1 / 12

Diagnosis & Management of Diabetic Eye Disease Part 1

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

vburney
Télécharger la présentation

Diagnosis & Management of Diabetic Eye Disease Part 1

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

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

  2. Dr. Paul Chous received his undergraduate education at Brown University and the University of California at Irvine, where he was elected to Phi Beta Kappa in 1985. He received his Masters Degree in 1986 and his Doctorate of Optometry in 1991, both with highest honors from the University of California at Berkeley. Dr. Chous was selected as the Outstanding Graduating Optometrist in 1991. He has practiced in Renton, Kent, Auburn and Tacoma, Washington for the last 15 years, emphasizing diabetic eye disease and diabetes education. Dr. Chous has been a Type 1 diabetic since 1968. Dr. Chous serves as a consultant to dLife - Your Diabetes Life, Children With Diabetes, the Diabetes Exercise & Sports Association, and the American Diabetes Association, which honored him with its Distinguished Public Service Award in 1998. He is an Adjunct Faculty member at NOVA Southeastern University in Ft. Lauderdale, Florida. Dr. Chous has given numerous invited talks about diabetes and the eye to both patients and other health care professionals, a process which led him to write a unique and extremely important book aimed at diabetic patients, their families and friends: Diabetic Eye Disease: Lessons From A Diabetic Eye Doctor - How To Avoid Blindness and Get Great Eye Care.

  3. The Problem of Diabetes &Diabetic Eye Disease The Problem • Another American is Dx with DM every 24 seconds • 1.3 million new cases every year • Another American dies from a complication of diabetes every 2 minutes • More than 250,000 deaths each year

  4. Diabetic Eye Disease • Another American becomes legally blind from diabetic retinopathy every 30 minutes • No independent tracking of irreparable vision loss from other eye diseases commonly associated with diabetes (retinal vascular occlusion, AION, glaucoma) • Realistic accounting might increase the toll from 12-24 thousand to 30,000+ cases peryear

  5. The Pathobiology of Diabetic Eye Disease Biochemical & Hemodynamic Influences

  6. Biochemical Influences • In small vessels: • Hyperglycemia causes mitochondrial over-production of reactive oxygen species (ROS) • This drives four major biochemical pathways that cause microvascular disease: • Polyol • Hexosamine Flux • Advanced Glycation Endproducts • Protein Kinase C

  7. Each of these 4 pathways depends upon over-production of reactive oxygen species (Superoxide) by mitochondria Intracellular Glucose & FFAs mitochondria ATP + hSuperoxide (O2-) Mitochondrian

  8. Glucose Metabolism ROS Glucose Polyol Pathway Glucose-6-phosphate Fructose-6-phosphate Hexosamine Flux Glyceraldehyde-3-phosphate Protein Kinase C Advanced Glycation Endproducts GAPDH 1,3 Diphosphoglycerate (harmless metabolite)

  9. Small Vessel Biochemistry • Polyol Pathway Increased intracellular sorbitol leads to: Diabetic Peripheral Neuropathy, Diabetic Nephropathy, Diabetic Retinopathy, Keratopathy & Cataract

  10. small vessel biochemistry • Hexosamine Pathway Increased levels of inflammatory cytokines lead to: Diabetic Nephropathy

  11. small vessel biochemistry • AGE Pathway Non-enzymatic glycation of proteins results in advanced glycation endproducts (AGEs) AGEs are a “biological cement” causing altered protein function and increased oxidative stress Retinopathy, Nephropathy, Neuropathy, Alzheimer’s, ED, Pulmonary Fibrosis…..

  12. small vessel biochemistry • Protein Kinase C Pathway Increased Protein Kinase C (PKC) activates Vascular Endothelial Growth Factor (VEGF) leading to: Diabetic Macular Edema, Proliferative Retinopathy, Diabetic Kidney Disease

More Related