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Diagnosis & Management of Diabetic Eye Disease

Diagnosis & Management of Diabetic Eye Disease. Paul Chous, M.A., O.D., F.A.A.O. Specializing in Diabetes Eye Care & Education Part 3. Cataract. Hyperglycemia leads to sorbitol accumulation via aldose reductase (the polyol pathway) True diabetic “snowflake” cataracts

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Diagnosis & Management of Diabetic Eye Disease

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  1. Diagnosis & Management of Diabetic Eye Disease Paul Chous, M.A., O.D., F.A.A.O. Specializing in Diabetes Eye Care & Education Part 3

  2. Cataract • Hyperglycemia leads to sorbitol accumulation via aldose reductase (the polyol pathway) • True diabetic “snowflake” cataracts • Typical age-related cataracts develop prematurely due to AGE formation • Decreased elasticity of lens proteins causes premature presbyopia and, eventually, loss of tranparency

  3. Diabetic “Snowflake” Cortical Cataract

  4. Nuclear Sclerotic Cataract – 52 yo diabetic

  5. The Maillard Reaction Advanced Glycation Endproducts: AGEs – they’re what’s for dinner

  6. Cataract - Management • Improve & stabilize blood glucose • A1c < 6.5% (ideally) • Strive for a low standard deviation • Phacoemulsification when prudent or necessary • Much higher risk of post-operative CME and worsening retinopathy • Always address retinopathy prior to surgery

  7. Diabetic Keratopathy • Hyperglycemia & corneal sensory neuropathy weaken hemidesmosomal attachments between the basal epithelium and its basement membrane • PEK, Erosions, Neurotrophic Keratitis & Ulceration • Increased tear osmolarity and lacrimal autonomic neuropathy result in dry eye

  8. Photonic Colloidal Crystalline Array

  9. Prevalence of Dry Eye Syndrome and use of artificial tears is significantly higher amongst patients with diabetes and with a family Hx of diabetes Optometry. 2006 Nov;77(11):554-8 Am J Ophthalmol. 2005 Mar;139(3):498-503 Diabetic Keratopathy

  10. Diabetic Neurotrophic Ulcer

  11. Keratopathy - Management • Improve & stabilize blood glucose • Be careful with contact lenses & corneal refractive surgeries • Avoid vigorous eye rubbing • NP tears, plugs, immunomodulators, bandage SCLs, etc. as indicated • Beware infection

  12. Key Points • Diabetes and diabetic eye disease are epidemic • Ocular complications are myriad and associated with large blood vessel disease • State-of-the-art care is evolving rapidly

  13. “The only thing to do with good advice is to pass it on to others… It is of absolutely no use to oneself.” - Oscar Wilde

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