Transcript Diabetic Retinopathy

Diabetic Retinopathy
A condition that develops as a result of high
blood sugar levels in both Type 1 and Type 2
diabetes.
The blood vessels in the retina
become weak, causing a varied degree of
impact depending on the location and extent of
the damage.
May also result in cataracts
(clouding of the lens) and glaucoma (increased
pressure in the eye).
Diabetic Retinopathy
Diabetic Retinopathy
Diabetic Retinopathy
Diabetic Retinopathy
Diabetic Retinopathy
Visual acuity testing – measuring the ability to focus
Ophthalmoscopy and slit lamp exam – detects
changes in the retina and other structures
Gonioscopy – detects if the area where the fluid
drains out of your eye is open or closed
Tonometry – measures the pressure of the eye which
helps detect glaucoma
Diabetic Retinopathy
Diabetic Retinopathy
Ely Lilly & Co is testing a protein-based beta
inhibitor (known as Kinase C-Beta) that is
showing
promise
for
preventing
the
progression of diabetic retinopathy.
Genetech is testing drugs for macular
degeneration (loss of center vision) that may
have future benefits for diabetic retinopathy.
Diabetic Retinopathy
Diabetic Retinopathy
4.3% of people of all ages
8.2% of people 40 years and older
Diabetic Retinopathy
Diabetic Retinopathy
The main risk factors are poor nutrition and
blood sugar maintenance
The most important care for Diabetic
Retinopathy is having eye exams every 3 to 6
months in order to monitor for Glaucoma and
Cataracts
Diabetic Retinopathy
American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311-1717
1-800-342-2383 (National Headquarters)
E-mail: [email protected] www.diabetes.org
http://www.diabetes.org/
Diabetic Retinopathy
Texas Diabetes Council - Central Campus
1100 West 49th Street
Austin, TX 78756
(512) 458-7111
http://www.dshs.state.tx.us/diabetes/
Diabetic Retinopathy
American Federation for the Blind - Texas
11030 Ables Lane
Dallas, TX 75229-4524
(214) 352-7222
http://www.afb.org/
Diabetic Retinopathy
Ophthalmology Associates
1201 Summit Avenue
Fort Worth, Texas, 76102
Tel: 817-332-2020
Email: [email protected]
http://www.fortworth2020.com/diabetic_retinopathy.aspx
Diabetic Retinopathy
http://bascompalmer.org/site/disease/disease_diabetic.asp
http://diabetes.webmd.com/tc/diabetic-retinopathy-medications
http://www.mayoclinic.org/retinal-diseases/diabeticretinopathy.html
http://www.aoa.org/diabetic-retinopathy.xml
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002192/
Diabetic Retinopathy
Case Study
On November 11, 2001, a 54 year old man had his annual diabetic
visual evaluation. He had no complaints of his vision. He had stated
that his blood sugar normally reads around 155mg/dl and on
occasion he would get a reading of 220mg/dl. It was two years prior
that he had his last eye exam. Records from this particular visit
noted that the man had a diagnosis of mild non-proliferative diabetic
retinopathy without clinically significant macular edema. All of this
man’s ocular history was great except it was noted that he had hard
exudates in the posterior pole, but away from foveal tissue.
His medical history included renal insufficiency, depression,
hyperlipidemia, hypertension, cellulitis of the leg and type II
diabetes with renal and ophthalmic manifestations. Medications
include insulin injections b.i.d., dressings to treat cellulitis of the leg,
Zestril (Lisin-opril, AstraZeneca) and Zocor (Simvastatin, Merck).
Diabetic Retinopathy
Case Study
Entering his examination, his acuities were 20/40-2 OU and was best
corrected at 20/25 OU. His tonometry showed that he had intraocular
pressure of 12mm Hg OD and 15mm Hg OS. His results found no
rubeosis, mild cataract development OU, and exudates and
hemorrhages within 500 microns of the fovea OD with retinal
thickening. Microaneurysms and hemorrhages were present in all
four quadrants. This visit noted a diagnosis of mild/moderate nonproliferative diabetic retinopathy (NPDR) and clinically significant
macular edema, also known as CSME (retinal swelling and cysts
formation in the macular area).
A fluorescein study on March 4, 2002 showed scattered perfusion
from microaneurysms O.S. greater than O.D. (see figure 2). The
patient was treated with focal grid argon laser, with 27 burns O.D.
and 57 O.S.
Diabetic Retinopathy
Case Study
In September, 2002,six months later, the patient returned for a follow
up visit and had entering acuities of 20/30 OU. The assessment
included type II DM, moderate NPDR and minimal CSME O.U. The
retinal practitioner believed that the problem, CSME OS was
resolving so they rescheduled another follow up visit four months
later.
Almost four months later, in January, 2003, the man returned for his
visit and complained about blurry vision and reported that he had to
stop driving. He also reported that his glucose levels were normal
and measured 113mg that morning. The man said that after his last
surgery, his vision was stable but could no longer find use in his
glasses. Entering acuities were counting fingers at five feet OD and
20/60 OS. Diagnosis was altered to type II DM with severe NPDR and
diffuse CSME OU. After further testing the same day, a marked
increase in retinal edema was noted.
Diabetic Retinopathy
Case Study
Five months later, in May, 2003, he returned for another follow up
visit and received a laser treatment of 1400 burns OD and 1450
burns OS.
In July, 2003, his examination showed an entering acuity of bare
light perception OU and proliferative changes and diagnosed type II
DM with sever PDR OU were noted.
The practitioners questioned the dramatic change in this patient’s
vision. This case illustrates why you must conduct an objective
analysis of a patient's underlying medical condition. Upon careful
review of this case, several important findings were noted. The most
important was the patient’s glucose control over the past several
years. The data on his glucose levels were collected and his
Hemoglobin A1c counts. This analysis revealed the patient’s poor
dietary compliance over several years.
Diabetic Retinopathy
Case Study
A patient is considered a suspect for diabetes when
fasting serum glucose levels reach between 100 and
140mg/dl. The diagnosis is likely when that number is
over 140mg/dl. Further, the hemoglobin A1c count is
also utilized. If elevated above 7.0, a positive diagnosis
is likely. The patient had both of these extremely
elevated over many years. When a practitioner takes
this information into account, there becomes no point
in ocular treatment option because the disease is
already out of control. The patient needs to want to
help themselves first.
Diabetic Retinopathy
Case Study
This case study ends with suggestions to prevent and/or
postpone vision loss. It also provides excellent visuals for a
person to better understand the situation. Actual
glucose/A1c levels should be available. Practitioner reports
that patients can be easily misled by at-home readings which
can often seem reasonable without considering the A1c
levels from a lab. A1c counts are a better indication of a
patient’s plasma glucose levels over the past three to four
months. They provide a better indication of the patient’s
compliance. Also, careful clinical examination is vital to
monitor and treat ocular conditions. The practitioners say
that patient education can never be overstated. When a
patient realizes the severity of the situation and the
implications that are held, it can help to motivate the patient
to practice a higher form of control over the diabetes.
Diabetic Retinopathy
(Gibb & Olafsson) (Cassin, 2006, p. 87) (Levak, p. 132)Gibb, R., &
Olafsson, H. (2006, September). Case study: Rapid progression of
diabetic retinopathy. Retrieved from
http://www.optometric.com/article.aspx?article=71734
Cassin, B. (2006). Dictionary of eye terminology (p. 87). Gainesville,
FL: Triad Publishing Company.
Levak, N. (n.d.). Low vision: A resource guide with adaptations for
students with visual impairments (p. 132). Austin, TX: Texas School
fo the Blind and Visually Impaired.