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Diagnosis & Management of Diabetic Eye Disease

Learn about diabetic retinopathy progression, management strategies, and risk factors for vision loss. Understand the importance of controlling blood glucose, pressure, and lipids. Discover new international standards for staging diabetic retinopathy.

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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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