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Diabetes:Diabetes: Diabetic retinopathy Diabetic retinopathy
Olga Brochner Olga Brochner
Ophthalmology, Ophthalmology, ADHBADHB
Plan Plan
• The eyeThe eye• Diabetic retinopathy Diabetic retinopathy
(D.R.)(D.R.)• Influencing factorsInfluencing factors• Signs & stagesSigns & stages• ManagementManagement• QuestionsQuestions
D.M. & eyeD.M. & eye
• Lens changes - cataract, refraction Lens changes - cataract, refraction changeschanges
• Iris changes - diminished pupillary Iris changes - diminished pupillary responses, rubeosis, anterior responses, rubeosis, anterior synechiaesynechiae
• Optic neuropathyOptic neuropathy
• Extraocular muscle palsy Extraocular muscle palsy
Posterior segmentPosterior segmentPosterior segmentPosterior segment
• ScleraSclera
• ChoroidChoroid
• Optic discOptic disc
• VitreousVitreous
• RetinaRetina
• MaculaMacula
• ScleraSclera
• ChoroidChoroid
• Optic discOptic disc
• VitreousVitreous
• RetinaRetina
• MaculaMacula
RetinopathyRetinopathy
• Abnormal, pathological processes in Abnormal, pathological processes in retinaretina
• D.R. = microvascularD.R. = microvascular
• Asymptomatic Asymptomatic
until BADuntil BAD
• Prevention / monitorPrevention / monitor
TThere is no curehere is no cure
Influencing FactorsInfluencing Factors
• Length of timeLength of time
• Diabetic control Diabetic control
• HypertensionHypertension
• Lipids (?)Lipids (?)
HbA1cHbA1cSmall difference in HbA1c = significant Small difference in HbA1c = significant reduction on rate of complicationsreduction on rate of complications
Diabetic retinopathyDiabetic retinopathy
• Leading cause of blindness in Leading cause of blindness in working age group (Western World)working age group (Western World)
• Retinopathy universal diabetic related Retinopathy universal diabetic related complicationcomplication
• Asymptomatic Asymptomatic
• Stages of DRStages of DR
• Diabetes epidemicDiabetes epidemic
D.R. stages / signsD.R. stages / signs
• NilNil
• Non-Non-proliferative = proliferative = Mild – severe Mild – severe
• Proliferative DRProliferative DR
• Maculopathy Maculopathy (any time)(any time)
Visual lossVisual loss
2 pathways:2 pathways:
• IschaemiaIschaemia
• Leakage /Leakage /
oedemaoedema
PathogenesisPathogenesis• Structural changesStructural changes vascular permeabilityvascular permeability
• IschaemiaIschaemia
• Angiogenic factorsAngiogenic factors
• NeovascularisationNeovascularisation
• Vit haem & traction detachmentsVit haem & traction detachments
Loss of Loss of vision / vision /
blindnessblindness
• IschaemiaIschaemia
• LeakageLeakage
SignsSigns
• Structural changes capillary wallsStructural changes capillary walls• Microaneurysm (MA)Microaneurysm (MA)• HaemorrhagesHaemorrhages• Increased permeability Increased permeability = “hard” exudates= “hard” exudates• Retinal oedemaRetinal oedema• IRMAIRMA• New vesselsNew vessels• Cotton wool spotsCotton wool spots
Proliferative D.R.Proliferative D.R.
• Intra-retinal microvascular abnormalities Intra-retinal microvascular abnormalities (IRMA) (IRMA)
• New vessels (neovascularisaton)New vessels (neovascularisaton)
• Vitreous haemorrhagesVitreous haemorrhages
• Fibrous tissueFibrous tissue
• Traction detachments Traction detachments
( & rhegmatogenous)( & rhegmatogenous)
MaculopathyMaculopathy
• Results in visual lossResults in visual loss
• Retinal thickening / exudate within Retinal thickening / exudate within maculamacula
• Soggy ground Soggy ground
= soggy vision= soggy vision
• OCTOCT
• EducationEducation• DietDiet• LifestyleLifestyle• MonitoringMonitoring• MedicationsMedications• LASER treatmentLASER treatment• Surgery (ret det)Surgery (ret det)
What to do???What to do???
PhotoscreenPhotoscreen
Eye Clinic reviewEye Clinic review
•DilateDilate•TimeTime•Driving ….Driving ….
LASERLASER
• Application of Application of light energy to light energy to retinaretina
• Focal / grid laserFocal / grid laser
• PRP = pan retinal PRP = pan retinal photocoagulationphotocoagulation
Via Silt-lampVia Silt-lamp
IntravitrealIntravitreal
Triamcinolone / Triamcinolone / AvastinAvastin
Intravitreal = steroid / Intravitreal = steroid / anti VEGFanti VEGF
1.1. Prevent further VA Prevent further VA lossloss
2.2. ComplicationsComplications
3.3. Repeat & with laseRepeat & with laserr
VR surgeryVR surgery
Outcomes Outcomes
• Retina is vital for sightRetina is vital for sight
• Anxiety of vision lossAnxiety of vision loss
• Macula involved???Macula involved???
• Chronic conditionChronic condition
• Long term follow-up Long term follow-up
= huge demand = huge demand
SummariseSummarise
• No visual symptoms until No visual symptoms until
well advancedwell advanced
• Regular checksRegular checks
• Early treatment always more effective & Early treatment always more effective & long-term better resultlong-term better result
• Can not improve sight – aims to stop Can not improve sight – aims to stop worseningworsening
Questions?Questions?Thank youThank you