Transcript Diagnosis & Management of Diabetic Eye Disease

Diagnosis &
Management of
Diabetic Eye Disease
Paul Chous, M.A., O.D., F.A.A.O.
Specializing in Diabetes Eye Care & Education
Part 3
Cataract

Hyperglycemia leads to sorbitol
accumulation via aldose reductase
(the polyol pathway)
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True diabetic “snowflake” cataracts
Typical age-related cataracts
develop prematurely due to AGE
formation

Decreased elasticity of lens proteins
causes premature presbyopia and,
eventually, loss of tranparency
Diabetic “Snowflake” Cortical Cataract
Nuclear Sclerotic Cataract – 52 yo diabetic
The Maillard Reaction
Advanced Glycation Endproducts:
AGEs – they’re what’s for dinner
Cataract - Management

Improve & stabilize blood glucose
 A1c
< 6.5% (ideally)
 Strive for a low standard deviation

Phacoemulsification when prudent
or necessary
 Much
higher risk of post-operative
CME and worsening retinopathy
 Always address retinopathy prior to
surgery
Diabetic Keratopathy

Hyperglycemia & corneal sensory
neuropathy weaken hemidesmosomal
attachments between the basal epithelium
and its basement membrane


PEK, Erosions, Neurotrophic Keratitis &
Ulceration
Increased tear osmolarity and lacrimal
autonomic neuropathy result in dry eye
Photonic Colloidal Crystalline Array
Prevalence of Dry Eye Syndrome and
use of artificial tears is significantly
higher amongst patients with diabetes
and with a family Hx of diabetes
Optometry. 2006 Nov;77(11):554-8
Am J Ophthalmol. 2005 Mar;139(3):498-503
Diabetic Keratopathy
Diabetic Neurotrophic Ulcer
Keratopathy - Management

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Improve & stabilize blood glucose
Be careful with contact lenses &
corneal refractive surgeries
Avoid vigorous eye rubbing
NP tears, plugs, immunomodulators,
bandage SCLs, etc. as indicated
Beware infection
Key Points
 Diabetes
and diabetic eye
disease are epidemic
 Ocular complications are myriad
and associated with large blood
vessel disease
 State-of-the-art care is evolving
rapidly
“The only thing to do
with good advice is to
pass it on to others…
It is of absolutely no
use to oneself.”
- Oscar Wilde