figures for arvo cme article edited with refs

8/18/2019 Figures for ARVO CME Article Edited With Refs

1/35

Global Diabetes Prevalence Is Projected to

Increase 242% Between 2000 and 2030

Global data

2000: 151 million patients



Amos AF, et al. Diabet Med . 1997;14:S7-S85.

Wild S, et al. Diabetes Care. 2004;27:1047-1053.

2000: 14!2 "

2010: 1#!5 "

$23%

2000: !4 "

2010: 14!2 "

$50%

2000: &4!5 "

2010: 132!3 "

$5#%

2000: 15! "

2010: 22!5 "$44%

2000: 2!5 "

2010: 32!& "

$24%

2000: 1!04 "

2010: 1!33 "

$2&%


2/35

Potential "etabolic Pat'wa(s )eadin* to

Diabetic "icrovasc+lar ,omplications

Pol(ol

pat'wa(

Diabetic nep'ropat'(

Diabetic retinopat'(

Diabetic ne+ropat'(

Diabetes

-lcers.amp+tations

/(per*l(cemia

+peroide

overprod+ction

P,

activation

ision loss

enal disease

Diabetes6ind+ced microvasc+lar dama*e

Gl(cationDiac(l*l(cerol

©2005 Intenational !edi"al #ess

76II 8G9

$ot s%o&n in t%is dia'am d(e to s)a"e limitations: a"ti*ation o+ additional in+lammato and 'o&t% +a"tos.


3/35

P+rpose Bene;its and )imitations o; ,ommon

etinal Dia*nostic Proced+res

pacit( ma( limiteam

Indirectop't'almos6cop(

7ssessperip'eralretina

7lternative to slit6lampbiomicroscop(

>pacit( ma( limiteam

tereoscopic

30? color;+nd+sp'oto*rap'(

Doc+ment

retinal stat+s

Permits objective

comparison over time"ore sensitive andreprod+cible t'anclinical eam

e@+ires trained

p'oto*rap'er andtrained reader

>pacit( ma(de*rade ima*e@+alit(

Amei"an A"adem o+ )%t%almolo'. Preferred Practice Pattern: Diabetic Retinopathy .San Fan"is"o, ali+onia: Amei"an A"adem o+ )%t%almolo'; 2003.


4/35

P+rpose Bene;its and )imitations o; 7dvanced

etinal Dia*nostic Proced+res


5/35

/ 7llows ;or retinal

ima*in* in presence

o; media opacit(/ 7ids in dia*nosis o;

retinal detac'ment

/7ssesses need and+r*enc( ;or

vitreoretinal s+r*er(

-ltrasono*rap'(

Ima'e "o(tes o+ %omas i(lla, !

etinal

detac'ment $

/emorr'a*e


6/35

/ I97 is *ood ;or:

/i*'li*'tin*

microane+r(sms

'owin* isc'emia

'owin* brea=6

down o; t'e blood

retinal barrier

Dia*nosin*proli;erative diabetic

retinopat'(

-tilit( o; Intraveno+s 9l+orescein

7n*io*rap'( CI97

P'oto*rap'ic ;+nd+s ima*e

9l+orescein an*io*ram


7/35

>,< and D"8

/ pon*e6li=e ;l+id acc+m+lation in t'e o+ter

retina

C0% to % o; e(es corresponds to ;ocal.di;;+se "8


8/35

>,< and D"8

/ ,(stoid mac+lar edema C,"8 C50%


9/35

>,< and D"8

/ "ec'anicalE'(aloidal traction and.or8" C1%


10/35

>,< and D"8

/ ero+s mac+lar detac'ment wit' orwit'o+t traction C15%


11/35

i*ns and (mptoms o;

Diabetic etinopat'(

Preclinical PD PD D"8

(mptoms one one or bl+rredvision and *lare

one or red+cedvision and ;loaters

one orbl+rred vision

,linicalsi*ns

ormal6appearin*retina

etinal veno+sdilation

"icroane+r(sms

,otton6woolspots

Intraretinal'emorr'a*es

I"7s

eno+s beadin*

etinal veno+sdilation

eno+s beadin*

I"7s

eovasc+lariAation

wellin* o;retina

Increasedcapillar(lea=a*e

9l+idacc+m+lationin retinalla(ers

I"7 F intraretinal microvasc+lar abnormalit(

adne W, Aiello #. #at%o'enesis o+ diaeti" etino)at%. In: Flnn 6W, Smidd W, eds. Diabetes and OcularDisease: Past, Present, and Future Therapies. AA !ono'a)% $(me 14. San Fan"is"o: %e Fo(ndation o+ t%e

Amei"an A"adem o+ )%t%almolo'; 2000:1-17.


