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

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

3. ANATOMY OF THE EYE

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

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

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

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

8. Diabetic Cataract

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

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

11. DIABETIC RETINOPATHY

12. Normal Retina

13. 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

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

15. 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

16. 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%

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

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

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

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

21. 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

22. RETINAL HEMORRHAGE

23. HARD EXUDATES

24. COTTON WOOL SPOTS

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

26. Normal Retina

27. NEOVACULARIZATION

28. VITREOUS HEMORRHAGE

29. VITREOUS/PRERETINAL HEME

30. TRACTIONAL DETACHMENT

31. TRACTIONAL DETACHMENT

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

33. MILD BACKGROUND

34. MODERATE BACKGROUND

35. SEVERE BACKGROUND

36. PROLIFERATIVE RETINOPATHY

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

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

39. LASER THERAPY

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

41. 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

42. 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

44. THANK YOU!