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Clinical Phenotypes of Diabetic Retinopathy

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Visual Dysfunction in Diabetes

Part of the book series: Ophthalmology Research ((OPHRES))

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Abstract

The natural history of the initial lesions occurring in the diabetic retina has particular relevance because these alterations are still reversible and, therefore, amenable to effective treatment.

It is well recognized that the duration of diabetes and the level of metabolic control are major risk factors for retinopathy progression. However, these risk factors do not explain the great variability that characterizes the evolution and rate of progression of the retinopathy in different diabetic individuals.

By combining different imaging methodologies and performing repeated examinations, we have been able to identify three major patterns of retinopathy progression in the early stages of nonproliferative retinopathy in diabetes type 2.

Pattern A includes eyes with a slow rate of microaneurysm formation, moderate increases in fluorescein leakage, and the presence of a normal foveal avascular zone (FAZ). This appears to characterize a slow progressing retinopathy. Pattern B includes eyes with a high rate of microaneurysm formation, persistently high leakage, increased values of retinal thickness, and a normal FAZ. This group appears to identify a “wet” form of retinopathy. Pattern C includes eyes with a high rate of microaneurysm formation, variable leakage, and alterations in the FAZ, appearing to identify an “ischemic” form of retinopathy.

In long-term follow-up studies of eyes with nonproliferative retinopathy in diabetes type 2, severe macular edema needing laser photocoagulation developed only in eyes identified as belonging to phenotypes B and C.

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Authors and Affiliations

  1. AIBILI, Azinhaga Santa Comba, Celas, Coimbra, Portugal

    José Cunha-Vaz, Rui Bernardes & Conceição Lobo

Authors
  1. José Cunha-Vaz
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  2. Rui Bernardes
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  3. Conceição Lobo
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Corresponding author

Correspondence to José Cunha-Vaz .

Editor information

Editors and Affiliations

  1. Milton S. Hershey Medical Center, Dept. Neural and Behavioral Sciences, Penn State College of Medicine, University Drive 500, Hershey, 17033, Pennsylvania, USA

    Joyce Tombran-Tink

  2. Milton S. Hershey Medical Center, Dept. Neural and Behavioral Sciences, Penn State College of Medicine, University Drive 500, Hershey, 17033, Pennsylvania, USA

    Colin J. Barnstable

  3. Molecular and Integrative Physiology, Ophthalmology and Visual Sciences, Kellogg Eye Center, Wall Street 1000, Ann Arbor, 17033-2390, Michigan, USA

    Thomas W. Gardner

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Cunha-Vaz, J., Bernardes, R., Lobo, C. (2012). Clinical Phenotypes of Diabetic Retinopathy. In: Tombran-Tink, J., Barnstable, C., Gardner, T. (eds) Visual Dysfunction in Diabetes. Ophthalmology Research. Springer, New York, NY. https://doi.org/10.1007/978-1-60761-150-9_5

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  • DOI: https://doi.org/10.1007/978-1-60761-150-9_5

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-60761-149-3

  • Online ISBN: 978-1-60761-150-9

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