diabetes and your eyes
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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Josephine Carlos-Raboca, M.D.Josephine Carlos-Raboca, M.D.
Makati Medical CenterMakati Medical Center
DIABETES AND YOUR EYESDIABETES AND YOUR EYES
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DIABETES MELLITUSDIABETES MELLITUS
ABNORMALITY IN GLUCOSE METABOLISMABNORMALITY IN GLUCOSE METABOLISM ALTERED INSULIN PRODUCTION OR ALTERED INSULIN PRODUCTION OR
ACTIVITYACTIVITY ELEVATED BLOOD SUGAR LEVELSELEVATED BLOOD SUGAR LEVELS NUMEROUS COMPLICATIONSNUMEROUS COMPLICATIONS ENORMOUS SOCIAL/ECONOMIC IMPACTENORMOUS SOCIAL/ECONOMIC IMPACT
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ANATOMY OF THE EYEANATOMY OF THE EYE
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Mga SimtomasMga Simtomas
panlalabo ng paninginpanlalabo ng paningin pagdilim ng paninginpagdilim ng paningin pagdoble ng paninginpagdoble ng paningin itim na ‘spots’ sa paninginitim na ‘spots’ sa paningin
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EYE COMPLICATIONSEYE COMPLICATIONS
CORNEAL ABNORMALITIESCORNEAL ABNORMALITIES CATARACTSCATARACTS IRIS NEW VESSELSIRIS NEW VESSELS GLAUCOMAGLAUCOMA NEUROPATHIESNEUROPATHIES RETINOPATHYRETINOPATHY
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CORNEAL PROBLEMSCORNEAL PROBLEMS
More prone to abrasions, infectionsMore prone to abrasions, infections Delayed/poor wound healingDelayed/poor wound healing
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LENSLENS
Earliest sign is blurring of visionEarliest sign is blurring of vision Drastic changes in blood sugar affects the Drastic changes in blood sugar affects the
grade of your eyegrade of your eye Diabetics prone to develop cataracts earlierDiabetics prone to develop cataracts earlier
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Diabetic CataractDiabetic Cataract
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GlaucomaGlaucoma
A rise in the internal pressure of the eyeA rise in the internal pressure of the eye Usually a result of the new vessels in the iris Usually a result of the new vessels in the iris
which block the outflowwhich block the outflow
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NeuropathiesNeuropathies
Can affect muscles that move the eyeCan affect muscles that move the eye Or the optic nerveOr the optic nerve
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DIABETIC DIABETIC RETINOPATHYRETINOPATHY
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Normal RetinaNormal Retina
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DIABETIC RETINOPATHYDIABETIC RETINOPATHY
MOST COMMON CAUSE OF NEW CASES MOST COMMON CAUSE OF NEW CASES OF BLINDNESS OF BLINDNESS
10-20% OF ALL NEW CASES OF 10-20% OF ALL NEW CASES OF BLINDNESS (US & EUROPE)BLINDNESS (US & EUROPE)
INCREASING PREVALENCE DUE TO INCREASING PREVALENCE DUE TO INCREASING SURVIVAL OF DM PATIENTSINCREASING SURVIVAL OF DM PATIENTS
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RISK FACTORSRISK FACTORS
TYPETYPE DURATIONDURATION GLUCOSE CONTROLGLUCOSE CONTROL RENAL DISEASERENAL DISEASE SYSTEMIC HYPERTENSIONSYSTEMIC HYPERTENSION ELEVATED SERUM LIPIDSELEVATED SERUM LIPIDS PREGNANCYPREGNANCY
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TYPE OF DIABETES TYPE OF DIABETES MELLITUSMELLITUS
10-15%: Type 110-15%: Type 1 MAJORITY: Type 2MAJORITY: Type 2 OCULAR COMPLICATIONS SIMILAROCULAR COMPLICATIONS SIMILAR Type 1: HIGH INCIDENCE OF SEVERE Type 1: HIGH INCIDENCE OF SEVERE
OCULAR COMPLICATIONS/FASTER OCULAR COMPLICATIONS/FASTER PROGRESSIONPROGRESSION
Type 2: MAJORITY OF CLINICAL CASES Type 2: MAJORITY OF CLINICAL CASES OF EYE DISEASEOF EYE DISEASE
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DURATIONDURATION
DURATION Type 1 Type 2
0-5 YEARS 0%
10-15 YEARS 25-50% 23 -43%
15-29 YEARS 75-95% 60%
30+ YEARS 100%
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GLUCOSE CONTROLGLUCOSE CONTROL
INTENSIVE GLUCOSE CONTROL INTENSIVE GLUCOSE CONTROL REDUCED INCIDENCE AND REDUCED INCIDENCE AND PROGRESSION OF RETINOPATHY IN PROGRESSION OF RETINOPATHY IN IDDMIDDM
• Diabetes Control and Complications Diabetes Control and Complications TrialTrial
GLYCOSYLATED Hg <7%GLYCOSYLATED Hg <7%
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RENAL DISEASERENAL DISEASE
PROTEINURIA, ELEVATED BUN/CREA PROTEINURIA, ELEVATED BUN/CREA LEVELS: EXCELLENT PREDICTORLEVELS: EXCELLENT PREDICTOR
MICROANGIOPATHYMICROANGIOPATHY AGGRESSIVE MANAGEMENT IS AGGRESSIVE MANAGEMENT IS
BENEFICIALBENEFICIAL
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SYSTEMIC HYPERTENSIONSYSTEMIC HYPERTENSION
HTN + NEPHROPATHY: EXCELLENT HTN + NEPHROPATHY: EXCELLENT PREDICTOR OF RETINOPATHYPREDICTOR OF RETINOPATHY
MAY BE SUPERIMPOSEDMAY BE SUPERIMPOSED MUST BE CONTROLLEDMUST BE CONTROLLED
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ELEVATED SERUM LIPIDSELEVATED SERUM LIPIDS
MAY COMPLICATE RETINOPATHYMAY COMPLICATE RETINOPATHY INCREASES VESSEL LEAKAGE AND INCREASES VESSEL LEAKAGE AND
HARD EXUDATE FORMATIONHARD EXUDATE FORMATION REASON????REASON????
