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

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Presentation on theme: "Seeing beyond vision loss Welcome to CNIB’s InFocus Webinar Series Webinar 1: Diabetic Retinopathy Basics Netan Choudhry M.D. FRCS(C) 25 October 2012."— Presentation transcript:

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

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

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

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

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

6 seeing beyond vision loss 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 seeing beyond vision loss 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. Late stages: Proliferative diabetic retinopathy (PDR) Retinal vessels close causing significant reduction in blood flow. The retina responds by growing new abnormal vessels. Can affect both central and peripheral vision. Vitreous hemorrhage New blood vessels bleed into vitreous cavity. Types of Diabetic Retinopathy

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

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

10 seeing beyond vision loss Treatments Proliferative retinopathy 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 Laser surgery Figure 10: Laser photocoagulation Microscopic thermal laser burns are made in the retina

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

12 seeing beyond vision loss Treatments Diabetic macular edema Lucentis Health-Canada-approved anti-VEGF treatment Approved for reimbursement in Quebec only

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

15 seeing beyond vision loss 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. CNIB Contacts and Resources

16 seeing beyond vision loss Q&A Session

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


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