Nonproliferative Diabetic Retinopathy (NPDR)

• Most common form of diabetic retinopathy.
• After 20 years of the disease, almost 100% of patients with type 1 and 60% of type 2 have some degree of retinopathy.

Clinical Features

• Signs:
  • Microaneurysm, intraretinal hemorrhages, cotton wool spots and hard exudates
  • Venous tortuosity or beading, capillary dropout and intraretinal microvascular abnormalities (IRMA)
  • Increasing formation of microaneurysm leads to increased vascular permeability of the retinal capillaries and result in retinal edema particularly in the macular area

Fluorescein Angiography Demonstrates

• Scattered hyperfluorescence dots of microaneurysms which can be associated with minimal dye leakage
• Spots of hypofluorescense in the area of hemorrhages and exudates
• Areas of irregular capillary pattern or capillary closure

Management

• Improve patients education and understanding about the disease process.
• Control of blood glucose, cholesterol and blood pressure.
• Photocoagulation in severe nonproliferative retinopathy.
• Annual check-up 5 years after onset for patient aged less than 30 years old, and at time of diagnosis for patients aged 30 and older.
• Frequency of scheduled check-up depends on the status of the retinopathy.