diabetic retinopathy

Diabetic Retinopathy

Donna Bloom, Karen Burns, Benjamin

Davisson, Mary Ivey and Erica Simms

Diabetic RetinopathyA condition that develops as a result of high A condition that develops as a result of high blood sugar levels in both Type 1 and Type 2 blood sugar levels in both Type 1 and Type 2 diabetes. The blood vessels in the retina diabetes. The blood vessels in the retina become weak, causing a varied degree of become weak, causing a varied degree of impact depending on the location and extent impact depending on the location and extent of the damage. May also result in cataracts of the damage. May also result in cataracts (clouding of the lens) and glaucoma (clouding of the lens) and glaucoma (increased pressure in the eye).(increased pressure in the eye).


Visual acuity testing – measuring the ability to focusVisual acuity testing – measuring the ability to focus

Ophthalmoscopy and slit lamp exam – detects Ophthalmoscopy and slit lamp exam – detects changes in the retina and other structureschanges in the retina and other structures

Gonioscopy – detects if the area where the fluid Gonioscopy – detects if the area where the fluid drains out of your eye is open or closeddrains out of your eye is open or closed

Tonometry – measures the pressure of the eye which Tonometry – measures the pressure of the eye which helps detect glaucomahelps detect glaucoma


Ely Lilly & Co is testing a protein-based beta Ely Lilly & Co is testing a protein-based beta inhibitor (known as Kinase C-Beta) that is inhibitor (known as Kinase C-Beta) that is showing promise for preventing the showing promise for preventing the progression of diabetic retinopathy.progression of diabetic retinopathy.

Genetech is testing drugs for macular Genetech is testing drugs for macular degeneration (loss of center vision) that may degeneration (loss of center vision) that may have future benefits for diabetic retinopathy.have future benefits for diabetic retinopathy.


4.3% of people of all ages4.3% of people of all ages8.2% of people 40 years and older8.2% of people 40 years and older


The main risk factors are poor nutrition and The main risk factors are poor nutrition and blood sugar maintenanceblood sugar maintenanceThe most important care for Diabetic The most important care for Diabetic Retinopathy is having eye exams every 3 to 6 Retinopathy is having eye exams every 3 to 6 months in order to monitor for Glaucoma and months in order to monitor for Glaucoma and CataractsCataracts


American Diabetes AssociationAmerican Diabetes Association1701 North Beauregard Street1701 North Beauregard StreetAlexandria, VA 22311-1717Alexandria, VA 22311-17171-800-342-2383 (National Headquarters)1-800-342-2383 (National Headquarters)E-mail: E-mail: [email protected] www.diabetes.orghttp://www.diabetes.org/

mailto:[email protected]

http://www.diabetes.org/

http://www.diabetes.org/


Texas Diabetes Council - Central Campus Texas Diabetes Council - Central Campus

1100 West 49th Street1100 West 49th Street

Austin, TX 78756Austin, TX 78756

(512) 458-7111(512) 458-7111

http://www.dshs.state.tx.us/diabetes/http://www.dshs.state.tx.us/diabetes/


American Federation for the Blind - TexasAmerican Federation for the Blind - Texas11030 Ables Lane11030 Ables LaneDallas, TX 75229-4524Dallas, TX 75229-4524(214) 352-7222(214) 352-7222http://www.afb.org/http://www.afb.org/


Ophthalmology AssociatesOphthalmology Associates1201 Summit Avenue1201 Summit AvenueFort Worth, Texas, 76102 Fort Worth, Texas, 76102 Tel: 817-332-2020Tel: 817-332-2020Email: Email: [email protected]@fortworth2020.comhttp://www.fortworth2020.com/http://www.fortworth2020.com/

diabetic_retinopathy.aspxdiabetic_retinopathy.aspx


http://bascompalmer.org/site/disease/disease_diabetic.asphttp://bascompalmer.org/site/disease/disease_diabetic.asp

http://diabetes.webmd.com/tc/diabetic-retinopathy-http://diabetes.webmd.com/tc/diabetic-retinopathy-medicationsmedications

http://www.mayoclinic.org/retinal-diseases/diabetic-http://www.mayoclinic.org/retinal-diseases/diabetic-retinopathy.htmlretinopathy.html

http://www.aoa.org/diabetic-retinopathy.xmlhttp://www.aoa.org/diabetic-retinopathy.xml

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002192/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002192/

