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

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

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

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)

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

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

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.

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

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)

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

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

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

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

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

CNIB Contacts and Resources CNIB website: cnib.ca Toll-free CNIB Helpline: 1-800-563-2642 Email: info@cnib.ca 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.

Q&A Session

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