seeing beyond vision loss welcome to cnib’s infocus webinar series webinar 1: diabetic retinopathy...
TRANSCRIPT
seeing beyond vision loss
Welcome to CNIB’s InFocus Webinar Series
Webinar 1: Diabetic Retinopathy Basics
Netan Choudhry M.D. FRCS(C)
25 October 2012
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• Anatomy of the eye
Diabetic Retinopathy Basics: Objectives
Participants will learn about:
• Signs and symptoms
• Types of diabetic retinopathy
• Risk factors and prevention
• Diagnostic tests
• Treatment
• Diabetic retinopathy defined
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Anatomy of the Eye
The retina – senses light & transmits images to the brain
Figure 1: The human eye
The macula – central part of the retina used to read and see fine details clearly
The vitreous – clear gel fills the back of the eye and sits in front of the retina
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• Occurs when elevated blood sugar levels cause blood vessels in the eye to swell and leak into the retina.
What Is Diabetic Retinopathy?
Figure 2: Diabetic macula edema (swelling of the retina)
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Figure 3: Normal Vision
Figure 4: How vision may be affected by diabetic retinopathy
Signs and Symptoms
• Floaters• Blurred vision • Blank or dark areas in field of vision• Poor night vision
• Vision loss
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Types of Diabetic RetinopathyEarly stages:
Non-proliferative diabetic retinopathy (NPDR)
• Damaged blood vessels in the retina begin to leak fluid and small amounts of blood and cholesterol.
• Mild NPDR may not necessarily affect vision.
• Results of blurred vision:
Figure 5: Macula edema Figure 6: Fluorescein angiogram of macular edema
Fluorescein dye leaking in macula
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Figure 7: Tractional retinal detachment
Tractional retinal detachmentScar tissue can shrink causing the retina to detach and result in vision loss. More severe vision loss occurs if the macula is detached.
Late stages:
Proliferative diabetic retinopathy (PDR)
• Retinal vessels close causing significant reduction in blood flow.
• The retina responds by growing new abnormal vessels.
• Can affect both central and peripheral vision.
Vitreous hemorrhageNew blood vessels bleed into vitreous cavity.
Types of Diabetic Retinopathy
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Risk Factors/Prevention
Early detection via eye exams is paramount
Gestational diabetes: within 1st trimester Type 2 diabetes: at time of diagnosis, then annuallyType 1 diabetes: within 5 years of diagnosis, then annually
• Diabetes type• High blood sugar
• Ethinicity • Smoking
• Obesity • High cholesterol • High blood pressure
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Diagnostic Tests
Basic assessment
• Tonometry: Measures pressure
inside the eye
• Visual acuity test
• Dilated eye exam
Advanced assessment• Fluorescein angiogram: dye is
injected systemically which
demonstrates retinal circulation
Figure 8: Fluorescein angiogram
• Optical coherence tomography
(OCT): non-invasive imaging study that reveals retinal anatomy
Figure 9: Optical coherencetomography (OCT)
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Treatments
Proliferative retinopathy
• Shrinks and prevents abnormal new blood vessel growth, and stops leaking of blood vessels
• Can reduce risk of further vision loss by 50%
• Also recommended to treat macular edema
Laser surgery
Figure 10: Laser photocoagulation
• Microscopic thermal laser burns are made in the retina
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Treatments
Proliferative retinopathy
Intraocular (anti-VEGF) injections
Figure 11: Intraocular injection
• Reduces swelling in the retina and causes abnormal vessels to regress
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Treatments
Diabetic macular edemaLucentis
• Health-Canada-approved anti-VEGF treatment
• Approved for reimbursement in Quebec only
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Treatments
Advanced proliferative retinopathyVitrectomy
• Cloudy vitreous is removed and replaced with a clear solution
that mimics the normal eye fluids
• Allows light rays to focus on the retina again
Figure 12: Pars plana vitrectomy
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cnib.ca/dr
- Diabetic retinopathy basics- Prevention- Diagnosis and treatment- Living with diabetic retinopathy- Health care professionals’ page- Patient guide
Eye Connect: Diabetic Retinopathy
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• CNIB website: cnib.ca
• Toll-free CNIB Helpline: 1-800-563-2642
• Email: [email protected]
Production of this material has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.
CNIB Contacts and Resources
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Q&A Session
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• Webinar 2: Diabetes Management with Vision LossWhen: 13th November @ 1:00pm EST
• Webinar 3: Supporting Your Patients with Vision Loss: Practical Tips and StrategiesWhen: 15th November @ 1:00pm EST
• Webinar 4: Adjusting to Vision Loss When: 21st November @ 1:00pm EST
CNIB In Focus Webinar Series
cnib.ca/[email protected]