josephine carlos-raboca, m.d. makati medical center makati medical center diabetes and your eyes
TRANSCRIPT
Josephine Carlos-Raboca, M.D.Josephine Carlos-Raboca, M.D.
Makati Medical CenterMakati Medical Center
DIABETES AND YOUR EYESDIABETES AND YOUR EYES
DIABETES MELLITUSDIABETES MELLITUS
ABNORMALITY IN GLUCOSE METABOLISMABNORMALITY IN GLUCOSE METABOLISM ALTERED INSULIN PRODUCTION OR ALTERED INSULIN PRODUCTION OR
ACTIVITYACTIVITY ELEVATED BLOOD SUGAR LEVELSELEVATED BLOOD SUGAR LEVELS NUMEROUS COMPLICATIONSNUMEROUS COMPLICATIONS ENORMOUS SOCIAL/ECONOMIC IMPACTENORMOUS SOCIAL/ECONOMIC IMPACT
ANATOMY OF THE EYEANATOMY OF THE EYE
Mga SimtomasMga Simtomas
panlalabo ng paninginpanlalabo ng paningin pagdilim ng paninginpagdilim ng paningin pagdoble ng paninginpagdoble ng paningin itim na ‘spots’ sa paninginitim na ‘spots’ sa paningin
EYE COMPLICATIONSEYE COMPLICATIONS
CORNEAL ABNORMALITIESCORNEAL ABNORMALITIES CATARACTSCATARACTS IRIS NEW VESSELSIRIS NEW VESSELS GLAUCOMAGLAUCOMA NEUROPATHIESNEUROPATHIES RETINOPATHYRETINOPATHY
CORNEAL PROBLEMSCORNEAL PROBLEMS
More prone to abrasions, infectionsMore prone to abrasions, infections Delayed/poor wound healingDelayed/poor wound healing
LENSLENS
Earliest sign is blurring of visionEarliest sign is blurring of vision Drastic changes in blood sugar affects the Drastic changes in blood sugar affects the
grade of your eyegrade of your eye Diabetics prone to develop cataracts earlierDiabetics prone to develop cataracts earlier
Diabetic CataractDiabetic Cataract
GlaucomaGlaucoma
A rise in the internal pressure of the eyeA rise in the internal pressure of the eye Usually a result of the new vessels in the iris Usually a result of the new vessels in the iris
which block the outflowwhich block the outflow
NeuropathiesNeuropathies
Can affect muscles that move the eyeCan affect muscles that move the eye Or the optic nerveOr the optic nerve
DIABETIC DIABETIC RETINOPATHYRETINOPATHY
Normal RetinaNormal Retina
DIABETIC RETINOPATHYDIABETIC RETINOPATHY
MOST COMMON CAUSE OF NEW CASES MOST COMMON CAUSE OF NEW CASES OF BLINDNESS OF BLINDNESS
10-20% OF ALL NEW CASES OF 10-20% OF ALL NEW CASES OF BLINDNESS (US & EUROPE)BLINDNESS (US & EUROPE)
INCREASING PREVALENCE DUE TO INCREASING PREVALENCE DUE TO INCREASING SURVIVAL OF DM PATIENTSINCREASING SURVIVAL OF DM PATIENTS
RISK FACTORSRISK FACTORS
TYPETYPE DURATIONDURATION GLUCOSE CONTROLGLUCOSE CONTROL RENAL DISEASERENAL DISEASE SYSTEMIC HYPERTENSIONSYSTEMIC HYPERTENSION ELEVATED SERUM LIPIDSELEVATED SERUM LIPIDS PREGNANCYPREGNANCY
TYPE OF DIABETES TYPE OF DIABETES MELLITUSMELLITUS
10-15%: Type 110-15%: Type 1 MAJORITY: Type 2MAJORITY: Type 2 OCULAR COMPLICATIONS SIMILAROCULAR COMPLICATIONS SIMILAR Type 1: HIGH INCIDENCE OF SEVERE Type 1: HIGH INCIDENCE OF SEVERE
OCULAR COMPLICATIONS/FASTER OCULAR COMPLICATIONS/FASTER PROGRESSIONPROGRESSION
Type 2: MAJORITY OF CLINICAL CASES Type 2: MAJORITY OF CLINICAL CASES OF EYE DISEASEOF EYE DISEASE
DURATIONDURATION
DURATION Type 1 Type 2
0-5 YEARS 0%
10-15 YEARS 25-50% 23 -43%
15-29 YEARS 75-95% 60%
30+ YEARS 100%
GLUCOSE CONTROLGLUCOSE CONTROL
INTENSIVE GLUCOSE CONTROL INTENSIVE GLUCOSE CONTROL REDUCED INCIDENCE AND REDUCED INCIDENCE AND PROGRESSION OF RETINOPATHY IN PROGRESSION OF RETINOPATHY IN IDDMIDDM
• Diabetes Control and Complications Diabetes Control and Complications TrialTrial
GLYCOSYLATED Hg <7%GLYCOSYLATED Hg <7%
RENAL DISEASERENAL DISEASE
PROTEINURIA, ELEVATED BUN/CREA PROTEINURIA, ELEVATED BUN/CREA LEVELS: EXCELLENT PREDICTORLEVELS: EXCELLENT PREDICTOR
MICROANGIOPATHYMICROANGIOPATHY AGGRESSIVE MANAGEMENT IS AGGRESSIVE MANAGEMENT IS
BENEFICIALBENEFICIAL
SYSTEMIC HYPERTENSIONSYSTEMIC HYPERTENSION
HTN + NEPHROPATHY: EXCELLENT HTN + NEPHROPATHY: EXCELLENT PREDICTOR OF RETINOPATHYPREDICTOR OF RETINOPATHY
MAY BE SUPERIMPOSEDMAY BE SUPERIMPOSED MUST BE CONTROLLEDMUST BE CONTROLLED
ELEVATED SERUM LIPIDSELEVATED SERUM LIPIDS
MAY COMPLICATE RETINOPATHYMAY COMPLICATE RETINOPATHY INCREASES VESSEL LEAKAGE AND INCREASES VESSEL LEAKAGE AND
HARD EXUDATE FORMATIONHARD EXUDATE FORMATION REASON????REASON????