Diabetic RetinopathyCase Study

On November 11, 2001, a 54 year old man had his annual diabetic On November 11, 2001, a 54 year old man had his annual diabetic visual evaluation. He had no complaints of his vision. He had stated visual evaluation. He had no complaints of his vision. He had stated that his blood sugar normally reads around 155mg/dl and on that his blood sugar normally reads around 155mg/dl and on occasion he would get a reading of 220mg/dl. It was two years prior occasion he would get a reading of 220mg/dl. It was two years prior that he had his last eye exam. Records from this particular visit that he had his last eye exam. Records from this particular visit noted that the man had a diagnosis of mild non-proliferative diabetic noted that the man had a diagnosis of mild non-proliferative diabetic retinopathy without clinically significant macular edema. All of this retinopathy without clinically significant macular edema. All of this man’s ocular history was great except it was noted that he had hard man’s ocular history was great except it was noted that he had hard exudates in the posterior pole, but away from foveal tissue. exudates in the posterior pole, but away from foveal tissue.

His medical history included renal insufficiency, depression, His medical history included renal insufficiency, depression, hyperlipidemia, hypertension, cellulitis of the leg and type II diabetes hyperlipidemia, hypertension, cellulitis of the leg and type II diabetes with renal and ophthalmic manifestations. Medications include with renal and ophthalmic manifestations. Medications include insulin injections b.i.d., dressings to treat cellulitis of the leg, Zestril insulin injections b.i.d., dressings to treat cellulitis of the leg, Zestril (Lisin-opril, AstraZeneca) and Zocor (Simvastatin, Merck). (Lisin-opril, AstraZeneca) and Zocor (Simvastatin, Merck).


Entering his examination, his acuities were 20/40-2 OU and was Entering his examination, his acuities were 20/40-2 OU and was best corrected at 20/25 OU. His tonometry showed that he had best corrected at 20/25 OU. His tonometry showed that he had intraocular pressure of 12mm Hg OD and 15mm Hg OS. His intraocular pressure of 12mm Hg OD and 15mm Hg OS. His results found no rubeosis, mild cataract development OU, and results found no rubeosis, mild cataract development OU, and exudates and hemorrhages within 500 microns of the fovea OD exudates and hemorrhages within 500 microns of the fovea OD with retinal thickening. Microaneurysms and hemorrhages were with retinal thickening. Microaneurysms and hemorrhages were present in all four quadrants. This visit noted a diagnosis of present in all four quadrants. This visit noted a diagnosis of mild/moderate non-proliferative diabetic retinopathy (NPDR) and mild/moderate non-proliferative diabetic retinopathy (NPDR) and clinically significant macular edema, also known as CSME (retinal clinically significant macular edema, also known as CSME (retinal swelling and cysts formation in the macular area). swelling and cysts formation in the macular area).

A fluorescein study on March 4, 2002 showed scattered perfusion A fluorescein study on March 4, 2002 showed scattered perfusion from microaneurysms O.S. greater than O.D. (see figure 2). The from microaneurysms O.S. greater than O.D. (see figure 2). The patient was treated with focal grid argon laser, with 27 burns O.D. patient was treated with focal grid argon laser, with 27 burns O.D. and 57 O.S. and 57 O.S.


In September, 2002,six months later, the patient returned for a In September, 2002,six months later, the patient returned for a follow up visit and had entering acuities of 20/30 OU. The follow up visit and had entering acuities of 20/30 OU. The assessment included type II DM, moderate NPDR and minimal assessment included type II DM, moderate NPDR and minimal CSME O.U. The retinal practitioner believed that the problem, CSME O.U. The retinal practitioner believed that the problem, CSME OS was resolving so they rescheduled another follow up CSME OS was resolving so they rescheduled another follow up visit four months later. visit four months later.

Almost four months later, in January, 2003, the man returned for Almost four months later, in January, 2003, the man returned for his visit and complained about blurry vision and reported that he his visit and complained about blurry vision and reported that he had to stop driving. He also reported that his glucose levels were had to stop driving. He also reported that his glucose levels were normal and measured 113mg that morning. The man said that normal and measured 113mg that morning. The man said that after his last surgery, his vision was stable but could no longer after his last surgery, his vision was stable but could no longer find use in his glasses. Entering acuities were counting fingers at find use in his glasses. Entering acuities were counting fingers at five feet OD and 20/60 OS. Diagnosis was altered to type II DM five feet OD and 20/60 OS. Diagnosis was altered to type II DM with severe NPDR and diffuse CSME OU. After further testing the with severe NPDR and diffuse CSME OU. After further testing the same day, a marked increase in retinal edema was noted. same day, a marked increase in retinal edema was noted.


