Josephine Carlos-Raboca, M.D. Makati Medical Center DIABETES AND YOUR EYES Josephine Carlos-Raboca, M.D. Makati Medical Center

DIABETES MELLITUS ABNORMALITY IN GLUCOSE METABOLISM ALTERED INSULIN PRODUCTION OR ACTIVITY ELEVATED BLOOD SUGAR LEVELS NUMEROUS COMPLICATIONS ENORMOUS SOCIAL/ECONOMIC IMPACT

ANATOMY OF THE EYE

Mga Simtomas panlalabo ng paningin pagdilim ng paningin pagdoble ng paningin itim na ‘spots’ sa paningin

EYE COMPLICATIONS RETINOPATHY CORNEAL ABNORMALITIES CATARACTS IRIS NEW VESSELS GLAUCOMA NEUROPATHIES RETINOPATHY

CORNEAL PROBLEMS More prone to abrasions, infections Delayed/poor wound healing

LENS Earliest sign is blurring of vision Drastic changes in blood sugar affects the grade of your eye Diabetics prone to develop cataracts earlier

Diabetic Cataract

Glaucoma A rise in the internal pressure of the eye Usually a result of the new vessels in the iris which block the outflow

Neuropathies Can affect muscles that move the eye Or the optic nerve

DIABETIC RETINOPATHY

Normal Retina

DIABETIC RETINOPATHY MOST COMMON CAUSE OF NEW CASES OF BLINDNESS 10-20% OF ALL NEW CASES OF BLINDNESS (US & EUROPE) INCREASING PREVALENCE DUE TO INCREASING SURVIVAL OF DM PATIENTS

RISK FACTORS TYPE DURATION GLUCOSE CONTROL RENAL DISEASE SYSTEMIC HYPERTENSION ELEVATED SERUM LIPIDS PREGNANCY

TYPE OF DIABETES MELLITUS MAJORITY: Type 2 OCULAR COMPLICATIONS SIMILAR Type 1: HIGH INCIDENCE OF SEVERE OCULAR COMPLICATIONS/FASTER PROGRESSION Type 2: MAJORITY OF CLINICAL CASES OF EYE DISEASE

DURATION 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 CONTROL INTENSIVE GLUCOSE CONTROL REDUCED INCIDENCE AND PROGRESSION OF RETINOPATHY IN IDDM Diabetes Control and Complications Trial GLYCOSYLATED Hg <7%

RENAL DISEASE PROTEINURIA, ELEVATED BUN/CREA LEVELS: EXCELLENT PREDICTOR MICROANGIOPATHY AGGRESSIVE MANAGEMENT IS BENEFICIAL

SYSTEMIC HYPERTENSION HTN + NEPHROPATHY: EXCELLENT PREDICTOR OF RETINOPATHY MAY BE SUPERIMPOSED MUST BE CONTROLLED

ELEVATED SERUM LIPIDS MAY COMPLICATE RETINOPATHY INCREASES VESSEL LEAKAGE AND HARD EXUDATE FORMATION REASON????

PREGNANCY PREGNANT WOMEN W/O DM RETINOPATHY: 10% RISK FOR NPDR PREGNANT WOMEN WITH NPDR: 4% RISK FOR PDR THOSE WITH PDR: VERY POOR PROGNOSIS BASELINE AND STRICT FOLLOW UP

RETINAL HEMORRHAGE

HARD EXUDATES

COTTON WOOL SPOTS

NEOVASCULARIZATION RESPONSE TO SEVERE AND PROLONGED LACK OF OXYGEN ANGIOGENIC FACTORS GROWTH OF NEW BLOOD VESSELS IN THE RETINA POOR QUALITY OF VESSELS

Normal Retina

NEOVACULARIZATION

VITREOUS HEMORRHAGE

VITREOUS/PRERETINAL HEME

TRACTIONAL DETACHMENT

TRACTIONAL DETACHMENT

STAGING/TERMINOLOGY “BACKGROUND” OR NON-PROLIFERATIVE DIABETIC RETINOPATHY (BDR/NPDR) PROLIFERATIVE DIABETIC RETINOPATHY (PDR)

MILD BACKGROUND

MODERATE BACKGROUND

SEVERE BACKGROUND

PROLIFERATIVE RETINOPATHY

PROGNOSIS W/O TREATMENT MODERATE VISUAL LOSS IN BDR: 30% IN 3 YEARS SEVERE VISUAL LOSS( VISION LESS THAN 5/200) IN PDR: 35% IN 2 YEARS

TREATMENT GLUCOSE CONTROL LASER THERAPY FOCAL PANRETINAL PHOTOCOAGULATION VITRECTOMY BP CONTROL LIPID CONTROL

LASER THERAPY

LASER THERAPY GOAL IS TO PRESERVE VISION !!! Improvement is secondary

RECOMMENDATIONS Get at Baseline DILATED eye exam Type 1 DM: FIVE YEARS AFTER DIAGNOSIS Type 2 DM: IMMEDIATELY AFTER DIAGNOSIS GESTATIONAL DM: DURING 1ST TRIMESTER IMMEDIATE EXAM IF SYMPTOMATIC

RECOMMENDATIONS MILD BDR: YEARLY EXAM MODERATE BDR: EVERY 4-8 MONTHS SEVERE BDR: EVERY 2-4 MONTHS PDR: IMMEDIATE LASER TX THEN EVERY 2-4 MONTHS UNTIL STABLE

THANK YOU!