Josephine Carlos-Raboca, M.D.Josephine Carlos-Raboca, M.D.

Makati Medical CenterMakati Medical Center

DIABETES AND YOUR EYESDIABETES AND YOUR EYES

DIABETES MELLITUSDIABETES MELLITUS

ABNORMALITY IN GLUCOSE METABOLISMABNORMALITY IN GLUCOSE METABOLISM ALTERED INSULIN PRODUCTION OR ALTERED INSULIN PRODUCTION OR

ACTIVITYACTIVITY ELEVATED BLOOD SUGAR LEVELSELEVATED BLOOD SUGAR LEVELS NUMEROUS COMPLICATIONSNUMEROUS COMPLICATIONS ENORMOUS SOCIAL/ECONOMIC IMPACTENORMOUS SOCIAL/ECONOMIC IMPACT

ANATOMY OF THE EYEANATOMY OF THE EYE

Mga SimtomasMga Simtomas

panlalabo ng paninginpanlalabo ng paningin pagdilim ng paninginpagdilim ng paningin pagdoble ng paninginpagdoble ng paningin itim na ‘spots’ sa paninginitim na ‘spots’ sa paningin

EYE COMPLICATIONSEYE COMPLICATIONS

CORNEAL ABNORMALITIESCORNEAL ABNORMALITIES CATARACTSCATARACTS IRIS NEW VESSELSIRIS NEW VESSELS GLAUCOMAGLAUCOMA NEUROPATHIESNEUROPATHIES RETINOPATHYRETINOPATHY

CORNEAL PROBLEMSCORNEAL PROBLEMS

More prone to abrasions, infectionsMore prone to abrasions, infections Delayed/poor wound healingDelayed/poor wound healing

LENSLENS

Earliest sign is blurring of visionEarliest sign is blurring of vision Drastic changes in blood sugar affects the Drastic changes in blood sugar affects the

grade of your eyegrade of your eye Diabetics prone to develop cataracts earlierDiabetics prone to develop cataracts earlier

Diabetic CataractDiabetic Cataract

GlaucomaGlaucoma

A rise in the internal pressure of the eyeA rise in the internal pressure of the eye Usually a result of the new vessels in the iris Usually a result of the new vessels in the iris

which block the outflowwhich block the outflow

NeuropathiesNeuropathies

Can affect muscles that move the eyeCan affect muscles that move the eye Or the optic nerveOr the optic nerve

DIABETIC DIABETIC RETINOPATHYRETINOPATHY

Normal RetinaNormal Retina

DIABETIC RETINOPATHYDIABETIC RETINOPATHY

MOST COMMON CAUSE OF NEW CASES MOST COMMON CAUSE OF NEW CASES OF BLINDNESS OF BLINDNESS

10-20% OF ALL NEW CASES OF 10-20% OF ALL NEW CASES OF BLINDNESS (US & EUROPE)BLINDNESS (US & EUROPE)

INCREASING PREVALENCE DUE TO INCREASING PREVALENCE DUE TO INCREASING SURVIVAL OF DM PATIENTSINCREASING SURVIVAL OF DM PATIENTS

RISK FACTORSRISK FACTORS

TYPETYPE DURATIONDURATION GLUCOSE CONTROLGLUCOSE CONTROL RENAL DISEASERENAL DISEASE SYSTEMIC HYPERTENSIONSYSTEMIC HYPERTENSION ELEVATED SERUM LIPIDSELEVATED SERUM LIPIDS PREGNANCYPREGNANCY

TYPE OF DIABETES TYPE OF DIABETES MELLITUSMELLITUS

10-15%: Type 110-15%: Type 1 MAJORITY: Type 2MAJORITY: Type 2 OCULAR COMPLICATIONS SIMILAROCULAR COMPLICATIONS SIMILAR Type 1: HIGH INCIDENCE OF SEVERE Type 1: HIGH INCIDENCE OF SEVERE

OCULAR COMPLICATIONS/FASTER OCULAR COMPLICATIONS/FASTER PROGRESSIONPROGRESSION

Type 2: MAJORITY OF CLINICAL CASES Type 2: MAJORITY OF CLINICAL CASES OF EYE DISEASEOF EYE DISEASE

DURATIONDURATION

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%

GLUCOSE CONTROLGLUCOSE CONTROL

INTENSIVE GLUCOSE CONTROL INTENSIVE GLUCOSE CONTROL REDUCED INCIDENCE AND REDUCED INCIDENCE AND PROGRESSION OF RETINOPATHY IN PROGRESSION OF RETINOPATHY IN IDDMIDDM

• Diabetes Control and Complications Diabetes Control and Complications TrialTrial

GLYCOSYLATED Hg <7%GLYCOSYLATED Hg <7%

RENAL DISEASERENAL DISEASE

PROTEINURIA, ELEVATED BUN/CREA PROTEINURIA, ELEVATED BUN/CREA LEVELS: EXCELLENT PREDICTORLEVELS: EXCELLENT PREDICTOR

MICROANGIOPATHYMICROANGIOPATHY AGGRESSIVE MANAGEMENT IS AGGRESSIVE MANAGEMENT IS

BENEFICIALBENEFICIAL

SYSTEMIC HYPERTENSIONSYSTEMIC HYPERTENSION

HTN + NEPHROPATHY: EXCELLENT HTN + NEPHROPATHY: EXCELLENT PREDICTOR OF RETINOPATHYPREDICTOR OF RETINOPATHY

MAY BE SUPERIMPOSEDMAY BE SUPERIMPOSED MUST BE CONTROLLEDMUST BE CONTROLLED

ELEVATED SERUM LIPIDSELEVATED SERUM LIPIDS

MAY COMPLICATE RETINOPATHYMAY COMPLICATE RETINOPATHY INCREASES VESSEL LEAKAGE AND INCREASES VESSEL LEAKAGE AND

HARD EXUDATE FORMATIONHARD EXUDATE FORMATION REASON????REASON????