Five months later, in May, 2003, he returned for another follow up Five months later, in May, 2003, he returned for another follow up visit and received a laser treatment of 1400 burns OD and 1450 visit and received a laser treatment of 1400 burns OD and 1450 burns OS.burns OS.

In July, 2003, his examination showed an entering acuity of bare In July, 2003, his examination showed an entering acuity of bare light perception OU and proliferative changes and diagnosed type light perception OU and proliferative changes and diagnosed type II DM with sever PDR OU were noted. II DM with sever PDR OU were noted.

The practitioners questioned the dramatic change in this patient’s The practitioners questioned the dramatic change in this patient’s vision. This case illustrates why you must conduct an objective vision. This case illustrates why you must conduct an objective analysis of a patient's underlying medical condition. Upon careful analysis of a patient's underlying medical condition. Upon careful review of this case, several important findings were noted. The review of this case, several important findings were noted. The most important was the patient’s glucose control over the past most important was the patient’s glucose control over the past several years. The data on his glucose levels were collected and several years. The data on his glucose levels were collected and his Hemoglobin A1c counts. This analysis revealed the patient’s his Hemoglobin A1c counts. This analysis revealed the patient’s poor dietary compliance over several years.poor dietary compliance over several years.


A patient is considered a suspect for diabetes when A patient is considered a suspect for diabetes when fasting serum glucose levels reach between 100 and fasting serum glucose levels reach between 100 and 140mg/dl. The diagnosis is likely when that number 140mg/dl. The diagnosis is likely when that number is over 140mg/dl. Further, the hemoglobin A1c count is over 140mg/dl. Further, the hemoglobin A1c count is also utilized. If elevated above 7.0, a positive is also utilized. If elevated above 7.0, a positive diagnosis is likely. The patient had both of these diagnosis is likely. The patient had both of these extremely elevated over many years. When a extremely elevated over many years. When a practitioner takes this information into account, practitioner takes this information into account, there becomes no point in ocular treatment option there becomes no point in ocular treatment option because the disease is already out of control. The because the disease is already out of control. The patient needs to want to help themselves first.patient needs to want to help themselves first.


This case study ends with suggestions to prevent and/or This case study ends with suggestions to prevent and/or postpone vision loss. It also provides excellent visuals for a postpone vision loss. It also provides excellent visuals for a person to better understand the situation. Actual person to better understand the situation. Actual glucose/A1c levels should be available. Practitioner reports glucose/A1c levels should be available. Practitioner reports that patients can be easily misled by at-home readings that patients can be easily misled by at-home readings which can often seem reasonable without considering the which can often seem reasonable without considering the A1c levels from a lab. A1c counts are a better indication of a A1c levels from a lab. A1c counts are a better indication of a patient’s plasma glucose levels over the past three to four patient’s plasma glucose levels over the past three to four months. They provide a better indication of the patient’s months. They provide a better indication of the patient’s compliance. Also, careful clinical examination is vital to compliance. Also, careful clinical examination is vital to monitor and treat ocular conditions. The practitioners say monitor and treat ocular conditions. The practitioners say that patient education can never be overstated. When a that patient education can never be overstated. When a patient realizes the severity of the situation and the patient realizes the severity of the situation and the implications that are held, it can help to motivate the patient implications that are held, it can help to motivate the patient to practice a higher form of control over the diabetes. to practice a higher form of control over the diabetes.


(Gibb & Olafsson) (Cassin, 2006, p. 87) (Levak, p. 132)Gibb, R., (Gibb & Olafsson) (Cassin, 2006, p. 87) (Levak, p. 132)Gibb, R., & Olafsson, H. (2006, September). & Olafsson, H. (2006, September). Case study: Rapid Case study: Rapid progression of diabetic retinopathyprogression of diabetic retinopathy. Retrieved from . Retrieved from http://www.optometric.com/article.aspx?article=71734http://www.optometric.com/article.aspx?article=71734Cassin, B. (2006). Cassin, B. (2006). Dictionary of eye terminologyDictionary of eye terminology (p. 87). (p. 87). Gainesville, FL: Triad Publishing Company.Gainesville, FL: Triad Publishing Company.Levak, N. (n.d.). Levak, N. (n.d.). Low vision: A resource guide with adaptations Low vision: A resource guide with adaptations for students with visual impairmentsfor students with visual impairments (p. 132). Austin, TX: Texas (p. 132). Austin, TX: Texas School fo the Blind and Visually Impaired. School fo the Blind and Visually Impaired.

diabetic retinopathy

Documents

eye exams

blood sugar maintenancethe

blood vessels

glaucoma increased pressure

retinopathyamerican

renal insufficiency

medical history

years prior