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Age Group 10 20 30 40 50 60

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Basic Considerations for Prevention of Blindness in Diabetes Care and Education Prof. Morsi Arab Emeritus Professor of Medicine University of Alexandria Age Group 10 20 30 40 50 60

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Basic Considerations for Prevention of Blindness in Diabetes Care and EducationProf. Morsi Arab Emeritus Professor of Medicine University of Alexandria
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Causes of visual loss and blindness in Diabetes- Diabetic Retinopathy ( DR) is most common - Glucoma less common - Cataract less common - Vitreous hemorrhage
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The Burden of diabetes on visual abilityThe WHO identifiesDRas the leading causeofpreventable blindnessand visual disabilityin adults ineconomically developedsocieties
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Significant Observations in DR1- DR takes a long time to become manifest. During this time it is asymptomatic 2- DR. may not be arrested after establishment of normoglycaemia ( bec. glycated subs. can continue to bind to proteins after …) 3- However , glycaemic control at earlystages is effective in controlling progression of DR ( DCCT)
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Prevalence of Diabetic Retinopathy ( DR)( The Wisconsin Study )all DR Prolif.DRin type 1 (onset of DM >30 ys) 71% 23 %in type 2 (onset after 30ys ) - on insulin 70% 14 % - no insulin 39% 2 %
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Prevalence of DR in relation to GlycaemiaThe DCCT ( type 1)intensified Rx reduced progression of DR by 76% in primary preven. cohort 54% in secondary preven. cohort 47% progression to severe NPDR 56% necessity for Laser RxDCCT results show importance of both Duration and Glucose exposure ( hyperglyceamia) for the development of DR
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Preval. of DR in relation to Glycaemia UKPDS ( type 2)intensified Rx with improved metaboliccontrol - risk of worsening DR by 21 % - need for Laser Rx by 29% - Cataract extraction by 24%
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Prevalence of DR / Duration of DiabetesThe prev. of DR is highly correlated with the duration of DMat 5ysat 25 ysin type 1 : (10 %) ( steep rise) 100 %in type 2 : (25 %) almost 85%
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Hypertension and DRmost studies show a causal association UKPDS :Tight control of B.P. 34 % of progress DR 47 % of moderate loss of Vis. Acuity( N.B. independent on the degree of glycaemic control )No specific type of anti hypertensive medication is superior than other
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The Genetic factor in DRThere is evidence that severity of DR is influenced by familial , and possibly a genetic factor
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Dyslipidaemia and DRan association is found between more severe DR and - Total cholesterol - but not with TG (lipid modulation by statins…? not conclusive )
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Smoking and DRAlthough smoking is a risk factor in albuminuria and nephropathy , its effect on DR is not clear
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Aspirin in DR- Anti inflam. agents did not show effect in Rx vasc. complications - aspirin failed to prevent dev. of DR - aspirin can be used if indicated ( card) without adverse effect on DR
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The Risk Factors for DRMostdefinitive:1- Duration of DM 2- High glycaemic levelLess definite: 1- Hypertension 2- Pregnancy 3- Genetic factor 4- Hyperlipidaemia 5- Close assoc. with albuminuria 6- ? Smoking
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Screening for and follow up of DRin type 1 :screen within 3-5 yrs after diag. ( onset) ( not necessary before age 10 )in type 2 : screen shortly after diagnosis Follow up : - repeat annually if no DR - more frequently if DR is progressing N.B. : In Pregnancy : -- Screen at planning preg. or during first trimest. – Follow up through preg.
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Education for Prevention of DR ( basic considerations ) 1- knowledge of the Risk factors 2- control of glycaemic level 3- control hypertension 4- screen + follows up , and early intervention 5- close observation in pregnancy 6- control serum lipids 7- discourage smoking 8- no restriction on aspirin ( if required for cardiac )
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