PREGNANCYPREGNANCY

PREGNANT WOMEN W/O DM PREGNANT WOMEN W/O DM RETINOPATHY: 10% RISK FOR NPDRRETINOPATHY: 10% RISK FOR NPDR

PREGNANT WOMEN WITH NPDR: 4% PREGNANT WOMEN WITH NPDR: 4% RISK FOR PDRRISK FOR PDR

THOSE WITH PDR: VERY POOR THOSE WITH PDR: VERY POOR PROGNOSISPROGNOSIS

BASELINE AND STRICT FOLLOW UPBASELINE AND STRICT FOLLOW UP

RETINAL HEMORRHAGERETINAL HEMORRHAGE

HARD EXUDATESHARD EXUDATES

COTTON WOOL SPOTSCOTTON WOOL SPOTS

NEOVASCULARIZATIONNEOVASCULARIZATION

RESPONSE TO SEVERE AND RESPONSE TO SEVERE AND PROLONGED LACK OF OXYGENPROLONGED LACK OF OXYGEN

ANGIOGENIC FACTORS ANGIOGENIC FACTORS GROWTH GROWTH OF NEW BLOOD VESSELSOF NEW BLOOD VESSELS IN IN

THE RETINATHE RETINA POOR QUALITY OF VESSELSPOOR QUALITY OF VESSELS

Normal RetinaNormal Retina

NEOVACULARIZATIONNEOVACULARIZATION

VITREOUS HEMORRHAGEVITREOUS HEMORRHAGE

VITREOUS/PRERETINAL VITREOUS/PRERETINAL HEMEHEME

TRACTIONAL DETACHMENTTRACTIONAL DETACHMENT

TRACTIONAL DETACHMENTTRACTIONAL DETACHMENT

STAGING/TERMINOLOGYSTAGING/TERMINOLOGY

““BACKGROUND” OR NON-PROLIFERATIVE BACKGROUND” OR NON-PROLIFERATIVE DIABETIC RETINOPATHY (DIABETIC RETINOPATHY (BDR/NPDRBDR/NPDR))

PROLIFERATIVE DIABETIC RETINOPATHY PROLIFERATIVE DIABETIC RETINOPATHY ((PDRPDR))

MILD BACKGROUND MILD BACKGROUND

MODERATE BACKGROUNDMODERATE BACKGROUND

SEVERE BACKGROUNDSEVERE BACKGROUND

PROLIFERATIVE PROLIFERATIVE RETINOPATHYRETINOPATHY

PROGNOSIS W/O TREATMENTPROGNOSIS W/O TREATMENT

MODERATE VISUAL LOSS IN BDR: MODERATE VISUAL LOSS IN BDR:

30% IN 3 YEARS30% IN 3 YEARS SEVERE VISUAL LOSS( VISION LESS SEVERE VISUAL LOSS( VISION LESS

THAN 5/200) IN PDR: THAN 5/200) IN PDR: 35% IN 2 35% IN 2 YEARSYEARS

TREATMENTTREATMENT

GLUCOSE CONTROLGLUCOSE CONTROL LASER THERAPYLASER THERAPY

FOCALFOCAL PANRETINAL PHOTOCOAGULATIONPANRETINAL PHOTOCOAGULATION

VITRECTOMYVITRECTOMY BP CONTROLBP CONTROL LIPID CONTROLLIPID CONTROL

LASER THERAPYLASER THERAPY

LASER THERAPYLASER THERAPY

GOAL IS TO PRESERVE VISION !!!GOAL IS TO PRESERVE VISION !!! Improvement is secondaryImprovement is secondary

RECOMMENDATIONSRECOMMENDATIONS

Get at Baseline Get at Baseline DILATEDDILATED eye exam eye exam Type 1 DM: FIVE YEARS AFTER Type 1 DM: FIVE YEARS AFTER

DIAGNOSISDIAGNOSIS Type 2 DM: IMMEDIATELY AFTER Type 2 DM: IMMEDIATELY AFTER

DIAGNOSISDIAGNOSIS GESTATIONAL DM: DURING 1ST GESTATIONAL DM: DURING 1ST

TRIMESTER TRIMESTER IMMEDIATE EXAM IF SYMPTOMATICIMMEDIATE EXAM IF SYMPTOMATIC

RECOMMENDATIONSRECOMMENDATIONS

MILD BDR: YEARLY EXAMMILD BDR: YEARLY EXAM MODERATE BDR: EVERY 4-8 MODERATE BDR: EVERY 4-8

MONTHS MONTHS SEVERE BDR: EVERY 2-4 MONTHSSEVERE BDR: EVERY 2-4 MONTHS PDR: IMMEDIATE LASER TX THEN PDR: IMMEDIATE LASER TX THEN

EVERY 2-4 MONTHS UNTIL STABLE EVERY 2-4 MONTHS UNTIL STABLE

THANK YOU!THANK YOU!