopathy have no visual symptoms. That is why the American Optometric Association recommends that everyone with diabetes have a comprehensive dilated eye examination once a year. Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy. T Continue reading >>
Similarities And Differences In Early Retinal Phenotypes In Hypertension And Diabetes.
Similarities and differences in early retinal phenotypes in hypertension and diabetes. J Hypertens. 2011 Sep;29(9):1667-75. doi: 10.1097/HJH.0b013e3283496655. The use of retinal photography in clinical practice and research has substantially increased the knowledge about the epidemiology, natural history and significance of diabetic and hypertensive retinopathy. Early retinopathy signs, including retinal microaneurysms, blot hemorrhages, cotton-wool spots and hard exudates, are common vascular abnormalities found in middle-aged to older people with diabetes and hypertension. The presence of these early retinopathy signs is associated with an increased risk of systemic vascular diseases, such as stroke, cognitive impairment, coronary heart disease, heart failure and nephropathy. These retinopathy lesions may therefore be considered as biomarkers of systemic microvascular processes caused by diabetes and hypertension. Nevertheless, whereas the interest in retinopathy assessment continues to grow, a core concept remains undefined: what is the relative importance and contribution of diabetes and hypertension in the development of early retinopathy signs? The answer of this fundamental question holds the key to better understanding of the systemic associations of early hypertensive and diabetic retinopathy. In this review, we summarize the similarities and differences of early retinopathy signs seen in diabetes and hypertension, and discuss the conceptual relevance from epidemiological, pathophysiological, and clinical perspectives. Continue reading >>
- The Differences & Similarities Between Type 1 and Type 2 Diabetes
- Conjoint Associations of Gestational Diabetes and Hypertension With Diabetes, Hypertension, and Cardiovascular Disease in Parents: A Retrospective Cohort Study
- Untargeted metabolomic analysis in naturally occurring canine diabetes mellitus identifies similarities to human Type 1 Diabetes
Case Study: Diagnosing Malignant Hypertensive Retinopathy
Exam findings and a patients history of hypertension at a young age helped lead doctors to a diagnosis of malignant hypertensive retinopathy in a teen. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services Policy A 19-year-old male college student presented to the ER with a four-day history of left eye pain and redness that began after a sneeze. He initially felt a pop in his left eye, then experienced pain in the left eye while in the bathroom, says ophthalmologist Dan Feiler, MD, a resident at Cleveland Clinics Cole Eye Institute . When he came to the ER, he also had tearing, blurry vision and photosensitivity in his left eye. The patient had no history of trauma, recent illness, sudden vision loss, flashes or floaters, painful extraocular muscle, diplopia or any relevant family history. The patient was born at 27 weeks and had a history of asthma, obstructive sleep apnea and allergic rhinitis. He also had a history of hypertension at age 10 and subsequently developed chronic kidney disease at age 16. His medications included amlodipine, carvedilol, furosemide, hydralazine, isosorbide mononitrate (Imdur), atorvastatin, albuterol, cetirizine and montelukast (Singulair). On examination, the patients visual acuity without refractive correction was 20/25 in the right eye (pin hole 20/20) and 20/400 in the left eye (pin hole 20/100). Intraocular pressure via pneumotonometer was16 in the right eye and 13.5 in the left, Dr. Feiler says. Visual fields in both eyes were full to confrontation. The patient had full extraocular muscle function in both eyes and orthophoria. Pupils of both eyes were symmetric and equally reactive with no afferent pupillary defect. Whe Continue reading >>
Similarities And Differences In Early Retinal Phenotypes In Hypertension And Diabetes
The use of retinal photography in clinical practice and research has substantially increased the knowledge about the epidemiology, natural history and significance of diabetic and hypertensive retinopathy. Early retinopathy signs, including retinal microaneurysms, blot hemorrhages, cotton-wool spots and hard exudates, are common vascular abnormalities found in middle-aged to older people with diabetes and hypertension. The presence of these early retinopathy signs is associated with an increased risk of systemic vascular diseases, such as stroke, cognitive impairment, coronary heart disease, heart failure and nephropathy. These retinopathy lesions may therefore be considered as biomarkers of systemic microvascular processes caused by diabetes and hypertension. Nevertheless, whereas the interest in retinopathy assessment continues to grow, a core concept remains