Metabolic Factor of DR Polyol pathway hepatocyte NADPH

Metabolic Factor of DR Polyol pathway hepatocyte NADPH NADP Aldose reductase phosphatase ATP hexokinase NADH Polyol dehydrogenase Hyperosmetic gradient ADP -Swelling and cellular damage of lens (cataract) -Damage of retinal pericyte (DR) -Basement membrane thickening of vessels (DR)

Definition Macular edema Diabetic Retinopathy Non proliferative diabetic retinopathy (NPDR) Proliferative retinopathy (PDR) Mild NPDR Moderate NPDR Severe NPDR

Definition Macular edema Diabetic Retinopathy Non proliferative diabetic retinopathy (NPDR) Proliferative retinopathy (PDR) Mild NPDR Moderate NPDR Severe NPDR Non vision threatening DR Good control BS FU every year Vision threatening DR LASER treatment

Definition of non vision threatening of DR Mild Non-proliferative Diabetic Retinopathy ( mild NPDR) Microaneurysm or dot hemorrthage

Definition of non vision threatening of DR Moderate Non-proliferative Diabetic Retinopathy (Mod NPDR) Hard exudate

Definition of Vision Threatening Diabetic Retinopathy Severe Non-proliferative Diabetic Retinopathy ( severe NPDR) Hemorrhage>20 in each quadrant of 4 Q Rule of 4: 2: 1 Vessel dilatation 2 Q Intraretina Microvascular Abnormality (IRMA) 1 Q

Definition of Vision Threatening Diabetic Retinopathy Proliferative Diabetic Retinopathy (PDR) Neovascularization At elsewhere (NVE) Vitrouse hemorrhage Neovascularization at disc (NVD) Traction retinal detachment

Definition of Vision Threatening Diabetic Retinopathy Proliferative Diabetic Retinopathy (PDR) Neovascularization at disc (NVD) Neovascularization At elsewhere (NVE) Neovascularization at disc (NVD) Traction retinal detachment

Definition of Vision Threatening Diabetic Retinopathy Macular Edema Macular edema or exudate within 500 micron Optic disc=1500 micron

DR screening n Direct ophthalmoscope

DR screening n Indirect ophthalmoscope Dilate pupil before eye examination

DR screening n Fundus camera

Retina image

Internet consultation

Internet consultation

LASER Treatment • LASER 532 nm • LASER multi-wavelengths

Anti VEGF Intra-vitreous injection

LASER Treatment n Pattern LASER 532 nm

Retina surgery Indication - Vitrouse Hemorrhage - Tractional Retinal detachment

Retina surgery

Vitrectomy and Endolaser

Vitrectomy and SF 6/silicone oil injection

Risk factor of DR Long Duration DM n Uncontrolled DM n Hypertension n Albuminuria or nephropathy n Pregnancy n

Patients' education n n Tight control BS (diet, exercise, medication) Control HT Eye examination annually etc

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