1. Update on Prevention, Diagnosis & Treatment of Diabetic Macular Edema (DME) Part 4 A. Paul Chous, MA, OD, FAAO Specializing in Diabetes Eye Care & Education Tacoma, WA Adjunct Instructor, Nova Southeastern University College of Optometry Principal Investigator for the Diabetes Visual Function Supplement Study (DiVFuSS)

2. Patients with Closer to Optimal Glucose Control Achieved Better Visual Outcomes on Anti-VEGF Therapy Best corrected vision during 1 year follow-up according to HbA 1c level Matsuda S et al. J Diabetes Complications. 2014;28(2):166-170. CMT=central macular thickness. Note: Retrospective case series of patients treated with bevacizumab A1c < 7% resulted in an extra Line on the eye chart when using Avastin™ in DME

3. Patient DKS – fell through the cracks 52 yo female with T2DM x 5 years Takes lisinopril but discontinued her metformin x 6 months due to GI distress “I’ve been having some vision trouble and am here for a better glasses prescription” No eye exam x 16 mos and last A1c = 8.4% + sleep apnea but does not use CPAP

4. CSME/Center-Involved DME 20/200 vision

5. Retinal Thickening Normal < 300 microns Retinal Edema On OCT

6. 5 Injections of Ranibizumab Later 20/40 Vision Foveal thickness now 280 microns Patient Can Legally Drive

7. Preventing DME Delay onset of diabetes Delay onset of diabetes Optimize metabolic control of DM Optimize metabolic control of DM Dx and treat obstructive sleep apnea Dx and treat obstructive sleep apnea If TZDs are indicated, use low dose If TZDs are indicated, use low dose Regular eye exams to reinforce evidence-based preventive strategies Regular eye exams to reinforce evidence-based preventive strategies

8. Preventing Vision Loss from DME Regular, dilated eye examinations Regular, dilated eye examinations 3% of newly diagnosed T2DM patients have CSME!!!!3% of newly diagnosed T2DM patients have CSME!!!! Do NOT delay until A1c is lowered!!!Do NOT delay until A1c is lowered!!! Achieve & Maintain metabolic control Achieve & Maintain metabolic control Communicate & collaborate with eye doctors (ophthalmology and optometry) Communicate & collaborate with eye doctors (ophthalmology and optometry) What is the A1c goal?What is the A1c goal? Ensure patients referred to retinal specialty for treatment keep their scheduled appointments Ensure patients referred to retinal specialty for treatment keep their scheduled appointments

9. Thank You! A. Paul Chous, MA, OD, FAAO dr.chous@diabeticeyes.com