Diabetes: Diabetic retinopathy Olga Brochner Ophthalmology, ADHB

Diabetes:Diabetes: Diabetic retinopathy Diabetic retinopathy

Olga Brochner Olga Brochner

Ophthalmology, Ophthalmology, ADHBADHB

Plan Plan

• The eyeThe eye• Diabetic retinopathy Diabetic retinopathy

(D.R.)(D.R.)• Influencing factorsInfluencing factors• Signs & stagesSigns & stages• ManagementManagement• QuestionsQuestions

D.M. & eyeD.M. & eye

• Lens changes - cataract, refraction Lens changes - cataract, refraction changeschanges

• Iris changes - diminished pupillary Iris changes - diminished pupillary responses, rubeosis, anterior responses, rubeosis, anterior synechiaesynechiae

• Optic neuropathyOptic neuropathy

• Extraocular muscle palsy Extraocular muscle palsy

Posterior segmentPosterior segmentPosterior segmentPosterior segment

• ScleraSclera

• ChoroidChoroid

• Optic discOptic disc

• VitreousVitreous

• RetinaRetina

• MaculaMacula

• ScleraSclera

• ChoroidChoroid

• Optic discOptic disc

• VitreousVitreous

• RetinaRetina

• MaculaMacula

RetinopathyRetinopathy

• Abnormal, pathological processes in Abnormal, pathological processes in retinaretina

• D.R. = microvascularD.R. = microvascular

• Asymptomatic Asymptomatic

until BADuntil BAD

• Prevention / monitorPrevention / monitor

TThere is no curehere is no cure

Influencing FactorsInfluencing Factors

• Length of timeLength of time

• Diabetic control Diabetic control

• HypertensionHypertension

• Lipids (?)Lipids (?)

HbA1cHbA1cSmall difference in HbA1c = significant Small difference in HbA1c = significant reduction on rate of complicationsreduction on rate of complications

Diabetic retinopathyDiabetic retinopathy

• Leading cause of blindness in Leading cause of blindness in working age group (Western World)working age group (Western World)

• Retinopathy universal diabetic related Retinopathy universal diabetic related complicationcomplication

• Asymptomatic Asymptomatic

• Stages of DRStages of DR

• Diabetes epidemicDiabetes epidemic

D.R. stages / signsD.R. stages / signs

• NilNil

• Non-Non-proliferative = proliferative = Mild – severe Mild – severe

• Proliferative DRProliferative DR

• Maculopathy Maculopathy (any time)(any time)

Visual lossVisual loss

2 pathways:2 pathways:

• IschaemiaIschaemia

• Leakage /Leakage /

oedemaoedema

PathogenesisPathogenesis• Structural changesStructural changes vascular permeabilityvascular permeability

• IschaemiaIschaemia

• Angiogenic factorsAngiogenic factors

• NeovascularisationNeovascularisation

• Vit haem & traction detachmentsVit haem & traction detachments

Loss of Loss of vision / vision /

blindnessblindness

• IschaemiaIschaemia

• LeakageLeakage

SignsSigns

• Structural changes capillary wallsStructural changes capillary walls• Microaneurysm (MA)Microaneurysm (MA)• HaemorrhagesHaemorrhages• Increased permeability Increased permeability = “hard” exudates= “hard” exudates• Retinal oedemaRetinal oedema• IRMAIRMA• New vesselsNew vessels• Cotton wool spotsCotton wool spots

Proliferative D.R.Proliferative D.R.

• Intra-retinal microvascular abnormalities Intra-retinal microvascular abnormalities (IRMA) (IRMA)

• New vessels (neovascularisaton)New vessels (neovascularisaton)

• Vitreous haemorrhagesVitreous haemorrhages

• Fibrous tissueFibrous tissue

• Traction detachments Traction detachments

( & rhegmatogenous)( & rhegmatogenous)

MaculopathyMaculopathy

• Results in visual lossResults in visual loss

• Retinal thickening / exudate within Retinal thickening / exudate within maculamacula

• Soggy ground Soggy ground

= soggy vision= soggy vision

• OCTOCT

• EducationEducation• DietDiet• LifestyleLifestyle• MonitoringMonitoring• MedicationsMedications• LASER treatmentLASER treatment• Surgery (ret det)Surgery (ret det)

What to do???What to do???

PhotoscreenPhotoscreen

Eye Clinic reviewEye Clinic review

•DilateDilate•TimeTime•Driving ….Driving ….

LASERLASER

• Application of Application of light energy to light energy to retinaretina

• Focal / grid laserFocal / grid laser

• PRP = pan retinal PRP = pan retinal photocoagulationphotocoagulation

Via Silt-lampVia Silt-lamp

IntravitrealIntravitreal

Triamcinolone / Triamcinolone / AvastinAvastin

Intravitreal = steroid / Intravitreal = steroid / anti VEGFanti VEGF

1.1. Prevent further VA Prevent further VA lossloss

2.2. ComplicationsComplications

3.3. Repeat & with laseRepeat & with laserr

VR surgeryVR surgery

Outcomes Outcomes

• Retina is vital for sightRetina is vital for sight

• Anxiety of vision lossAnxiety of vision loss

• Macula involved???Macula involved???

• Chronic conditionChronic condition

• Long term follow-up Long term follow-up

= huge demand = huge demand

SummariseSummarise

• No visual symptoms until No visual symptoms until

well advancedwell advanced

• Regular checksRegular checks

• Early treatment always more effective & Early treatment always more effective & long-term better resultlong-term better result

• Can not improve sight – aims to stop Can not improve sight – aims to stop worseningworsening

Questions?Questions?Thank youThank you