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PREGNANCYPREGNANCY
PREGNANT WOMEN W/O DM PREGNANT WOMEN W/O DM RETINOPATHY: 10% RISK FOR NPDRRETINOPATHY: 10% RISK FOR NPDR
PREGNANT WOMEN WITH NPDR: 4% PREGNANT WOMEN WITH NPDR: 4% RISK FOR PDRRISK FOR PDR
THOSE WITH PDR: VERY POOR THOSE WITH PDR: VERY POOR PROGNOSISPROGNOSIS
BASELINE AND STRICT FOLLOW UPBASELINE AND STRICT FOLLOW UP
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RETINAL HEMORRHAGERETINAL HEMORRHAGE
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HARD EXUDATESHARD EXUDATES
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COTTON WOOL SPOTSCOTTON WOOL SPOTS
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NEOVASCULARIZATIONNEOVASCULARIZATION
RESPONSE TO SEVERE AND RESPONSE TO SEVERE AND PROLONGED LACK OF OXYGENPROLONGED LACK OF OXYGEN
ANGIOGENIC FACTORS ANGIOGENIC FACTORS GROWTH GROWTH OF NEW BLOOD VESSELSOF NEW BLOOD VESSELS IN IN
THE RETINATHE RETINA POOR QUALITY OF VESSELSPOOR QUALITY OF VESSELS
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Normal RetinaNormal Retina
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NEOVACULARIZATIONNEOVACULARIZATION
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VITREOUS HEMORRHAGEVITREOUS HEMORRHAGE
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VITREOUS/PRERETINAL VITREOUS/PRERETINAL HEMEHEME
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TRACTIONAL DETACHMENTTRACTIONAL DETACHMENT
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TRACTIONAL DETACHMENTTRACTIONAL DETACHMENT
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STAGING/TERMINOLOGYSTAGING/TERMINOLOGY
““BACKGROUND” OR NON-PROLIFERATIVE BACKGROUND” OR NON-PROLIFERATIVE DIABETIC RETINOPATHY (DIABETIC RETINOPATHY (BDR/NPDRBDR/NPDR))
PROLIFERATIVE DIABETIC RETINOPATHY PROLIFERATIVE DIABETIC RETINOPATHY ((PDRPDR))
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MILD BACKGROUND MILD BACKGROUND
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MODERATE BACKGROUNDMODERATE BACKGROUND
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SEVERE BACKGROUNDSEVERE BACKGROUND
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PROLIFERATIVE PROLIFERATIVE RETINOPATHYRETINOPATHY
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PROGNOSIS W/O TREATMENTPROGNOSIS W/O TREATMENT
MODERATE VISUAL LOSS IN BDR: MODERATE VISUAL LOSS IN BDR:
30% IN 3 YEARS30% IN 3 YEARS SEVERE VISUAL LOSS( VISION LESS SEVERE VISUAL LOSS( VISION LESS
THAN 5/200) IN PDR: THAN 5/200) IN PDR: 35% IN 2 35% IN 2 YEARSYEARS
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TREATMENTTREATMENT
GLUCOSE CONTROLGLUCOSE CONTROL LASER THERAPYLASER THERAPY
FOCALFOCAL PANRETINAL PHOTOCOAGULATIONPANRETINAL PHOTOCOAGULATION
VITRECTOMYVITRECTOMY BP CONTROLBP CONTROL LIPID CONTROLLIPID CONTROL
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LASER THERAPYLASER THERAPY
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LASER THERAPYLASER THERAPY
GOAL IS TO PRESERVE VISION !!!GOAL IS TO PRESERVE VISION !!! Improvement is secondaryImprovement is secondary
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RECOMMENDATIONSRECOMMENDATIONS
Get at Baseline Get at Baseline DILATEDDILATED eye exam eye exam Type 1 DM: FIVE YEARS AFTER Type 1 DM: FIVE YEARS AFTER
DIAGNOSISDIAGNOSIS Type 2 DM: IMMEDIATELY AFTER Type 2 DM: IMMEDIATELY AFTER
DIAGNOSISDIAGNOSIS GESTATIONAL DM: DURING 1ST GESTATIONAL DM: DURING 1ST
TRIMESTER TRIMESTER IMMEDIATE EXAM IF SYMPTOMATICIMMEDIATE EXAM IF SYMPTOMATIC
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RECOMMENDATIONSRECOMMENDATIONS
MILD BDR: YEARLY EXAMMILD BDR: YEARLY EXAM MODERATE BDR: EVERY 4-8 MODERATE BDR: EVERY 4-8
MONTHS MONTHS SEVERE BDR: EVERY 2-4 MONTHSSEVERE BDR: EVERY 2-4 MONTHS PDR: IMMEDIATE LASER TX THEN PDR: IMMEDIATE LASER TX THEN
EVERY 2-4 MONTHS UNTIL STABLE EVERY 2-4 MONTHS UNTIL STABLE
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THANK YOU!THANK YOU!