Diabetic Retinopathy Me

7/31/2019 Diabetic Retinopathy Me

1/28

Click to edit Master subtitle style

7/29/12

Diabetic Retinopathy


2/28

7/29/12

Diabetic Retinopathy

It is an eye condition that affectspeople with diabetes (uncontrolledfor a prolonged period of time).

It is usually bilateral.

It is the result of damage caused by

diabetes to the small blood vesselslocated in the retina.

P.S. Too much blood sugar can destroy


3/28

7/29/12

How does diabetes causeDR?

Causes abnormal changes in theblood sugar (glucose) that your bodyordinarily converts into energy to fuel

different bodily functions

Uncontrolled diabetes, allowsunusually high levels of blood sugar

(hyperglycemia) to accumulate inblood vessels, causing damage thathampers or alters blood flow to your

bodys organs - including the EYE.


4/28

7/29/12

2 classifications:

Type 1 patients who are insulindependent because youll needinjections or other medications to

supply the insulin.

Type 2 patients who produceenough insulin but your body is

unable to make proper use of it. thebody compensates for it byproducing even more insulin.


5/28

7/29/12

Eye damage occurswhen:

Chronically high amounts of bloodsugar begin to clog or damage bloodvessels within the eyes retina, which

contains light-sensitive cells(photoreceptors) necessary for goodvision.


6/28

7/29/12

Prevalence

Data from the NNS showed that theprevalence of diabetesmellitus (DM) increases with age.

Among young adults 20-29 years old,DM prevalence is as low as 0.4percent, increasing at 3.2 percentamong adults 30-39 years old. This

nearly doubles at 5.7 percent amongthe 40-49 years old, then to 9.0percent among 50-59 years old. DM

prevalence is highest among older-


7/28

7/29/12

Symptoms of DR:

Fluctuating vision

Floaters

Development of a scotomas orshadow in your field of view

Exudates

Blurry and distorted vision

Corneal abrasions resulting toabnormalities


8/28


7/29/12

Assessment pearls:


9/28

7/29/12

Measure :

Visual acuity

LogMAR charts

Used to assess an individual'svisual acuity (VA).

LogMAR means the logarithmof the Minimum Angle of

Resolution.This has led to the assertion

that researches done using alogarithmic progression insize of letters on test chart

gives most accurate VAmeasurement.


10/28

7/29/12

2. Grading of DR:

Modified Airlie house classification

(Wisconsin system) Basis for detailed grading of DR and was used

in all major studies of risk factors and trials oflaser and other treatments.

Based on grading seven 30 degreesstereoscopic fields

Optic disc

Macula Lateral macula

Upper temporal arcades

Lower temporal arcades

Upper nasal arcades


11/28

7/29/12


12/28

7/29/12

3. Examinations, Sensitivity and Specificityin Detecting Diabetic Retinopathy

Stereoscopic 7 field fundus photography

It is the gold standard method of detectingDiabetic Retinopathy.

Slit lamp Biomicroscopy (routine practice) =

90D or 78D after pupil dilation. Ophthalmoscopy (direct or indirect)

retinal photography

4. New modalities to assess the severity ofdiabetic retinopathy

Slit lamp Biomicroscopy


13/28

7/29/12

Optical Coherence Tomography

Provides an effective qualitative and quantitativemethod of examining the eye, in particularscreening for early macular thickening and alsofollowing progression or regression of macularedema over the course of treatment.

Has good reproducibility and accuracy for themeasurement of retinal thickness with an axialresolution n the order of 10um.

Also correlates reasonably with both Biomicroscopicexamination and FA in CSME.

Heidelberg Retinal Tomography

Detects DME by using scanning laser

ophthalmoscopy to provide an indirect measure of


14/28

7/29/12

Retinal Thickness Analyzer

Projects oblique laser slits onto the posterior pole todetermine retinal thickness.

Electoretinogram(ERG)

Non-invasive objective method of evaluating retinal

function by measuring the bioelectrical response ofthe retina to visual stimuli.

Colour contrast threshold testing

Testing of tritan wavelengths as a useful method ofidentifying sight-threatening DR particularly whencombined with retinal photography.

Computerized diabetic retinopathy grading

system


15/28


7/29/12

Other factors


16/28

7/29/12

q Smoking - Smoking is also proven tobe a risk factor for insulin resistance.

