Diabetes Diabetic retinopathy Olga Brochner Ophthalmology ADHB Plan

Diabetes: Diabetic retinopathy Olga Brochner Ophthalmology, ADHB

Plan • • • The eye Diabetic retinopathy (D. R. ) Influencing factors Signs & stages Management Questions

D. M. & eye • Lens changes - cataract, refraction changes • Iris changes - diminished pupillary responses, rubeosis, anterior synechiae • Optic neuropathy • Extraocular muscle palsy

Posterior segment • • • Sclera Choroid Optic disc Vitreous Retina Macula

Retinopathy • Abnormal, pathological processes in retina • D. R. = microvascular • Asymptomatic until BAD • Prevention / monitor There is no cure

Influencing Factors • Length of time • Diabetic control • Hypertension • Lipids (? )

Hb. A 1 c Small difference in Hb. A 1 c = significant reduction on rate of complications

Diabetic retinopathy • Leading cause of blindness in working age group (Western World) • Retinopathy universal diabetic related complication • Asymptomatic • Stages of DR • Diabetes epidemic

D. R. stages / signs • Nil • Nonproliferative = Mild – severe • Proliferative DR • Maculopathy (any time)

Visual loss 2 pathways: • Ischaemia • Leakage / oedema

Pathogenesis • • • Structural changes vascular permeability Ischaemia Angiogenic factors Neovascularisation Vit haem & traction detachments Loss of vision / blindness • Ischaemia • Leakage

Signs • Structural changes capillary walls • Microaneurysm (MA) • Haemorrhages • Increased permeability = “hard” exudates • Retinal oedema • IRMA • New vessels • Cotton wool spots

Proliferative D. R. • Intra-retinal microvascular abnormalities (IRMA) • New vessels (neovascularisaton) • Vitreous haemorrhages • Fibrous tissue • Traction detachments ( & rhegmatogenous)

Maculopathy • Results in visual loss • Retinal thickening / exudate within macula • Soggy ground = soggy vision • OCT

What to do? ? ? • • Education Diet Lifestyle Monitoring Medications LASER treatment Surgery (ret det)

Photoscreen

Eye Clinic review • Dilate • Time • Driving ….

LASER • Application of light energy to retina • Focal / grid laser • PRP = pan retinal photocoagulation

Via Silt-lamp

Intravitreal Triamcinolone / Avastin Intravitreal = steroid / anti VEGF 1. Prevent further VA loss 2. Complications 3. Repeat & with laser

VR surgery

Outcomes • • • Retina is vital for sight Anxiety of vision loss Macula involved? ? ? Chronic condition Long term follow-up = huge demand

Summarise • No visual symptoms until well advanced • Regular checks • Early treatment always more effective & long-term better result • Can not improve sight – aims to stop worsening

Thank you Questions?