Transcript Diabetic Retinopathies - Josephine Carlos

DIABETES AND YOUR EYES
Josephine Carlos-Raboca, M.D.
Makati Medical Center
DIABETES MELLITUS
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ABNORMALITY IN GLUCOSE METABOLISM
ALTERED INSULIN PRODUCTION OR
ACTIVITY
ELEVATED BLOOD SUGAR LEVELS
NUMEROUS COMPLICATIONS
ENORMOUS SOCIAL/ECONOMIC IMPACT
ANATOMY OF THE EYE
Mga Simtomas

panlalabo ng paningin
 pagdilim ng paningin
 pagdoble ng paningin
 itim na ‘spots’ sa paningin
EYE COMPLICATIONS
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CORNEAL ABNORMALITIES
 CATARACTS
 IRIS NEW VESSELS
 GLAUCOMA
 NEUROPATHIES
 RETINOPATHY
CORNEAL PROBLEMS
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More prone to abrasions, infections
 Delayed/poor wound healing
LENS
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Earliest sign is blurring of vision
 Drastic changes in blood sugar affects the
grade of your eye
 Diabetics prone to develop cataracts earlier
Diabetic Cataract
Glaucoma
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A rise in the internal pressure of the eye
 Usually a result of the new vessels in the iris
which block the outflow
Neuropathies
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Can affect muscles that move the eye
 Or the optic nerve
DIABETIC
RETINOPATHY
Normal Retina
DIABETIC RETINOPATHY
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MOST COMMON CAUSE OF NEW CASES
OF BLINDNESS
 10-20% OF ALL NEW CASES OF
BLINDNESS (US & EUROPE)
 INCREASING PREVALENCE DUE TO
INCREASING SURVIVAL OF DM PATIENTS
RISK FACTORS
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TYPE
 DURATION
 GLUCOSE CONTROL
 RENAL DISEASE
 SYSTEMIC HYPERTENSION
 ELEVATED SERUM LIPIDS
 PREGNANCY
TYPE OF DIABETES
MELLITUS
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10-15%: Type 1
 MAJORITY: Type 2
 OCULAR COMPLICATIONS SIMILAR
 Type 1: HIGH INCIDENCE OF SEVERE
OCULAR COMPLICATIONS/FASTER
PROGRESSION
 Type 2: MAJORITY OF CLINICAL CASES
OF EYE DISEASE
DURATION
DURATION
0-5 YEARS
Type 1
Type 2
0%
10-15 YEARS
25-50%
23 -43%
15-29 YEARS
75-95%
60%
30+ YEARS
100%
GLUCOSE CONTROL
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INTENSIVE GLUCOSE CONTROL
REDUCED INCIDENCE AND
PROGRESSION OF RETINOPATHY IN
IDDM
• Diabetes Control and Complications Trial
 GLYCOSYLATED Hg <7%
RENAL DISEASE
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PROTEINURIA, ELEVATED BUN/CREA
LEVELS: EXCELLENT PREDICTOR
 MICROANGIOPATHY
 AGGRESSIVE MANAGEMENT IS
BENEFICIAL
SYSTEMIC HYPERTENSION
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HTN + NEPHROPATHY: EXCELLENT
PREDICTOR OF RETINOPATHY
 MAY BE SUPERIMPOSED
 MUST BE CONTROLLED
ELEVATED SERUM LIPIDS
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MAY COMPLICATE RETINOPATHY
 INCREASES VESSEL LEAKAGE AND
HARD EXUDATE FORMATION
 REASON????
PREGNANCY
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PREGNANT WOMEN W/O DM
RETINOPATHY: 10% RISK FOR NPDR
 PREGNANT WOMEN WITH NPDR: 4%
RISK FOR PDR
 THOSE WITH PDR: VERY POOR
PROGNOSIS
 BASELINE AND STRICT FOLLOW UP
RETINAL HEMORRHAGE
HARD EXUDATES
COTTON WOOL SPOTS
NEOVASCULARIZATION
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RESPONSE TO SEVERE AND
PROLONGED LACK OF OXYGEN
 ANGIOGENIC FACTORS
 GROWTH OF NEW BLOOD VESSELS IN
THE RETINA
 POOR QUALITY OF VESSELS
Normal Retina
NEOVACULARIZATION
VITREOUS HEMORRHAGE
VITREOUS/PRERETINAL
HEME
TRACTIONAL DETACHMENT
TRACTIONAL DETACHMENT
STAGING/TERMINOLOGY
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“BACKGROUND” OR NON-PROLIFERATIVE
DIABETIC RETINOPATHY (BDR/NPDR)
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PROLIFERATIVE DIABETIC RETINOPATHY
(PDR)
MILD BACKGROUND
MODERATE BACKGROUND
SEVERE BACKGROUND
PROLIFERATIVE
RETINOPATHY
PROGNOSIS W/O TREATMENT
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MODERATE VISUAL LOSS IN BDR:
30% IN 3 YEARS
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SEVERE VISUAL LOSS( VISION LESS
THAN 5/200) IN PDR: 35%
YEARS
IN 2
TREATMENT
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GLUCOSE CONTROL
 LASER THERAPY
 FOCAL
 PANRETINAL PHOTOCOAGULATION
 VITRECTOMY
 BP CONTROL
 LIPID CONTROL
LASER THERAPY
LASER THERAPY
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GOAL IS TO PRESERVE VISION !!!
 Improvement is secondary
RECOMMENDATIONS
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Get at Baseline DILATED eye exam
 Type 1 DM: FIVE YEARS AFTER
DIAGNOSIS
 Type 2 DM: IMMEDIATELY AFTER
DIAGNOSIS
 GESTATIONAL DM: DURING 1ST
TRIMESTER
 IMMEDIATE EXAM IF SYMPTOMATIC
RECOMMENDATIONS
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MILD BDR: YEARLY EXAM
 MODERATE BDR: EVERY 4-8
MONTHS
 SEVERE BDR: EVERY 2-4 MONTHS
 PDR: IMMEDIATE LASER TX THEN
EVERY 2-4 MONTHS UNTIL STABLE
THANK YOU!