prevalence of diabetic retinopathy in diabetic patients cared for at the family care center at rcrmc...
TRANSCRIPT
Prevalence of Diabetic Retinopathy
In Diabetic patients cared for at the Family Care Center at RCRMC
Kam Chan, DO
[ role of BP & glycemic control ]
Background Estimated 18.2 million Americans and one in 20
world-wide lives with diabetes Type II Diabetes account for 90% of total cases in
the US Diabetic Retinopathy is the most frequent cause
of new cases of blindness in diabetic patients aged 20-74 years in the US
Diabetic Retinopathy Background Retinopathy -
microaneurysm formation, capillary leakage causing dot blot hemorrhage & hard exudates
Pre-proliferative retinopathy - cotton-wool spots due to infarction of retinal nerve fiber layers and venous beading
Proliferative retinopathy { PDR } growth of new blood vessels from the optic nerve head OR posterior surface of vitreous
Diabetic Retinopathy
NON PROLIFERATIVE RETINOPATHY
PROLIFERATIVE RETINOPATHY
ASSOCIATED RISK FACTORS
Duration / Onset age Glycemic control Renal disease
Systemic HTN Hyperlipidemia Pregnancy
RETINOPATHY vs DURATION
TYPE I diabetes < 5 years - 17%
5 - 10 years - 74% > 15 years - 98%
TYPE II diabetes 0 - 10%
0 - 5 years - 29%> 15 years - 78%
Data TOTAL # of SUBJECTS = 133
Approx. 70% of patients were Hispanic Age range - 31-85 years Mean age = 57 +/- 8 years 68% females
50% patients had some type of eye disorder 26% with diabetic retinopathy 9% with PDR 17% with NPDR 9% cases – cataract alone 2% glaucoma alone 2% both 4 cases NPDR + cataract
PREVALENCE OF DIABETIC RETINOPATHY IN DIABETIC PATIENTS [ FCC-RCRMC ]
74%
17%
9%
No Retinopathy
NPDR
PDR
OTHER EYE DISORDERS
Cataract
Both
Glaucoma
No Eye disorder
NPDR
PDR
Impact of uncontrolled HTNPDR NPDR CATARACT GLAUCOMA
12 23 15 69% 17% 11% 5%
HTN HTN HTN HTN7 13 5 2
No of patients
Percent of Total
N = 133 subjects
Association of Hypertension with Diabetic Retinopathy
0
20
40
60
80
100
120
better BP control
Poor BP control
PDR NPDR No Retinopathy
No of patients
Glycemic Control - Role in Diabetic Retinopathy
0
2
4
6
8
10
PDR NPDR No Retinopathy
A1c
N=12 N=23 N= 98
<140 159 15.1
140–160 28 14.3
>160 9 33.3
Diabetes and Diabetic Retinopathy in a Mexican-American Population Proyecto VER
Sheila K. West, PHD1, Ronald Klein, MD2, Jorge Rodriguez, MD, MPH3, Beatriz Muñoz, MS1, Aimee T. Broman, MS1, Rosario Sanchez, MD, MPH1 and Robert Snyder, MD, PHD
3
Prevalence of retinopathy in patients with different presenting BP
CONCLUSION The prevalence of diabetic patients with
retinopathy in our clinic is 26% Tighter control of BP will have immense impact
on the progression of retinopathy More effort should be placed in making sure all
diabetics obtain eye exams This study will help provide a reference point for
implementing changes toward improved therapy
Bibliography1. Fong, DS et. al. Diabetic retinopathy. Diabetes Care. 2003 Jan; 26(1): 226-9. Review2. Tooke, JE. Possible pathophysiological mechanisms for diabetic angiopathy in type 2 diabetes.J Diabetes Complications. 2000 Jul-Aug; 14(4): 197-200. Review3. Klein R, et al: The Wisconsin Epidemiologic Study of Diabetic Retinopathy. II.Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 102:520–526, 19844. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317:708–713, 19985. Estacio RO et al: Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes. Diabetes Care 23 (Suppl. 2):B54–B64, 2000Sheila K. West, et al. Diabetes and Diabetic Retinopathy in a Mexican-American Population: Proyecto VER Diabetes Care 2001 24: 1204-12099. Harris MI, et al: Is the risk of diabetic retinopathy greater in non-Hispanic blacks and Mexican Americans than in non-Hispanic whites with type 2 diabetes? A U.S. population study. Diabetes Care 21:1230–1235, 1998