Ocular Manifestation of Diabetes Mellitus

Ocular Manifestation of Diabetes Mellitus
#Diabetes_and_Insuline_Conference
presented by #Joobin_Khadamy_MD
Feb2nd 2017
Birjand, Iran

1. Diabetes and Insuline Conference 2 nd Feb/2017 Birjand University of Medical Science (BIUMS) Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 1 Ocular Manifestations of Diabetes

2. Ocular Manifestations Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 2 Neuropathy(RGC) Ischemic Optic Neuropathy Glaucoma Corneal Edema Corneal Nerve Alterations Cataract Retinopathy

3. How Often Diabetic Retinopathy is? Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 3 Among leading cause of adults blindness in general population In Diabetics: Type1/95% Type2/60%

4. Genetic or Environmental Factors Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 4 Not All diabetics develope to DR!

5. Who Is at Risk for Diabetic Retinopathy ? Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 5 Simple answer; Every diabetics!

6. Diabetic retinopathy risk factors Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 6 Blood sugar levels Blood pressure (< 130/80 mmHg) Duration of diabetes Type 1/15 years/80 % Type 2/19 years/84 % Blood lipid levels greater accumulation of exudates, protein deposits higher risk of moderate visual loss . Ethnicity Pregnancy

7. Other RF investigations is needed Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 7 Common RF with Diabetic Nephropathy Elevated Cystatin C can predict DR ?

8. How does non-proliferative diabetic retinopathy affect your vision ? Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 8

9. How does proliferative diabetic retinopathy affect your vision ? Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 9

10. Examination Schedule Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 10 Type 2 Diabetes The patient should be referred for ophthalmologic evaluation at the time of diagnosis. The time of onset of Type 2 diabetes is often difficult to determine and may precede the diagnosis by a number of years. Up to 3% of patients whose diabetes is first diagnosed at age 30 or later will have CSME or high-risk features at the time of the initial diagnosis of diabetes.  About 30% of patients will have some manifestation of diabetic retinopathy at diagnosis.

11. Examination Schedule Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 11 Type 1 Diabetes Ophthalmic examinations are recommended beginning 5 years after the diagnosis of Type 1 diabetes and annually thereafter, which will detect the vast majority of Type 1 patients who require therapy. Adirect relationship between the prevalence and severity of retinopathy and the duration of diabetes .  The development of vision-threatening retinopathy is rare in children prior to puberty. Among patients with Type 1 diabetes, substantial retinopathy may become apparent as early as 6 to 7 years after onset of the disease. Patient education about the visual impact of early glucose control is important and should begin with the onset of disease. for ophthalmologic evaluation at the time of diagnosis .

12. Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 12

13. Diabetes Associated with Pregnancy Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 13 diabetics > an examination prior to pregnancy During the first trimester, with follow-up visits

14. Women who develop gestational diabetes  do not require an eye examination during pregnancy and do not appear to be at increased risk for diabetic retinopathy during pregnancy. Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 14

15. Physical Examination Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 15 Visual acuity Slit-lamp biomicroscopy Intraocular pressure (IOP) Gonioscopy before dilation, when indicated. Iris neovascularization is best recognized prior to dilation. When neovascularization of the iris is present or suspected, or if the IOP is elevated, undilated gonioscopy can be used to detect neovascularization in the anterior chamber angle. Pupillary assessment for optic nerve dysfunction funduscopy

16. Importance of Dilated Fundus exam Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 16 A dilated pupil is preferred to ensure optimal examination of the retina, because only 50% of eyes are correctly classified for the presence and severity of retinopathy through undilated pupils. Slit-lamp biomicroscopy is the recommended method to evaluate retinopathy in the posterior pole and midperipheral retina. Examination of the peripheral retina is best performed using indirect ophthalmoscopy or slit-lamp biomicroscopy .

17. Imagings Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 17 FA OCT OCTA WFI UWFI

18. FA Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 18

19. OCT Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 19

20. OCTA Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 20

21. Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 21

22. Type Of Diabetic Retinopathy Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 22 NPDR : Microaneurysms Retinal hemorrhages Hard exudates Macular edema Macular ischemia PDR: Neovascularization : NVD/NVE> Fibrovascular >Vitreous Hx> TRD Angle/Iris > NV glaucoma

23. NPDR Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 23

24. PDR Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 24

25. Grading Shortages! Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 25

26. Treatments Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 26 AntiVEGF + Laser therapy Surgery

27. Novel Treatments Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 27 Beta Blockers Steroid implants MTX Fenofibrate …….. Future: Combined Slow Release Implants

28. Exercise Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 28

29. Effects Related to Other Treatments Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 29 There have been case reports of idiosyncratic macular edema that is temporally associated with use of the glitazone class of oral antihyperglycemic agents.

30. Eye and Diabetes Novelties Source; AAO Guideline Joobin Khadamy. MD; Diabetes & Insuline conferece 30 Insulin Eye Drops Blood Sugar Contact Lenses Subconjunctival Glucose Sensors