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Diagnosis & Management of Diabetic Eye Disease

Diagnosis & Management of Diabetic Eye Disease. Part 5. A. Paul Chous, M.A., O.D., F.A.A.O. Tacoma, WA Specializing in Diabetes Eye Care & Education. Diabetic Retinopathy. Chronic hyperglycemia unleashes a progressive cascade of events Endothelial pericyte loss RGC death

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Diagnosis & Management of Diabetic Eye Disease

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  1. Diagnosis & Management of Diabetic Eye Disease Part 5 A. Paul Chous, M.A., O.D., F.A.A.O. Tacoma, WA Specializing in Diabetes Eye Care & Education

  2. Diabetic Retinopathy • Chronic hyperglycemia unleashes a progressive cascade of events • Endothelial pericyte loss • RGC death • Increased vascular permeability • Capillary closure • Release of vasoproliferative factors • Neovascularization, fibrovascular vitreo-retinal adhesions, vitreous hemorrhage

  3. Diabetic Retinopathy • Hypertension and increased retinal blood flow accelerate DR • Dyslipidemia aggravates diabetic macular edema • Most (60%) of patients have some DR after ten years • Electrophysiologic abnormalities are present within the first year (mfERG)

  4. Retinopathy - Management • Improve blood glucose, blood pressure & blood lipids • HbA1c < 6.5% • BP < 130/80 (ideally, < 120/75) • LDL-C < 100 & TGs < 150 • Limit glycemic variability • Mean Blood Gluose > 2 X Standard Deviation • Photocoagulation for PDR, CSME or severe NPDR in T2DM

  5. In the DCCT, “Intensive” Blood Glucose Control (less glycemic fluctuation) Decreased the Risk of Developing DR by 60% compared with “Conventional” Control (more fluctuation) For Patients Having IDENTICAL HbA1c

  6. Staging of Diabetic Retinopathy • New proposed international standard No Apparent DR no retinal findings Mild NPDR microaneurysms only Moderate NPDR > ‘mild’ but < ‘severe’ Severe NPDR > 20 hemorrhages in 4 quads or definite vein beading in 2+ quads or IRMA in 1+ quads (4-2-1 rule) PDR definite NVD or NVE and/or VH/PRH Ophthalmology, 2003 Sept: 110(9): 1677-82

  7. DR - Pearls • For HbA1c values between 5% and 8%, each 10% reduction (e.g. from 8% to 7.2%) lowers the risk of DR progression by 43% • In the UKPDS, a 10/5 mm drop in BP cut the risk of severe vision loss in half • Patients with two or more findings of Severe NPDR have a 45% chance of PDR within 1 year • ‘High Risk’ PDR if NVD > ½ DD, or NVD/NVE with VH/PRH • Untreated, 50% of patients with PDR are blind within 5 years

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