Transcript Diagnosis & Management of Diabetic Eye Disease

Diagnosis &
Management of
Diabetic Eye Disease
A. Paul Chous, M.A., O.D., F.A.A.O.
Tacoma, WA
Specializing in Diabetes Eye Care & Education
Part 2
Biochemical Influences

In large vessels:
 Free
fatty acids (FFAs) cause
inflammation, dyslipidemia, and
atherosclerosis
 Small, dense LDL
 Increased blood viscosity & vessel
rigidity causes HTN
 Increased platelet adhesion
Visceral Adipose Tissue



Visceral fat releases substances that
cause insulin resistance and
mobilize non-esterified fatty acids
(Free Fatty Acids)
Insulin resistance a Hyperglycemia
FFAs are oxidized by vascular
endothelium a inflammatory
cytokines (PAI-1, CRP & more)
A Unifying Mechanism for
Microvascular and Macrovascular
Diabetes Complications
Large vessel
hFFAs
Small vessel
Polyol
Hexosamine
PKC
AGEs
hGlu
Adapted source: Michael Brownlee, M.D.
Hemodynamic Influences

Conditions that increase retinal blood
flow increase the risk of severe DRT
– Hyperglycemia
– Systemic hypertension
– Pregnancy
– Ocular hypotension
Other Influences
 Genetic
Susceptibilities
 Haptoglobin
 Lipid
SNPs
 Endocrine
 Growth
factors
hormone (GH) and
Insulin-like growth factors (IGF)
Factors Contributing to Diabetic Eye Disease
Diabetes Epidemic
Macrovascular Biochemistry
Glycated LDL, sticky platelets, CRP
CAMs/leukocyte adhesion, 4 pathways
Hypertension
Diabetic
Eye Disease
Pericyte Damage
Increased Blood Flow:
Shear Stress
Shunting
Microvascular Biochemistry
PKC, AGEs, Polyol Flux, Hexosamine
Pericyte Damage
Hormonal Factors & Individual Genetic Susceptibility
It’s Not Just The Eye…..
PDR Doubled the Risk of
Cardiovascular Death in T1DM
Over 8 Years (EURODIAB
Complications Study, 2005)
In T2DM, NPDR Conferred 1.3 -1.7 X
Increased Risk of Death & PDR
Increased Risk of Death 3-5 Fold
Over 18 years
(Diabetes Care 2007 Feb)
Diagnosis & Management of
Distinct Entities

“Diabetic Eye Disease” refers to ocular
pathologies more commonly seen in
patients with diabetes

All of these conditions are attributable,
at least in part, to chronic
hyperglycemia
Ocular Diseases
Associated With Diabetes
Cataract
 Keratopathy
 Efferent Cranial Neuropathy
 Glaucoma
 Ischemic Optic Neuropathy
 Retinal Vascular Occlusion
 Diabetic Retinopathy
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