PREGNANCYPREGNANCY
PREGNANT WOMEN W/O DM PREGNANT WOMEN W/O DM RETINOPATHY: 10% RISK FOR NPDRRETINOPATHY: 10% RISK FOR NPDR
PREGNANT WOMEN WITH NPDR: 4% PREGNANT WOMEN WITH NPDR: 4% RISK FOR PDRRISK FOR PDR
THOSE WITH PDR: VERY POOR THOSE WITH PDR: VERY POOR PROGNOSISPROGNOSIS
BASELINE AND STRICT FOLLOW UPBASELINE AND STRICT FOLLOW UP
RETINAL HEMORRHAGERETINAL HEMORRHAGE
HARD EXUDATESHARD EXUDATES
COTTON WOOL SPOTSCOTTON WOOL SPOTS
NEOVASCULARIZATIONNEOVASCULARIZATION
RESPONSE TO SEVERE AND RESPONSE TO SEVERE AND PROLONGED LACK OF OXYGENPROLONGED LACK OF OXYGEN
ANGIOGENIC FACTORS ANGIOGENIC FACTORS GROWTH GROWTH OF NEW BLOOD VESSELSOF NEW BLOOD VESSELS IN IN
THE RETINATHE RETINA POOR QUALITY OF VESSELSPOOR QUALITY OF VESSELS
Normal RetinaNormal Retina
NEOVACULARIZATIONNEOVACULARIZATION
VITREOUS HEMORRHAGEVITREOUS HEMORRHAGE
VITREOUS/PRERETINAL VITREOUS/PRERETINAL HEMEHEME
TRACTIONAL DETACHMENTTRACTIONAL DETACHMENT
TRACTIONAL DETACHMENTTRACTIONAL DETACHMENT
STAGING/TERMINOLOGYSTAGING/TERMINOLOGY
““BACKGROUND” OR NON-PROLIFERATIVE BACKGROUND” OR NON-PROLIFERATIVE DIABETIC RETINOPATHY (DIABETIC RETINOPATHY (BDR/NPDRBDR/NPDR))
PROLIFERATIVE DIABETIC RETINOPATHY PROLIFERATIVE DIABETIC RETINOPATHY ((PDRPDR))
MILD BACKGROUND MILD BACKGROUND
MODERATE BACKGROUNDMODERATE BACKGROUND
SEVERE BACKGROUNDSEVERE BACKGROUND
PROLIFERATIVE PROLIFERATIVE RETINOPATHYRETINOPATHY
PROGNOSIS W/O TREATMENTPROGNOSIS W/O TREATMENT
MODERATE VISUAL LOSS IN BDR: MODERATE VISUAL LOSS IN BDR:
30% IN 3 YEARS30% IN 3 YEARS SEVERE VISUAL LOSS( VISION LESS SEVERE VISUAL LOSS( VISION LESS
THAN 5/200) IN PDR: THAN 5/200) IN PDR: 35% IN 2 35% IN 2 YEARSYEARS
TREATMENTTREATMENT
GLUCOSE CONTROLGLUCOSE CONTROL LASER THERAPYLASER THERAPY
FOCALFOCAL PANRETINAL PHOTOCOAGULATIONPANRETINAL PHOTOCOAGULATION
VITRECTOMYVITRECTOMY BP CONTROLBP CONTROL LIPID CONTROLLIPID CONTROL
LASER THERAPYLASER THERAPY
LASER THERAPYLASER THERAPY
GOAL IS TO PRESERVE VISION !!!GOAL IS TO PRESERVE VISION !!! Improvement is secondaryImprovement is secondary
RECOMMENDATIONSRECOMMENDATIONS
Get at Baseline Get at Baseline DILATEDDILATED eye exam eye exam Type 1 DM: FIVE YEARS AFTER Type 1 DM: FIVE YEARS AFTER
DIAGNOSISDIAGNOSIS Type 2 DM: IMMEDIATELY AFTER Type 2 DM: IMMEDIATELY AFTER
DIAGNOSISDIAGNOSIS GESTATIONAL DM: DURING 1ST GESTATIONAL DM: DURING 1ST
TRIMESTER TRIMESTER IMMEDIATE EXAM IF SYMPTOMATICIMMEDIATE EXAM IF SYMPTOMATIC
RECOMMENDATIONSRECOMMENDATIONS
MILD BDR: YEARLY EXAMMILD BDR: YEARLY EXAM MODERATE BDR: EVERY 4-8 MODERATE BDR: EVERY 4-8
MONTHS MONTHS SEVERE BDR: EVERY 2-4 MONTHSSEVERE BDR: EVERY 2-4 MONTHS PDR: IMMEDIATE LASER TX THEN PDR: IMMEDIATE LASER TX THEN
EVERY 2-4 MONTHS UNTIL STABLE EVERY 2-4 MONTHS UNTIL STABLE
THANK YOU!THANK YOU!