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Global Diabetes Prevalence Is Projected to
Increase 242% Between 2000 and 2030
Global data
2000: 151 million patients
2010: 221 million patients
2030: 3 million patients
Amos AF, et al. Diabet Med . 1997;14:S7-S85.
Wild S, et al. Diabetes Care. 2004;27:1047-1053.
2000: 14!2 "
2010: 1#!5 "
$23%
2000: !4 "
2010: 14!2 "
$50%
2000: &4!5 "
2010: 132!3 "
$5#%
2000: 15! "
2010: 22!5 "$44%
2000: 2!5 "
2010: 32!& "
$24%
2000: 1!04 "
2010: 1!33 "
$2&%
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Potential "etabolic Pat'wa(s )eadin* to
Diabetic "icrovasc+lar ,omplications
Pol(ol
pat'wa(
Diabetic nep'ropat'(
Diabetic retinopat'(
Diabetic ne+ropat'(
Diabetes
-lcers.amp+tations
/(per*l(cemia
+peroide
overprod+ction
P,
activation
ision loss
enal disease
Diabetes6ind+ced microvasc+lar dama*e
Gl(cationDiac(l*l(cerol
©2005 Intenational !edi"al #ess
76II 8G9
$ot s%o&n in t%is dia'am d(e to s)a"e limitations: a"ti*ation o+ additional in+lammato and 'o&t% +a"tos.
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P+rpose Bene;its and )imitations o; ,ommon
etinal Dia*nostic Proced+res
pacit( ma( limiteam
Indirectop't'almos6cop(
7ssessperip'eralretina
7lternative to slit6lampbiomicroscop(
>pacit( ma( limiteam
tereoscopic
30? color;+nd+sp'oto*rap'(
Doc+ment
retinal stat+s
Permits objective
comparison over time"ore sensitive andreprod+cible t'anclinical eam
e@+ires trained
p'oto*rap'er andtrained reader
>pacit( ma(de*rade ima*e@+alit(
Amei"an A"adem o+ )%t%almolo'. Preferred Practice Pattern: Diabetic Retinopathy .San Fan"is"o, ali+onia: Amei"an A"adem o+ )%t%almolo'; 2003.
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P+rpose Bene;its and )imitations o; 7dvanced
etinal Dia*nostic Proced+res
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/ 7llows ;or retinal
ima*in* in presence
o; media opacit(/ 7ids in dia*nosis o;
retinal detac'ment
/7ssesses need and+r*enc( ;or
vitreoretinal s+r*er(
-ltrasono*rap'(
Ima'e "o(tes o+ %omas i(lla, !
etinal
detac'ment $
/emorr'a*e
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/ I97 is *ood ;or:
/i*'li*'tin*
microane+r(sms
'owin* isc'emia
'owin* brea=6
down o; t'e blood
retinal barrier
Dia*nosin*proli;erative diabetic
retinopat'(
-tilit( o; Intraveno+s 9l+orescein
7n*io*rap'( CI97
P'oto*rap'ic ;+nd+s ima*e
9l+orescein an*io*ram
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>,< and D"8
/ pon*e6li=e ;l+id acc+m+lation in t'e o+ter
retina
C0% to % o; e(es corresponds to ;ocal.di;;+se "8
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>,< and D"8
/ ,(stoid mac+lar edema C,"8 C50%
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>,< and D"8
/ "ec'anicalE'(aloidal traction and.or8" C1%
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>,< and D"8
/ ero+s mac+lar detac'ment wit' orwit'o+t traction C15%
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i*ns and (mptoms o;
Diabetic etinopat'(
Preclinical PD PD D"8
(mptoms one one or bl+rredvision and *lare
one or red+cedvision and ;loaters
one orbl+rred vision
,linicalsi*ns
ormal6appearin*retina
etinal veno+sdilation
"icroane+r(sms
,otton6woolspots
Intraretinal'emorr'a*es
I"7s
eno+s beadin*
etinal veno+sdilation
eno+s beadin*
I"7s
eovasc+lariAation
wellin* o;retina
Increasedcapillar(lea=a*e
9l+idacc+m+lationin retinalla(ers
I"7 F intraretinal microvasc+lar abnormalit(
adne W, Aiello #. #at%o'enesis o+ diaeti" etino)at%. In: Flnn 6W, Smidd W, eds. Diabetes and OcularDisease: Past, Present, and Future Therapies. AA !ono'a)% $(me 14. San Fan"is"o: %e Fo(ndation o+ t%e
Amei"an A"adem o+ )%t%almolo'; 2000:1-17.