12/35

evere PD

onproli;erative Diabetic etinopat'(

Se*ee $#, "o(tes o+ iaeti" etino)at% St(d esea"% o()


13/35

eovasc+lariAation

/emorr'a*e

©2005 Intenational !edi"al #ess

Proli;erative Diabetic etinopat'(


14/35

/ ,(stoid mac+lar

edema

/ 9ocal mac+lar edema

-s+all( seen as

circinate e+dates

"icroane+r(sms at

t'e center

/ Di;;+se mac+lar edema

Diabetic "ac+lar 8dema:

3 ,linical arieties

Ima'e "o(tes o+ S (e, !


15/35

/


16/35

In;erior +perior

I)

I.>

>)

>P)

P8.>

8)"

IP)

G,)

9)

500Hm

2

etinal )a(ers on -ltra'i*' esol+tion >,<


17/35

8arl(


18/35

International ,linical Diabetic

"ac+lar 8dema Disease everit( cale

Proposed Disease everit()evel

9indin*s >bservable -pon Dilated >p't'almoscop(

D"8 apparentl( absent o apparent retinal t'ic=enin* or 'ard e+dates inposterior pole

D"8 apparentl( present ome apparent retinal t'ic=enin* or 'ard e+datesin posterior pole

I; D"8 is present it can be cate*oriAed as ;ollows:

"ild D"8 ome retinal t'ic=enin* or 'ard e+dates inposterior pole b+t distant ;rom t'e center o; t'emac+la

"oderate D"8 etinal t'ic=enin* or 'ard e+dates approac'in*

t'e center o; t'e mac+la b+t not involvin* t'ecenter

evere D"8 etinal t'ic=enin* or 'ard e+dates involvin* t'ecenter o; t'e mac+la

D"8 F diabetic mac+lar edema Wilinson #, et al. Ophthalmology . 2003;110:177-182. Amei"an A"adem o+ )%t%almolo'. Preferred practice pattern: diabetic retinopathy .

San Fan"is"o, ali+: Amei"an A"adem o+ )%t%almolo'; 2003.


19/35

International ,linical Diabetic

etinopat'( Disease everit( cale

Proposed Diseaseeverit( )evel 9indin*s >bservable -pon Dilated >p't'almoscop(

o apparent retinopat'( o abnormalities

"ild PD "icroane+r(sms onl(

"oderate PD "ore t'an j+st microane+r(sms b+t less t'an severe PD

evere PD

C4:2:1 +le

7n( o; t'e ;ollowin*:

/ "ore t'an 20 intraretinal 'emorr'a*es in eac' o; 4@+adrants

/ De;inite veno+s beadin* in 2 or more @+adrants

/ Prominent I"7 in 1 or more @+adrants and no si*ns o;

PD

PD >ne or bot' o; t'e ;ollowin*:

/ eovasc+lariAation

/ itreo+s.preretinal 'emorr'a*e

PD F nonproli;erative diabetic retinopat'( PD F proli;erative diabetic retinopat'(

I"7 F intraretinal microvasc+lar abnormalities

Wilinson #, et al. Ophthalmology . 2003;110:177-182; Amei"an A"adem o+ )%t%almolo'. Preferred practice pattern: diabetic retinopathy . San Fan"is"o, ali+: Amei"an A"adem o+ )%t%almolo'; 2003.


20/35

-PDL ) 71, , l t Mit' d d


21/35

-PDL: )ower 71, ,orrelates Mit' ed+ced

is= o; Development and Pro*ression o;

etinopat'( in


22/35

-PD: )ower BP ed+ces elative is= o;

Development and Pro*ression o; etinopat'(

>ver #!5 Jears in


23/35

/i*'6ris= PD

C3 or 4 'i*'6ris=;eat+res

o -s+all( o

Jes -s+all( -s+all(

Indications ;or )aser P'otocoa*+lation


24/35

Indications ;or itrectom( and

Potential ,omplications

Amei"an A"adem o+ )%t%almolo'. Preferred practice pattern: diabetic retinopathy . San Fan"is"o, ali+: Amei"an

A"adem o+ )%t%almolo'; 2003.

Flnn 6W, Smidd W, eds. Diabetes and Ocular Disease: Past, Present, and Future Therapies. AA !ono'a)% $o 14.

San Fan"is"o: %e Fo(ndation o+ t%e Amei"an A"adem o+ )%t%almolo'; 2000.iaeti" etino)at%


25/35

Intravitreal


26/35


27/35

Pe*aptanib Improves 7 >+tcomes

in D"8

(nnin'%am , et al. Ophthalmology . 2005;112:1747-1757.

ote: 7+t'ors state t'at st+d( was not powered to detect dose6

dependent treatment e;;ects!

