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Diabetes and the Eye

Diabetes and the Eye. Karen B. Saland, M.D. August 18, 2008. Diabetes and Eye Disease: Learning Objectives. Identify Systemic Risk Factors Differentiate Clinical Stages Describe treatment strategies and screening guidelines Recognize importance of team approach.

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Diabetes and the Eye

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  1. Diabetes and the Eye Karen B. Saland, M.D. August 18, 2008

  2. Diabetes and Eye Disease: Learning Objectives • Identify Systemic Risk Factors • Differentiate Clinical Stages • Describe treatment strategies and screening guidelines • Recognize importance of team approach

  3. Diabetes Mellitus: Epidemiology • 135 million people with diabetes worldwide (90% type 2) • 300 million with diabetes projected by 2025

  4. Diabetes Mellitus: Epidemiology • 16 million Americans affected • 800,000 new cases per year (type 2) • 2X greater risk in African-Americans, Latinos and Native Americans

  5. Diabetic Retinopathy • Retinal complications of Diabetes • Leading cause of blindness in working age Americans

  6. DCCT Findings:No Baseline Retinopathy

  7. DCCT Findings:Mild to Moderate Retinopathy

  8. DCCT Findings:Intensive Glucose Control, No baseline retinopathy • 27% reduction in developing retinopathy • 76% reduction in risk of developing progressive retinopathy

  9. DCCT FINDINGSIntensive Glucose Control, Mild to Moderate Retinopathy • 54 reduction in progression of retinopathy • 47% reduction in development of severe NPDR or PDR • 59% reduction in need for laser surgery • Pre-existing retinopathy may worsen in early stages of treatment

  10. UKPDS FindingsType 2 Diabetes • Increased glucose and BP control decreases progression of retinopathy

  11. UKPDS FindingsResults • Hemoglobin A1C reduced from 7.9 to 7.0 = 25% decrease in microvascular complications • BP reduced to <150/85 mm Hg = 34% decrease in retinopathy progression

  12. UKPDS FindingsHypertension Control • As important as glucose control in lowering risk of diabetic retinopathy • ACE inhibitor or beta blocker decreases microvascular complications

  13. DCCT/UKPDS Lessons • Professional and patient education • Good glucose and BP control • Regular examination

  14. Additional Systemic Controls • Proteinuria is a risk factor for macular edema • Lisinopril may benefit the diabetic kidney and retina even in normotensive patients

  15. Lowering cholesterol may lead to decreased hard exudates and improved vision.

  16. WESDR FindingsDiabetic Retinopathy and Cardiovascular Disease • PDR a risk indicator for MI, stroke, amputation • PDR elevates risk of developing nephropathy

  17. Diabetic Retinopathy:Clinical Stages • Nonproliferative diabetic retinopathy (NPDR) • Preproliferative diabetic retinopathy • Proliferative diabetic retinopathy (PDR)

  18. NPDR: Early Clinical Signs • Microaneurysms • Hard Exudates • Intraretinal hemorrhages Patients may be asymptomatic.

  19. Diabetic Macular Edema • Diabetes < /= 5 years = 5% prevalence • Diabetes >/= 15 years =15% prevalence

  20. PDR: Clinical Signs • Neovascularization • Vitreous hemorrhage and traction • NPDR features, including macular edema

  21. Vitreous Hemorrhage:Symptoms • Floaters • Severe visual loss Requires immediate ophthalmologic consultation

  22. Review of Clinical Stages • Nonproliferative diabetic retinopathy • Patients may be asymptomatic • Preproliferative retinopathy • Laser therapy at this stage may help prevent long-term visual loss • Proliferative retinopathy • Major cause of severe visual loss

  23. Panretinal Photocoagulation (PRP) • Outpatient procedure • Approximately 1000-2000 burns • 1 to 3 sessions

  24. PRP: Side Effects • Decreased night vision • Decreased peripheral vision

  25. Vitrectomy • Remove vitreous hemorrhage • Repair retinal detachment • Allow treatment with PRP

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