- accelerated vascular changes of the eye that normally occur with aging

- major retinal findings are AV crossing changes, reflective changes, and changes in the caliber of retinal arterioles

Chronic moderate hypertension

- example of chronic moderate hypertension

- associated with AV nicking, arteriolar light reflex, tortuous arterioles, and diffuse arteriolar narrowing

Arteriolar sclerosis

- visible more than 2 disc diameters away from the optic disc

- requires a clear space on each side of the arteriole as it crosses the venule (unreliable if not complete space)

- 90% of hypertensive pt's also ahve hypertensive heart disease

- compression of vein is more apparent than real (refractile properties of AV adventitia)

Complete AV crossing changes (AV nicking)

- develop in chronic moderate hypertension

- findings caused by increased refractile properties of the arteriole secondary to vessel wall thickening

Copper and silver wiring

(changes in arteriolar light reflex)

Copper and Silver Wiring

- caused by increased refractile properties of arteriole secondary to vessel wall thickening

Arteriolar Sclerosis

- manifestation of chronic moderate hypertension that manifests as soft curves of arterioles that look too long for the veins

- Arterioles tend to cross the veins at right angles

Tortuosity of arterioles

- develops in chronic moderate hypertension

- AV ratio is reduced to 1:3, 1:4, or even less

Diffuse arteriolar narrowing

- develops in acute accelerated hypertension (malignant hypertension and hypertensive crisis)

- characterized by cotton wool exudates, hard exudates, flame-shaped and dot hemorrhages, papilledema, and diffuse and focal arteriolar narrowing

Neuroretinitis

Cotton Wool Exudates (Spots)

- ischemic swellings in the superficial nerve fiber layer of the retina

- pale white and fuzzy with non-discrete borders

- resolve in 4-8 weeks with successful treatment

Neuroretinitis

Hard exudates

- protein or lipid deposits in the inner retinal layers that result from leaking of serum across the blood-retinal barrier

- discrete borders and vary in color from yellow to white

- sometimes arranged around macula like spokes of wheel

Neuroretinitis

Flame-shaped hemorrhages

- occur in superficial nerve fiber layers of the retina and run in parallel to the orientation of the fibers

- originate from retinal arterioles

Neuroretinitis

Dot and Blot hemorrhages

- occur in deeper middle nerve fiber layers of the retina

- originate from retinal venules

- round because they run perpendicular to nerve fibers

Neuroretinitis

- in acute hypertension retinal arteries develop diffuse and focal arteriolar narrowing due to this

- can also occur from constriction with the autoregularory response to the elevated pressure

Vasospasm

- swelling of the optic disc

- most serious manifestation of neuroretinitis

Papilledema

- leading cause of blindness in adults between 25-74

- longer patients have this, more likely to develop retinal disease

- with type I, 50% incidence after 20 years

- with type II, 20% incidence after 15 years

- preventable/manageable

Diabetes Mellitus

- the earliest retinal changes that occur with diabetes

- microaneurysms, hard exudates, blot hemorrhages, cotton wool spots, venous beading occur

Nonproliferative diabetic retinopathy (NPDR)

- hallmark of nonproliferative diabetic retinopathy

- dilated capillaries that appear as small, smooth, sharp red dots

- due to diabetes mellitus until proven otherwise

- if they leak, can cause macular edema -->decreased visual acuity

- normal visual acuity w/o macular edema and thus pt's are unaware they have it

Microaneurysms

- intraretinal accumulations of lipid-like material that has leaked from microaneurysms

Hard exudates

- small venules bleed within the inner plexiform layer of the retina in NPDR

Blot hemorrhages

- ischemic infarcts within the nerve fiber layer that occur near the disc

- associated with an increased risk of developing proliferative diabetic retinopathy

Cotton wool spots

- situation where retinal veins resemble a string of beads

- develops with hypoxia within venous circulation

- strong indicator developing PDR

Venous bleeding

- final and most severe stage of diabetic retinal disease

- characterized by neovascularization and fibrous proliferation

- can lead to retinal detachment and neovascular glaucoma

Proliferative Diabetic Retinopathy (PDR)

- retinal vessels proliferate widely in response to retinal ischemia in PDR

- new vessels formed are defective and leak fluid (edema) and red cells (hemorrhages)

- develops first around the optic disc and then macula

- vessels grow outward --> blindness results from fibrous scar formation

- scarring and fibrosis can lead to retinal detachment

- can grow over surface of iric and occlude the aqueous outflow tract --> neovascular glaucoma

Neovascularization

Neovascularization

- proliferation of defective retinal vessels which can result in blindness, retinal detachment and glaucoma

Proliferative diabetic retinopathy

- stripes of dark pigment commonly appear in elderly pt's

- normally uniform red-orange color

- can be uniformly darker in color due to increased choroidal pigment with different races

Tigroid retina