Download - Ocular Manifestation of Diabetes Mellitus
Joobin Khadamy. MD; Diabetes & Insuline conferece
1
DIABETES AND INSULINE CONFERENCE2 N D FEB/2017
BIRJAND UNIVERSITY OF MEDICAL SCIENCE (BIUMS)
Source; AAO Guideline
Ocular Manifestations of Diabetes
Joobin Khadamy. MD; Diabetes & Insuline conferece
2
Ocular Manifestations
Source; AAO Guideline
Neuropathy(RGC)Ischemic Optic NeuropathyGlaucomaCorneal EdemaCorneal Nerve AlterationsCataractRetinopathy
Joobin Khadamy. MD; Diabetes & Insuline conferece
3
How Often Diabetic Retinopathy is?
Source; AAO Guideline
Among leading cause of adults blindness in general population
In Diabetics: Type1/95% Type2/60%
Joobin Khadamy. MD; Diabetes & Insuline conferece
4
Genetic or Environmental Factors
Source; AAO Guideline
Not All diabetics develope to DR!
Joobin Khadamy. MD; Diabetes & Insuline conferece
5
Who Is at Risk for Diabetic Retinopathy?
Source; AAO Guideline
Simple answer; Every diabetics!
Joobin Khadamy. MD; Diabetes & Insuline conferece
6
Diabetic retinopathy risk factors
Source; AAO Guideline
Blood sugar levelsBlood pressure (<130/80 mmHg)Duration of diabetes
Type 1/15 years/80 % Type 2/19 years/84 %
Blood lipid levels greater accumulation of exudates, protein deposits higher risk of moderate visual loss.
EthnicityPregnancy
Joobin Khadamy. MD; Diabetes & Insuline conferece
7
Other RF investigations is needed
Source; AAO Guideline
Common RF with Diabetic Nephropathy Elevated Cystatin C can predict DR
?
Joobin Khadamy. MD; Diabetes & Insuline conferece
8
How does non-proliferative diabetic retinopathy affect your vision?
Source; AAO Guideline
Joobin Khadamy. MD; Diabetes & Insuline conferece
9
How does proliferative diabetic retinopathy affect your vision?
Source; AAO Guideline
Joobin Khadamy. MD; Diabetes & Insuline conferece
10
Examination Schedule
Source; AAO Guideline
Type 2 Diabetes The patient should be referred for ophthalmologic
evaluation at the time of diagnosis. The time of onset of Type 2 diabetes is often difficult
to determine and may precede the diagnosis by a number of years.
Up to 3% of patients whose diabetes is first diagnosed at age 30 or later will have CSME or high-risk features at the time of the initial diagnosis of diabetes.
About 30% of patients will have some manifestation of diabetic retinopathy at diagnosis.
Joobin Khadamy. MD; Diabetes & Insuline conferece
11
Examination Schedule
Source; AAO Guideline
Type 1 Diabetes Ophthalmic examinations are recommended beginning 5 years
after the diagnosis of Type 1 diabetes and annually thereafter, which will detect the vast majority of Type 1 patients who require therapy.
Adirect relationship between the prevalence and severity of retinopathy and the duration of diabetes.
The development of vision-threatening retinopathy is rare in children prior to puberty.
Among patients with Type 1 diabetes, substantial retinopathy may become apparent as early as 6 to 7 years after onset of the disease.
Patient education about the visual impact of early glucose control is important and should begin with the onset of disease.
for ophthalmologic evaluation at the time of diagnosis.
Joobin Khadamy. MD; Diabetes & Insuline conferece
12
Source; AAO Guideline
Joobin Khadamy. MD; Diabetes & Insuline conferece
13
Diabetes Associated with Pregnancy
Source; AAO Guideline
diabetics > an examination prior to pregnancy
During the first trimester, with follow-up visits
Joobin Khadamy. MD; Diabetes & Insuline conferece
14
Women who develop gestational diabetes do not require an eye examination
during pregnancy and do not appear to be at increased
risk for diabetic retinopathy during pregnancy.
Source; AAO Guideline
Joobin Khadamy. MD; Diabetes & Insuline conferece
15
Physical Examination
Source; AAO Guideline
Visual acuitySlit-lamp biomicroscopyIntraocular pressure (IOP)Gonioscopy before dilation, when indicated. Iris
neovascularization is best recognized prior to dilation. When neovascularization of the iris is present or suspected, or if the IOP is elevated, undilated gonioscopy can be used to detect neovascularization in the anterior chamber angle.
Pupillary assessment for optic nerve dysfunctionfunduscopy
Joobin Khadamy. MD; Diabetes & Insuline conferece
16
Importance of Dilated Fundus exam
Source; AAO Guideline
A dilated pupil is preferred to ensure optimal examination of the retina, because only 50% of eyes are correctly classified for the presence and severity of retinopathy through undilated pupils.
Slit-lamp biomicroscopy is the recommended method to evaluate retinopathy in the posterior pole and midperipheral retina.
Examination of the peripheral retina is best performed using indirect ophthalmoscopy or slit-lamp biomicroscopy.
Joobin Khadamy. MD; Diabetes & Insuline conferece
17
Imagings
Source; AAO Guideline
FAOCTOCTAWFIUWFI
Joobin Khadamy. MD; Diabetes & Insuline conferece
18
FA
Source; AAO Guideline
Joobin Khadamy. MD; Diabetes & Insuline conferece
19
OCT
Source; AAO Guideline
Joobin Khadamy. MD; Diabetes & Insuline conferece
20
OCTA
Source; AAO Guideline
Joobin Khadamy. MD; Diabetes & Insuline conferece
21
Source; AAO Guideline
Joobin Khadamy. MD; Diabetes & Insuline conferece
22
Type Of Diabetic Retinopathy
Source; AAO Guideline
NPDR : Microaneurysms Retinal hemorrhages Hard exudates Macular edema Macular ischemia
PDR: Neovascularization:
NVD/NVE> Fibrovascular>Vitreous Hx> TRD Angle/Iris > NV glaucoma
Joobin Khadamy. MD; Diabetes & Insuline conferece
23
NPDR
Source; AAO Guideline
Joobin Khadamy. MD; Diabetes & Insuline conferece
24
PDR
Source; AAO Guideline
Joobin Khadamy. MD; Diabetes & Insuline conferece
25Grading Shortages!
Source; AAO Guideline
Joobin Khadamy. MD; Diabetes & Insuline conferece
26
Treatments
Source; AAO Guideline
AntiVEGF + Laser therapySurgery
Joobin Khadamy. MD; Diabetes & Insuline conferece
27
Novel Treatments
Source; AAO Guideline
Beta BlockersSteroid implantsMTXFenofibrate…….. Futu
re:
Combined Slow
Release Im
plants
Joobin Khadamy. MD; Diabetes & Insuline conferece
28
Exercise
Source; AAO Guideline
Joobin Khadamy. MD; Diabetes & Insuline conferece
29
Effects Related to Other Treatments
Source; AAO Guideline
There have been case reports of idiosyncratic macular edema that is temporally associated with use of the glitazone class of oral antihyperglycemic agents.
Joobin Khadamy. MD; Diabetes & Insuline conferece
30
Eye and Diabetes Novelties
Source; AAO Guideline
Insulin Eye DropsBlood Sugar Contact LensesSubconjunctival Glucose Sensors