1. Welcome to CNIB’s InFocus Webinar Series
Webinar 1: Diabetic Retinopathy Basics
Netan Choudhry M.D. FRCS(C)
25 October 2012

2. Diabetic Retinopathy Basics: Objectives
Participants will learn about:
Anatomy of the eye
Diabetic retinopathy defined
Signs and symptoms
Types of diabetic retinopathy
Risk factors and prevention
Diagnostic tests
Treatment

3. Anatomy of the Eye
The retina – senses light & transmits images to the brain
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
Figure 1: The human eye

4. What Is Diabetic Retinopathy?
Occurs when elevated blood sugar levels cause blood vessels in the eye to swell and leak into the retina.
Figure 2: Diabetic macula edema
(swelling of the retina)

5. Signs and Symptoms Floaters Blurred vision
Figure 3: Normal Vision
Figure 4: How vision may be affected by diabetic retinopathy
Floaters
Blurred vision
Blank or dark areas in field of vision
Poor night vision
Vision loss

6. Types of Diabetic Retinopathy
Early 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

7. Types of Diabetic Retinopathy
Late stages:
Proliferative diabetic retinopathy (PDR)
Retinal vessels close causing significant reduction in blood flow.
The retina responds by growing new abnormal vessels.
Figure 7: Tractional retinal detachment
Tractional retinal detachment Scar tissue can shrink causing the retina to
detach and result in vision loss. More severe
vision loss occurs if the macula is detached.
Can affect both central and peripheral vision.
Vitreous hemorrhage New blood vessels bleed into vitreous cavity.

8. Risk Factors/Prevention
High blood sugar
Diabetes type
Smoking
Ethinicity
High blood pressure
High cholesterol
Obesity
Early detection via eye exams is paramount
Type 1 diabetes: within 5 years of diagnosis, then annually
Type 2 diabetes: at time of diagnosis, then annually
Gestational diabetes: within 1st trimester

9. Diagnostic Tests Basic assessment Advanced assessment
Fluorescein angiogram: dye is
injected systemically which
demonstrates retinal circulation
Figure 8: Fluorescein angiogram
Visual acuity test
Tonometry: Measures pressure
inside the eye
Dilated eye exam
Advanced assessment
Optical coherence tomography
(OCT): non-invasive imaging study that reveals retinal anatomy
Figure 9: Optical coherence
tomography (OCT)

10. Treatments Proliferative retinopathy Laser surgery
Figure 10: Laser photocoagulation
Microscopic thermal laser burns
are made in the retina
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

11. Treatments Proliferative retinopathy
Intraocular (anti-VEGF) injections
Figure 11: Intraocular injection
Reduces swelling in the retina and causes abnormal vessels to regress

12. Treatments Diabetic macular edema Lucentis
Health-Canada-approved anti-VEGF treatment
Approved for reimbursement in Quebec only

13. Treatments Advanced proliferative retinopathy Vitrectomy
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

14. Eye Connect: Diabetic Retinopathy
cnib.ca/dr
- Diabetic retinopathy basics - Prevention - Diagnosis and treatment - Living with diabetic retinopathy - Health care professionals’ page - Patient guide

15. CNIB Contacts and Resources
CNIB website: cnib.ca
Toll-free CNIB Helpline:
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.

16. Q&A Session

17. CNIB In Focus Webinar Series
Webinar 2: Diabetes Management with Vision Loss When: 13th 1:00pm EST
Webinar 3: Supporting Your Patients with Vision Loss: Practical Tips and Strategies When: 15th 1:00pm EST
Webinar 4: Adjusting to Vision Loss When: 21st 1:00pm EST
cnib.ca/dr