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DIABETES AND YOUR EYES

DIABETES AND YOUR EYES. Josephine Carlos-Raboca, M.D. Makati Medical Center. DIABETES MELLITUS. 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.

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DIABETES AND YOUR EYES

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  1. DIABETES AND YOUR EYES Josephine Carlos-Raboca, M.D. Makati Medical Center

  2. DIABETES MELLITUS • ABNORMALITY IN GLUCOSE METABOLISM • ALTERED INSULIN PRODUCTION OR ACTIVITY • ELEVATED BLOOD SUGAR LEVELS • NUMEROUS COMPLICATIONS • ENORMOUS SOCIAL/ECONOMIC IMPACT

  3. ANATOMY OF THE EYE

  4. Mga Simtomas • panlalabo ng paningin • pagdilim ng paningin • pagdoble ng paningin • itim na ‘spots’ sa paningin

  5. EYE COMPLICATIONS • CORNEAL ABNORMALITIES • CATARACTS • IRIS NEW VESSELS • GLAUCOMA • NEUROPATHIES • RETINOPATHY

  6. CORNEAL PROBLEMS • More prone to abrasions, infections • Delayed/poor wound healing

  7. LENS • Earliest sign is blurring of vision • Drastic changes in blood sugar affects the grade of your eye • Diabetics prone to develop cataracts earlier

  8. Diabetic Cataract

  9. Glaucoma • A rise in the internal pressure of the eye • Usually a result of the new vessels in the iris which block the outflow

  10. Neuropathies • Can affect muscles that move the eye • Or the optic nerve

  11. DIABETIC RETINOPATHY

  12. Normal Retina

  13. DIABETIC RETINOPATHY • 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

  14. RISK FACTORS • TYPE • DURATION • GLUCOSE CONTROL • RENAL DISEASE • SYSTEMIC HYPERTENSION • ELEVATED SERUM LIPIDS • PREGNANCY

  15. TYPE OF DIABETES MELLITUS • 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

  16. DURATION

  17. GLUCOSE CONTROL • INTENSIVE GLUCOSE CONTROL REDUCED INCIDENCE AND PROGRESSION OF RETINOPATHY IN IDDM • Diabetes Control and Complications Trial • GLYCOSYLATED Hg <7%

  18. RENAL DISEASE • PROTEINURIA, ELEVATED BUN/CREA LEVELS: EXCELLENT PREDICTOR • MICROANGIOPATHY • AGGRESSIVE MANAGEMENT IS BENEFICIAL

  19. SYSTEMIC HYPERTENSION • HTN + NEPHROPATHY: EXCELLENT PREDICTOR OF RETINOPATHY • MAY BE SUPERIMPOSED • MUST BE CONTROLLED

  20. ELEVATED SERUM LIPIDS • MAY COMPLICATE RETINOPATHY • INCREASES VESSEL LEAKAGE AND HARD EXUDATE FORMATION • REASON????

  21. PREGNANCY • 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

  22. RETINAL HEMORRHAGE

  23. HARD EXUDATES

  24. COTTON WOOL SPOTS

  25. NEOVASCULARIZATION • RESPONSE TO SEVERE AND PROLONGED LACK OF OXYGEN • ANGIOGENIC FACTORS • GROWTH OF NEW BLOOD VESSELSIN THE RETINA • POOR QUALITY OF VESSELS

  26. Normal Retina

  27. NEOVACULARIZATION

  28. VITREOUS HEMORRHAGE

  29. VITREOUS/PRERETINAL HEME

  30. TRACTIONAL DETACHMENT

  31. TRACTIONAL DETACHMENT

  32. STAGING/TERMINOLOGY • “BACKGROUND” OR NON-PROLIFERATIVE DIABETIC RETINOPATHY (BDR/NPDR) • PROLIFERATIVE DIABETIC RETINOPATHY (PDR)

  33. MILD BACKGROUND

  34. MODERATE BACKGROUND

  35. SEVERE BACKGROUND

  36. PROLIFERATIVE RETINOPATHY

  37. PROGNOSIS W/O TREATMENT • MODERATE VISUAL LOSS IN BDR: 30% IN 3 YEARS • SEVERE VISUAL LOSS( VISION LESS THAN 5/200) IN PDR: 35% IN 2 YEARS

  38. TREATMENT • GLUCOSE CONTROL • LASER THERAPY • FOCAL • PANRETINAL PHOTOCOAGULATION • VITRECTOMY • BP CONTROL • LIPID CONTROL

  39. LASER THERAPY

  40. LASER THERAPY • GOAL IS TO PRESERVE VISION !!! • Improvement is secondary

  41. RECOMMENDATIONS • 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

  42. RECOMMENDATIONS • 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

  43. THANK YOU!

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