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evere PD
onproli;erative Diabetic etinopat'(
Se*ee $#, "o(tes o+ iaeti" etino)at% St(d esea"% o()
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eovasc+lariAation
/emorr'a*e
©2005 Intenational !edi"al #ess
Proli;erative Diabetic etinopat'(
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/ ,(stoid mac+lar
edema
/ 9ocal mac+lar edema
-s+all( seen as
circinate e+dates
"icroane+r(sms at
t'e center
/ Di;;+se mac+lar edema
Diabetic "ac+lar 8dema:
3 ,linical arieties
Ima'e "o(tes o+ S (e, !
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/
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In;erior +perior
I)
I.>
>)
>P)
P8.>
8)"
IP)
G,)
9)
500Hm
2
etinal )a(ers on -ltra'i*' esol+tion >,<
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8arl(
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International ,linical Diabetic
"ac+lar 8dema Disease everit( cale
Proposed Disease everit()evel
9indin*s >bservable -pon Dilated >p't'almoscop(
D"8 apparentl( absent o apparent retinal t'ic=enin* or 'ard e+dates inposterior pole
D"8 apparentl( present ome apparent retinal t'ic=enin* or 'ard e+datesin posterior pole
I; D"8 is present it can be cate*oriAed as ;ollows:
"ild D"8 ome retinal t'ic=enin* or 'ard e+dates inposterior pole b+t distant ;rom t'e center o; t'emac+la
"oderate D"8 etinal t'ic=enin* or 'ard e+dates approac'in*
t'e center o; t'e mac+la b+t not involvin* t'ecenter
evere D"8 etinal t'ic=enin* or 'ard e+dates involvin* t'ecenter o; t'e mac+la
D"8 F diabetic mac+lar edema Wilinson #, et al. Ophthalmology . 2003;110:177-182. Amei"an A"adem o+ )%t%almolo'. Preferred practice pattern: diabetic retinopathy .
San Fan"is"o, ali+: Amei"an A"adem o+ )%t%almolo'; 2003.
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International ,linical Diabetic
etinopat'( Disease everit( cale
Proposed Diseaseeverit( )evel 9indin*s >bservable -pon Dilated >p't'almoscop(
o apparent retinopat'( o abnormalities
"ild PD "icroane+r(sms onl(
"oderate PD "ore t'an j+st microane+r(sms b+t less t'an severe PD
evere PD
C4:2:1 +le
7n( o; t'e ;ollowin*:
/ "ore t'an 20 intraretinal 'emorr'a*es in eac' o; 4@+adrants
/ De;inite veno+s beadin* in 2 or more @+adrants
/ Prominent I"7 in 1 or more @+adrants and no si*ns o;
PD
PD >ne or bot' o; t'e ;ollowin*:
/ eovasc+lariAation
/ itreo+s.preretinal 'emorr'a*e
PD F nonproli;erative diabetic retinopat'( PD F proli;erative diabetic retinopat'(
I"7 F intraretinal microvasc+lar abnormalities
Wilinson #, et al. Ophthalmology . 2003;110:177-182; Amei"an A"adem o+ )%t%almolo'. Preferred practice pattern: diabetic retinopathy . San Fan"is"o, ali+: Amei"an A"adem o+ )%t%almolo'; 2003.
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-PDL ) 71, , l t Mit' d d
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-PDL: )ower 71, ,orrelates Mit' ed+ced
is= o; Development and Pro*ression o;
etinopat'( in
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-PD: )ower BP ed+ces elative is= o;
Development and Pro*ression o; etinopat'(
>ver #!5 Jears in
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/i*'6ris= PD
C3 or 4 'i*'6ris=;eat+res
o -s+all( o
Jes -s+all( -s+all(
Indications ;or )aser P'otocoa*+lation
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Indications ;or itrectom( and
Potential ,omplications
Amei"an A"adem o+ )%t%almolo'. Preferred practice pattern: diabetic retinopathy . San Fan"is"o, ali+: Amei"an
A"adem o+ )%t%almolo'; 2003.
Flnn 6W, Smidd W, eds. Diabetes and Ocular Disease: Past, Present, and Future Therapies. AA !ono'a)% $o 14.
San Fan"is"o: %e Fo(ndation o+ t%e Amei"an A"adem o+ )%t%almolo'; 2000.iaeti" etino)at%
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Intravitreal
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Pe*aptanib Improves 7 >+tcomes
in D"8
(nnin'%am , et al. Ophthalmology . 2005;112:1747-1757.
ote: 7+t'ors state t'at st+d( was not powered to detect dose6
dependent treatment e;;ects!
