Josephine Carlos-Raboca, M.D.

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DIABETES AND YOUR EYES

• Josephine Carlos-Raboca, M.D.
• Makati Medical Center

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DIABETES MELLITUS

• ABNORMALITY IN GLUCOSE METABOLISM
• ALTERED INSULIN PRODUCTION OR ACTIVITY
• ELEVATED BLOOD SUGAR LEVELS
• NUMEROUS COMPLICATIONS
• ENORMOUS SOCIAL/ECONOMIC IMPACT

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ANATOMY OF THE EYE
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Mga Simtomas

• panlalabo ng paningin
• pagdilim ng paningin
• pagdoble ng paningin
• itim na spots sa paningin

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EYE COMPLICATIONS

• CORNEAL ABNORMALITIES
• CATARACTS
• IRIS NEW VESSELS
• GLAUCOMA
• NEUROPATHIES
• RETINOPATHY

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CORNEAL PROBLEMS

• More prone to abrasions, infections
• Delayed/poor wound healing

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LENS

• Earliest sign is blurring of vision
• Drastic changes in blood sugar affects the grade
  of your eye
• Diabetics prone to develop cataracts earlier

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Diabetic Cataract
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Glaucoma

• A rise in the internal pressure of the eye
• Usually a result of the new vessels in the iris
  which block the outflow

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Neuropathies

• Can affect muscles that move the eye
• Or the optic nerve

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DIABETIC RETINOPATHY
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Normal Retina
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DIABETIC RETINOPATHY

• MOST COMMON CAUSE OF NEW CASES OF BLINDNESS
• 10-20 OF ALL NEW CASES OF BLINDNESS (US
  EUROPE)
• INCREASING PREVALENCE DUE TO INCREASING SURVIVAL
  OF DM PATIENTS

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RISK FACTORS

• TYPE
• DURATION
• GLUCOSE CONTROL
• RENAL DISEASE
• SYSTEMIC HYPERTENSION
• ELEVATED SERUM LIPIDS
• PREGNANCY

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TYPE OF DIABETES MELLITUS

• 10-15 Type 1
• MAJORITY Type 2
• OCULAR COMPLICATIONS SIMILAR
• Type 1 HIGH INCIDENCE OF SEVERE OCULAR
  COMPLICATIONS/FASTER PROGRESSION
• Type 2 MAJORITY OF CLINICAL CASES OF EYE DISEASE

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DURATION
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
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GLUCOSE CONTROL

• INTENSIVE GLUCOSE CONTROL REDUCED INCIDENCE AND
  PROGRESSION OF RETINOPATHY IN IDDM
• Diabetes Control and Complications Trial
• GLYCOSYLATED Hg lt7

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RENAL DISEASE

• PROTEINURIA, ELEVATED BUN/CREA LEVELS EXCELLENT
  PREDICTOR
• MICROANGIOPATHY
• AGGRESSIVE MANAGEMENT IS BENEFICIAL

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SYSTEMIC HYPERTENSION

• HTN NEPHROPATHY EXCELLENT PREDICTOR OF
  RETINOPATHY
• MAY BE SUPERIMPOSED
• MUST BE CONTROLLED

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ELEVATED SERUM LIPIDS

• MAY COMPLICATE RETINOPATHY
• INCREASES VESSEL LEAKAGE AND HARD EXUDATE
  FORMATION
• REASON????

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PREGNANCY

• PREGNANT WOMEN W/O DM RETINOPATHY 10 RISK FOR
  NPDR
• PREGNANT WOMEN WITH NPDR 4 RISK FOR PDR
• THOSE WITH PDR VERY POOR PROGNOSIS
• BASELINE AND STRICT FOLLOW UP

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RETINAL HEMORRHAGE
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HARD EXUDATES
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COTTON WOOL SPOTS
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NEOVASCULARIZATION

• RESPONSE TO SEVERE AND PROLONGED LACK OF OXYGEN
• ANGIOGENIC FACTORS
• GROWTH OF NEW BLOOD VESSELS IN THE RETINA
• POOR QUALITY OF VESSELS

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Normal Retina
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NEOVACULARIZATION
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VITREOUS HEMORRHAGE
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VITREOUS/PRERETINAL HEME
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TRACTIONAL DETACHMENT
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TRACTIONAL DETACHMENT
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STAGING/TERMINOLOGY

• BACKGROUND OR NON-PROLIFERATIVE DIABETIC
  RETINOPATHY (BDR/NPDR)
• PROLIFERATIVE DIABETIC RETINOPATHY (PDR)

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MILD BACKGROUND
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MODERATE BACKGROUND
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SEVERE BACKGROUND
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PROLIFERATIVE RETINOPATHY
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PROGNOSIS W/O TREATMENT

• MODERATE VISUAL LOSS IN BDR 30 IN 3 YEARS
• SEVERE VISUAL LOSS( VISION LESS THAN 5/200) IN
  PDR 35 IN 2 YEARS

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TREATMENT

• GLUCOSE CONTROL
• LASER THERAPY
• FOCAL
• PANRETINAL PHOTOCOAGULATION
• VITRECTOMY
• BP CONTROL
• LIPID CONTROL

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LASER THERAPY
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LASER THERAPY

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

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RECOMMENDATIONS

• Get at Baseline DILATED eye exam
• Type 1 DM FIVE YEARS AFTER DIAGNOSIS
• Type 2 DM IMMEDIATELY AFTER DIAGNOSIS
• GESTATIONAL DM DURING 1ST TRIMESTER
• IMMEDIATE EXAM IF SYMPTOMATIC

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RECOMMENDATIONS

• MILD BDR YEARLY EXAM
• MODERATE BDR EVERY 4-8 MONTHS
• SEVERE BDR EVERY 2-4 MONTHS
• PDR IMMEDIATE LASER TX THEN EVERY 2-4
  MONTHS UNTIL STABLE

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THANK YOU!