ocular manifestation of diabetes mellitus

Joobin Khadamy. MD; Diabetes & Insuline conferece

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DIABETES AND INSULINE CONFERENCE2 N D FEB/2017

BIRJAND UNIVERSITY OF MEDICAL SCIENCE (BIUMS)

Source; AAO Guideline

Ocular Manifestations of Diabetes


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Ocular Manifestations


Neuropathy(RGC)Ischemic Optic NeuropathyGlaucomaCorneal EdemaCorneal Nerve AlterationsCataractRetinopathy


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How Often Diabetic Retinopathy is?


Among leading cause of adults blindness in general population

In Diabetics: Type1/95% Type2/60%


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Genetic or Environmental Factors


Not All diabetics develope to DR!


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Who Is at Risk for Diabetic Retinopathy?


Simple answer; Every diabetics!


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Diabetic retinopathy risk factors


Blood sugar levelsBlood pressure (<130/80 mmHg)Duration of diabetes

Type 1/15 years/80 % Type 2/19 years/84 %

Blood lipid levels greater accumulation of exudates, protein deposits higher risk of moderate visual loss.

EthnicityPregnancy


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Other RF investigations is needed


Common RF with Diabetic Nephropathy Elevated Cystatin C can predict DR

?


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How does non-proliferative diabetic retinopathy affect your vision?



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How does proliferative diabetic retinopathy affect your vision?



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Examination Schedule


Type 2 Diabetes The patient should be referred for ophthalmologic

evaluation at the time of diagnosis. The time of onset of Type 2 diabetes is often difficult

to determine and may precede the diagnosis by a number of years.

Up to 3% of patients whose diabetes is first diagnosed at age 30 or later will have CSME or high-risk features at the time of the initial diagnosis of diabetes.

About 30% of patients will have some manifestation of diabetic retinopathy at diagnosis.


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Examination Schedule


Type 1 Diabetes Ophthalmic examinations are recommended beginning 5 years

after the diagnosis of Type 1 diabetes and annually thereafter, which will detect the vast majority of Type 1 patients who require therapy.

Adirect relationship between the prevalence and severity of retinopathy and the duration of diabetes.

The development of vision-threatening retinopathy is rare in children prior to puberty.

Among patients with Type 1 diabetes, substantial retinopathy may become apparent as early as 6 to 7 years after onset of the disease.

Patient education about the visual impact of early glucose control is important and should begin with the onset of disease.

for ophthalmologic evaluation at the time of diagnosis.


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Diabetes Associated with Pregnancy


diabetics > an examination prior to pregnancy

During the first trimester, with follow-up visits


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Women who develop gestational diabetes do not require an eye examination

during pregnancy and do not appear to be at increased

risk for diabetic retinopathy during pregnancy.



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Physical Examination


Visual acuitySlit-lamp biomicroscopyIntraocular pressure (IOP)Gonioscopy before dilation, when indicated. Iris

neovascularization is best recognized prior to dilation. When neovascularization of the iris is present or suspected, or if the IOP is elevated, undilated gonioscopy can be used to detect neovascularization in the anterior chamber angle.

Pupillary assessment for optic nerve dysfunctionfunduscopy


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Importance of Dilated Fundus exam


A dilated pupil is preferred to ensure optimal examination of the retina, because only 50% of eyes are correctly classified for the presence and severity of retinopathy through undilated pupils.

Slit-lamp biomicroscopy is the recommended method to evaluate retinopathy in the posterior pole and midperipheral retina.

Examination of the peripheral retina is best performed using indirect ophthalmoscopy or slit-lamp biomicroscopy.


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Imagings


FAOCTOCTAWFIUWFI


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FA



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OCT



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OCTA



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Type Of Diabetic Retinopathy


NPDR : Microaneurysms Retinal hemorrhages Hard exudates Macular edema Macular ischemia

PDR: Neovascularization:

NVD/NVE> Fibrovascular>Vitreous Hx> TRD Angle/Iris > NV glaucoma


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NPDR



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PDR



25Grading Shortages!



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Treatments


AntiVEGF + Laser therapySurgery


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Novel Treatments


Beta BlockersSteroid implantsMTXFenofibrate…….. Futu

re:

Combined Slow

Release Im

plants


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Exercise



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Effects Related to Other Treatments


There have been case reports of idiosyncratic macular edema that is temporally associated with use of the glitazone class of oral antihyperglycemic agents.


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Eye and Diabetes Novelties


Insulin Eye DropsBlood Sugar Contact LensesSubconjunctival Glucose Sensors

ocular manifestation of diabetes mellitus

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