Increase in7
Cletters
Pe*aptanib Dose
'am
Cn F 41
0!3 m*
Cn F 44
1 m*
Cn F 43
3 m*
Cn F 42
N 10 10% 34%
P F !003
30% 14%
N 15 #% 1&%P F !12
14% #%
Patients attainin* N 26line increase a;ter 3 wee=s o; treatment
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Pe*aptanib 7dverse 8vents
8vent 'am Pe*aptanib
8(e pain 1# 31
itreo+s ;loaters # 22
,onj+nctival 'emorr'a*e 10
itreo+s opacities 5
itreo+s disorder > #
is+al dist+rbance > 2 #
terile endop't'almitis 1
>c+lar adverse events t'at occ+rred si*ni;icantl( more o;ten in st+d( e(es1
(nnin'%am , et al. Ophthalmology . 2005;112:1747-1757.
Data are percenta*e o; total patient *ro+p! Qeroes omitted! > F not ot'erwise
speci;ied!1P+nctate =eratitis cataracts and e(e disc'ar*e occ+rred at approimatel( e@+al
rates in bot' s'am and pe*aptanib *ro+ps! o clinicall( relevant di;;erences were
observed between treatment *ro+ps ;or cardiac 'emorr'a*ic t'romboembolic
or *astrointestinal disorders!
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8palrestat 'ows
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8palrestat 7dverse 8vents
Steele W, Fa(lds , oa =. Drugs Aging . 1993;3:532-555.
)iver enA(me elevations
7lanine aminotrans;erase 1!0%
7spartate aminotrans;erase 1!0%
Gl+tam(l transpeptidase 1!0%
Diarr'ea 0!2%
8r(t'ema 0!2%
=in b+llae 0!2%
er+m creatinine elevation 0!2%
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100 .d "id t i I
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100 m*.da( "idosta+rin Improves
"ean 7 b( 7bo+t 1 )ine at 3 "ont's
am)o"%iao #A, et al. #n$est Ophthalmol %is &ci . 2004;45:922-931.
Placebo Cn F 34
P,412 50 m*.d Cn F 32
P,412 100 m*.d Cn F 3&
P,412 150 m*.d Cn F 3#
"ont'
, ' a n *
e i n 4 7 C n + m b e r o ; l e t t e r s D
100: P F !00#
150: P F !01
50: P F !02
0 1 2 3 4 5 # & 10 11 12 13 14 15
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"idosta+rin CP,412 7dverse 8vents
am)o"%iao #A, et al. #n$est Ophthalmol %is &ci . 2004;45:922-931.
Data are percenta*e o; total patient *ro+p! Qeroes omitted!
> F not ot'erwise speci;ied PB> F placebo
>r*ans(stem
8vent PB> 50 m*.d 100 m*.d 150 m*.d
Gastro6intestinal
a+sea 3% % 21% 3&%
Diarr'ea > 3% 3% 1% 1%
omitin* 3% 3% 1%
/epatic
Increased 7)< % &% 14%
Increased 7< 3% &% &%
8vents occ+rrin* in O5% o; patients in an( treatment *ro+p
+boista+rin ed+ces is= o; "oderate
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+boista+rin ed+ces is= o; "oderate
or Morse is+al )oss in Diabetic
etinopat'( Mit' or Mit'o+t D"8
#=-S St(d o(). Diabetes. 2005;54:2188-2197.
Placebo Cn F 100 e(es& m* Cn F e(es
1 m* Cn F 104 e(es
32 m* Cn F 10& e(es
50
40
P r o b a b i l i t ( o ; " 4 ) :
%
"ont's
)o* an= P val+es:
>verall: !032 m* vs Placebo: !03&
0 12 1& 24 30 3 42
30
20
10
0
") F moderate vis+al loss CN15
letters
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+boista+rin 7dverse 8vents
#= S St d Di b t 2005 54 2188 2197
Data are percenta*e o; total patient *ro+p!
,7D F coronar( arter( disease > F not ot'erwise speci;ied 1? 7 bloc= F ;irst6de*ree
atrioventric+lar bloc=
>r*an s(stem 8vent PB> 4.& m*.d 1 m*.d 32 m*.d
GastrointestinalDiarr'ea > 1! 13! 24!4 14!
9lat+lence 1!# 1!3 4!2 0!4
,ardiovasc+lar ,7D > !& 3!5 13!0 4!#
1? 7 Bloc= 0 1!3 1!3 3!4
P+lmonar( 7st'ma > 0!& 1!& 1!# 4!#
enalD(s+ria 1!3 0! 1!# 4!3
Protein+ria 0!& 1!3 3!& 0!
Dermatolo*ical /(per=eratosis 5!5 ! 2!5 2!1
8vents occ+rrin* in O3% o; patients in an( treatment *ro+p and wit'
statisticall( si*ni;icant di;;erence between *ro+ps