Increase in7

Cletters

Pe*aptanib Dose

'am

Cn F 41

0!3 m*

Cn F 44

1 m*

Cn F 43

3 m*

Cn F 42

N 10 10% 34%

P F !003

30% 14%

N 15 #% 1&%P F !12

14% #%

Patients attainin* N 26line increase a;ter 3 wee=s o; treatment


28/35

Pe*aptanib 7dverse 8vents

8vent 'am Pe*aptanib

8(e pain 1# 31

itreo+s ;loaters # 22

,onj+nctival 'emorr'a*e 10

itreo+s opacities 5

itreo+s disorder > #

is+al dist+rbance > 2 #

terile endop't'almitis 1

>c+lar adverse events t'at occ+rred si*ni;icantl( more o;ten in st+d( e(es1

(nnin'%am , et al. Ophthalmology . 2005;112:1747-1757.

Data are percenta*e o; total patient *ro+p! Qeroes omitted! > F not ot'erwise

speci;ied!1P+nctate =eratitis cataracts and e(e disc'ar*e occ+rred at approimatel( e@+al

rates in bot' s'am and pe*aptanib *ro+ps! o clinicall( relevant di;;erences were

observed between treatment *ro+ps ;or cardiac 'emorr'a*ic t'romboembolic

or *astrointestinal disorders!


29/35

8palrestat 'ows


30/35

8palrestat 7dverse 8vents

Steele W, Fa(lds , oa =. Drugs Aging . 1993;3:532-555.

)iver enA(me elevations

7lanine aminotrans;erase 1!0%

7spartate aminotrans;erase 1!0%

Gl+tam(l transpeptidase 1!0%

Diarr'ea 0!2%

8r(t'ema 0!2%

=in b+llae 0!2%

er+m creatinine elevation 0!2%


31/35

100 .d "id t i I


32/35

100 m*.da( "idosta+rin Improves

"ean 7 b( 7bo+t 1 )ine at 3 "ont's

am)o"%iao #A, et al. #n$est Ophthalmol %is &ci . 2004;45:922-931.

Placebo Cn F 34

P,412 50 m*.d Cn F 32

P,412 100 m*.d Cn F 3&

P,412 150 m*.d Cn F 3#

"ont'

, ' a n *

e i n 4 7 C n + m b e r o ; l e t t e r s D

100: P F !00#

150: P F !01

50: P F !02

0 1 2 3 4 5 # & 10 11 12 13 14 15


33/35

"idosta+rin CP,412 7dverse 8vents

am)o"%iao #A, et al. #n$est Ophthalmol %is &ci . 2004;45:922-931.

Data are percenta*e o; total patient *ro+p! Qeroes omitted!

> F not ot'erwise speci;ied PB> F placebo

>r*ans(stem

8vent PB> 50 m*.d 100 m*.d 150 m*.d

Gastro6intestinal

a+sea 3% % 21% 3&%

Diarr'ea > 3% 3% 1% 1%

omitin* 3% 3% 1%

/epatic

Increased 7)< % &% 14%

Increased 7< 3% &% &%

8vents occ+rrin* in O5% o; patients in an( treatment *ro+p

+boista+rin ed+ces is= o; "oderate


34/35

+boista+rin ed+ces is= o; "oderate

or Morse is+al )oss in Diabetic

etinopat'( Mit' or Mit'o+t D"8

#=-S St(d o(). Diabetes. 2005;54:2188-2197.

Placebo Cn F 100 e(es& m* Cn F e(es

1 m* Cn F 104 e(es

32 m* Cn F 10& e(es

50

40

P r o b a b i l i t ( o ; " 4 ) :

%

"ont's

)o* an= P val+es:

>verall: !032 m* vs Placebo: !03&

0 12 1& 24 30 3 42

30

20

10

0

") F moderate vis+al loss CN15

letters


35/35

+boista+rin 7dverse 8vents

#= S St d Di b t 2005 54 2188 2197

Data are percenta*e o; total patient *ro+p!

,7D F coronar( arter( disease > F not ot'erwise speci;ied 1? 7 bloc= F ;irst6de*ree

atrioventric+lar bloc=

>r*an s(stem 8vent PB> 4.& m*.d 1 m*.d 32 m*.d

GastrointestinalDiarr'ea > 1! 13! 24!4 14!

9lat+lence 1!# 1!3 4!2 0!4

,ardiovasc+lar ,7D > !& 3!5 13!0 4!#

1? 7 Bloc= 0 1!3 1!3 3!4

P+lmonar( 7st'ma > 0!& 1!& 1!# 4!#

enalD(s+ria 1!3 0! 1!# 4!3

Protein+ria 0!& 1!3 3!& 0!

Dermatolo*ical /(per=eratosis 5!5 ! 2!5 2!1

8vents occ+rrin* in O3% o; patients in an( treatment *ro+p and wit'

statisticall( si*ni;icant di;;erence between *ro+ps

figures for arvo cme article edited with refs

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