undefined: what is the relative importance and contribution of diabetes and hypertension in the development of early retinopathy signs? The answer of this fundamental question holds the key to better understanding of the systemic associations of early hypertensive and diabetic retinopathy. In this review, we summarize the similarities and differences of early retinopathy signs seen in diabetes and hypertension, and discuss the conceptual relevance from epidemiological, pathophysiological, and clinical perspectives. aCentre for Macular Research and Vitreo-retinal Diseases, Ophthalmic Private Practice, San Mauro.T.se, Italy bCentre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Australia cInternal Medicine Division and Hypertension Unit, Department of Internal Medicine and Experimental Oncology, Molinette Hospital, University of Torino, Italy dSingapore Eye Research Inst Continue reading >>
- The Differences & Similarities Between Type 1 and Type 2 Diabetes
- Conjoint Associations of Gestational Diabetes and Hypertension With Diabetes, Hypertension, and Cardiovascular Disease in Parents: A Retrospective Cohort Study
- Untargeted metabolomic analysis in naturally occurring canine diabetes mellitus identifies similarities to human Type 1 Diabetes
Hypertensive Retinopathy
Hypertensive retinopathy is damage to the retina and retinal circulation due to high blood pressure (i.e. hypertension). Signs and symptoms[edit] Most patients with hypertensive retinopathy have no symptoms. However, some may report decreased or blurred vision,[1] and headaches.[2] Signs[edit] Signs of damage to the retina caused by hypertension include: Arteriolar changes, such as generalized arteriolar narrowing, focal arteriolar narrowing, arteriovenous nicking, changes in the arteriolar wall (arteriosclerosis) and abnormalities at points where arterioles and venules cross. Manifestations of these changes include Copper wire arterioles where the central light reflex occupies most of the width of the arteriole and Silver wire arterioles where the central light reflex occupies all of the width of the arteriole, and "arterio-venular (AV) nicking" or "AV nipping", due to venous constriction and banking. advanced retinopathy lesions, such as microaneurysms, blot hemorrhages and/or flame hemorrhages, ischemic changes (e.g. "cotton wool spots"), hard exudates and in severe cases swelling of the optic disc (optic disc edema), a ring of exudates around the retina called a "macular star" and visual acuity loss, typically due to macular involvement. Mild signs of hypertensive retinopathy can be seen quite frequently in normal people (3–14% of adult individuals aged ≥40 years), even without hypertension.[3] Hypertensive retinopathy is commonly considered a diagnostic feature of a hypertensive emergency although it is not invariably present.[4] Keith Wagener Barker (KWB) Grades[edit] Grade 1 Vascular Attenuation Grade 2 As grade 1 + Irregularly located, tight constrictions - Known as "AV nicking" or "AV nipping" - Salus's sign Grade 3 As grade 2 + Retinal edema, cotton wool s Continue reading >>
Diabetic Retinopathy
Practice Essentials Diabetes mellitus (DM) is a major medical problem throughout the world. Diabetes causes an array of long-term systemic complications that have considerable impact on the patient as well as society, as the disease typically affects individuals in their most productive years. [1] An increasing prevalence of diabetes is occurring throughout the world. [2] In addition, this increase appears to be greater in developing countries. The etiology of this increase involves changes in diet, with higher fat intake, sedentary lifestyle changes, and decreased physical activity. [3, 4] Patients with diabetes often develop ophthalmic complications, such as corneal abnormalities, glaucoma, iris neovascularization, cataracts, and neuropathies. The most common and potentially most blinding of these complications, however, is diabetic retinopathy, [5, 6, 7] which is, in fact, the leading cause of new blindness in persons aged 25-74 years in the United States. Approximately 700,000 persons in the United States have proliferative diabetic retinopathy, with an annual incidence of 65,000. An estimate of the prevalence of diabetic retinopathy in the United States showed a high prevalence of 28.5% among those with diabetes aged 40 years or older. [8] (See Epidemiology.) The exact mechanism by which diabetes causes retinopathy remains unclear, but several theories have been postulated to explain the typical course and history of the disease. [9, 10] See the image below. In the initial stages of diabetic retinopathy, patients are generally asymptomatic, but in more advanced stages of the disease patients may experience symptoms that include floaters, distortion, and/or blurred vision. Microaneurysms are the earliest clinical sign of diabetic retinopathy. (See Clinical Presentat Continue reading >>
Diabetic Retinopathy And Diabetic Macular Edema
Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of blindness in the working-age population of most developed countries. The increasing number of individuals with diabetes worldwide suggests that DR and DME will continue to be major contributors to vision loss and associated functional impairment for years to come. Early detection of retinopathy in individuals with diabetes is critical in preventing visual loss, but current methods of screening fail to identify a sizable number of high-risk patients. The control of diabetes-associated metabolic abnormalities (i.e., hyperglycemia, hyperlipidemia, and hypertension) is also important in preserving visual function because these conditions have been identified as risk factors for both the development and progression of DR/DME. The currently available interventions for DR/DME, laser photocoagulation and vitrectomy, only target advanced stages of disease. Several biochemical mechanisms, including protein kinase C–β activation, increased vascular endothelial growth factor production, oxidative stress, and accumulation of intracellular sorbitol and advanced glycosylation end products, may contribute to the vascular disruptions that characterize DR/DME. The inhibition of these pathways holds the promise of intervention for DR at earlier non–sight-threatening stages. To implement new therapies effectively, more individuals will need to be screened for DR/DME at earlier stages—a process requiring both improved technology and interdisciplinary cooperation among physicians caring for patients with diabetes. CURRENT EPIDEMIOLOGY, NEW PATHOPHYSIOLOGY INSIGHTS, UPDATED DIAGNOSTIC STAGING SYSTEM, RECENT SCREENING TECHNOLOGIES, AND TREATMENT Diabetic retinopathy (DR) and diabetic macular edema (DME) are Continue reading >>
Funduscopic Findings | The Atlas Of Emergency Medicine, 4e | Accessemergency Medicine | Mcgraw-hill Medical
The disk is pale pink, approximately 1.5 mm in diameter, with sharp, flat margins. The physiologic cup is located within the disk and usually measures less than six-tenths the disk diameter. The cups should be approximately equal in both eyes. The central retinal artery and central retinal vein travel within the optic nerve, branching near the surface into the inferior and superior branches of arterioles and venules, respectively. Normally the walls of the vessels are not visible; the column of blood within the walls is visualized. The venules are seen as branching, dark red lines. The arterioles are seen as bright red branching lines, approximately two-thirds or three-fourths the diameter of the venules. This is an area of the retina located temporal to the disk; it is void of visible vessels. The fovea is an area of depression approximately 1.5 mm in diameter (similar to the optic disk) in the center of the macula. The foveola is a tiny pit located in the center of the fovea. These areas correspond to central vision. The background fundus is red; there is some variation in the color, depending on the amount of individual pigmentation and the visibility of the choroidal vessels beneath the retina. Continue reading >>
Hypertensive Retinopathy Vs Diabeticretinopathy
Hypertensive Retinopathy vs DiabeticRetinopathy Hypertension (Htn) and Diabetes Mellitus (DM) can lead to serious complication for the uncontrolled patients . Hypertensive retinopathy (HR) is a complication of Htn that leads to damage to the retina and retinal circulation due to high BP . Usually they are asymptomatic but may present with decreased vision or headache . Diabetic Retinopathy (DR) is a complication of DM that can lead to blindness . The longer the disease , the higher risk to get DR . There is no early sign of DR hence , they need to do eye check up to diabetic patients . For macular oedema for instance , it does not have any early symptoms although it can cause rapid loss of vision . They may have difficulty for daily activity like driving because of loss of vision . It is grade based on Keith-Wagener Barker (KWB) system : GRADE 1 : Tortuosity (twisting) of retinal arteries with increased reflectiveness (silver wiring) GRADE 2 : Grade 1 + Arteriovenous napping (thickened retinal arteries pass over retinal veins) GRADE 3 : Grade 2 + flamed shape haemorrhage and cotton wool exudates (due to small infarct) GRADE 4 : Grade 3 + papilloedema (blurry margin of the optic disc) GRADE 1 : Tortuosity of retinal arteries and silver wiring . GRADE 2 : G1 + AV nipping (arrow artery cross over onto vein) . GRADE 3 : G2 + flame-shaped haemorrhage and cotton wool exudate (whitish) . GRADE 4 : G3 + papilloedema (picture below only showing different between normal optic disc and papilloedema) Treatment for HR : Prevent , limit and reverse target organ damage by lowering patients BP level with anti hypertensive drug treatment and reduce the risk for cerebrovascular disease and death . DR can be divided into different classes : Category 1 : Mild Non Proliperative Retinopathy Continue reading >>