Patients who are insulin resistantcannot use their bodily insulinproperly. Smoking is now proven to

be an independent risk factor fordiabetes, and amongst diabetics itincreases the risk of complications.

q

Pregnancy - Pregnancy may cause arapid increase in the progression ofdiabetic retinopathy. That is, if awoman has mild retinopathy, it mayprogress into a much more severe


17/28

7/29/12

Classifications of DR


18/28

7/29/12

on-pro era ve(Background)

Retinopathy Early state of the disease in which symptoms will bemild or non-existent.

The blood vessels are weakened causing tiny bulgescalled MICROANUERYSMS (may leak fluid which may

lead to swelling of the macula).


19/28

7/29/12

Early ProliferativeRetinopathy

The blood vessels on the surface ofthe optic disc and nearby retina forma tangle instead of an orderly

branching. Arising under chronic retinal

ischemia, these new blood vessels

are weak-walled and bleed easily intothe retina or vitreous cavity


20/28

7/29/12

Advanced ProliferativeRetinopathy

More advanced form.

New fragile blood vessels can begin to grow in theretina and into the vitreous due to the circulationproblem causing oxygen deprivation of the retina.

The new blood vessels may leak blood into thevitreous, causing clouding of vision.

Retinal detachment (scar tissue formation anddevelopment of glaucoma)

a e c


21/28

7/29/12

a e cMacular

Edema (DME) Capillary leak in the macular or perimacular region Thickening located within two disc diameters of the

centre of the macula.

When this is present within or close to the centralmacula, it is termed clinically significant macularedema (CSME)


22/28


7/29/12

Complications:


23/28

7/29/12

Vitreous Hemorrhage

hemorrhage from fragile blood vessels leaking intothe vitreous, the clear gel-like substance that fillsthe interior of the eye. If blood clouds the vitreous,light passing from the lens through the vitreous tothe retina is blocked, and vision is markedly

reduced. Cataract

Diabetes increases the possibility of cataract, a

clouding of the transparent lens of the eye.Cataract may cause hazy vision and glaresensitivity. If retinopathy has not damaged theretina, surgical removal of a cataract usuallyresults in improved vision. If there is damage tothe retina, the cataract may still be removed in


24/28

7/29/12

Secondary Glaucoma

Fragile new blood vessels in the eye of someonewith diabetes may form a new network directly onthe iris, blocking the outflow of fluid from the eye.

This condition, called secondary glaucoma, resultsin elevated pressure of the fluids within the eye,

and can cause optic nerve atrophy and loss of thefull visual field. Treatment involves the applicationof laser to the leaking areas. Standard glaucomatreatment with drops or diuretics may also be

recommended to lower intraocular pressure. Macular Damage

In chronic macular edema, faulty color vision mayresult and usually is irreversible. Even after themacula has been treated with laser, there may still


25/28

7/29/12

Treatment Options


26/28

7/29/12

Background Retinopathy

Requires no treatment, butregular eye examinations areessential as it may progress.


27/28

7/29/12

Proliferative Retinopathy

Scatter or Pan-retinal photocoagulation

Performed using 200 to 500 um burnsplaced approximately one half burn width

apart, from the posterior fundus to theequator.

Used to slow down the growth of newabnormal blood vessels that have

developed over a wide area of the retina. Vitrectomety done when: there is bleeding

into the eye from abnormal blood vessels,proliferative retinopathy has been identified

at a late stage, laser treatment has been


28/28

7/29/12

Maculopathy

Laser treatment = firing laser at the area ofleakage to seal off the leaking and prevent itfrom progressing. Will burn the retina but insmall quantities that the eye can recover from.

Intravitreal anti-VEGF injections (anti-vascularendothelial growth factor) such as lucentis orAvastin.

Avastin is an injection into the eye. It is one of

the anti-VEGF drugs. These may need to begiven monthly, as in the Restore study see.(Lucentis is similar to Avastin, but a lot moreexpensive.). The injections may need to becontinued long term to maintain sight.

Intravitreal steroids = which is rarely used

Date post:	05-Apr-2018
Category:	Documents
Upload:	michaelbarbon9831
View:	219 times
Download:	0 times

Diabetic Retinopathy Me

Documents