Moderate Nonproliferative Diabetic Retinopathy Dot Hemorrhages Blot Hemorrhages Hard Exudates
Severe Nonproliferative Diabetic Retinopathy
Intra Retinal Microvascular Abnormalities (IRMA)
Cotton wool spots- focal retinal ischemia
Beading and looping of the capillaries
Severe Nonproliferative Diabetic Retinopathy- Early Blot Hemorrhages Cotton Wool Spot Flame Hemorrhages
Severe Nonproliferative Diabetic Retinopathy- “pre-proliferative” Blot Hemorrhages Exudates Venous Beading IRMAs Looping capillaries
Proliferative Diabetic Retinopathy:
Neovascularization- New blood vessel growth
NVI - Rubeosis Iridis
NVD- optic disk
NVE- elsewhere in the retina
Proliferative Diabetic Retinopathy: NVI – neovascularization of the iris
NVE – neovascularization elsewhere
NVD – neovascularization of the disk
Serious Diabetic Retinopathy
If “neo” goes unnoticed and untreated, it will ultimately bleed .
Bleeding means Blindness!
New Diagnostic Modalities
Ocular Coherence Tomography –OCT is revolutionizing eye care in many instances it can be used in place of IVFA
OCT is less invasive
Allows for earlier and more sensitive diagnosis
Takes less time
Demonstrates greater anatomical details
Diabetic Retinopathy OCT
How is neovascularization treated?
Focal laser treatment is used to ablate neo before bleeding occurs.
If bleeding has occurred, lasers can be used to attempt to stop the bleeding and minimize loss of vision.
Laser surgery does not usually improve vision, it tries to stop vision from worsening.
Laser treatment strategies
Pan retinal laser
Laser treatment is used to destroy peripheral retina and decrease the chance of neo by decreasing the need for blood supply.
New Treament Options for PDR
Oral Angiogenic agents are being developed to be used in conjunction with laser treatment
There are two categories of oral angiogenic treatment-one is for the prevention of PDR and the other for early PDR-PKC inhibition
Currently on the market-Arxxant (Eli-Lilly)-a protein kinase C beta(PKC beta) inhibitor
Other surgical treatment
Non-clearing vitreal bleeds may need to be removed.
Diabetic Macular Edema
Can occur at any stage of diabetic retinopathy
Is caused by the leakage of microaneurysms
Is the main cause of visual impairment in patients with Diabetic retinopathy
Classification of Diabetic Macular Edema
Presents as hard yellow exudates (HYE) or thickening in the posterior pole
Mild-some thickening or HYE in the posterior pole but distant from the center
Moderate-approaching the center, but not involving the center
Severe-Involving the center of the macula
Diabetic Macular Edema Hard Exudates and Macular Edema (CSME) Intraocular steroid injections attempt to reduce edema
Treatment Options for Macular Edema
Steroid Implants and devices to the posterior segment
New Treatment options for Macular edema
Intravitreal injection of triamcinolone acetonide-for diffuse diabetic macular edema
Fluocinolone acetonide intravitreal implants
Vision Loss from Diabetic Retinopathy Normal or Mild Diabetic Retinopathy Severe Diabetic Retinopathy
Additional effects on the eyes
In addition to the damaging effects of diabetes on the retina, diabetic eye disease also increases the risk for developing:
NVI can lead to elevated intraocular pressure
How is Diabetic Eye Disease avoided?
Eye Care About My ABCs
Hg A 1c, B lood pressure, C holesterol
Annual dilated eye exams!
Diabetics with excellent control of blood sugar.
Diabetics who have fluctuating blood sugar or who have shown signs of diabetic retinopathy may require more frequent exams.
How to find an Optometrist
Medicare beneficiaries can receive assistance:
“ Diabetes Hotline” 800-826-3947
Eye Care Community Outreach (ECCO)
Helping Hoosiers find and afford eye care.
Indiana Optometric Association
American Optometric Association
www.aoa.org “Doctor Locator”
Thanks and Credits
American Optometric Association - www.aoa.org
Vision Service Plan (VSP) – www.vsp.com
Eye Care Community Outreach (ECCO)—
Kelli Barker, MSW and Dewana Allen, MPH
Helping Hoosiers find and afford eye care.
Vic Malinovsky, OD, FAAO - photography
Chief of Ophthalmic Disease Services at Indiana University School of Optometry
Edwin C. Marshall, OD, MS, MPH- design
Indiana University - Associate Dean for Academic Affairs and Student Administration, Professor of Optometry, and Adjunct Professor of Public Health, School of Medicine
Jack Downey, OD- Consultant
Indianapolis Eye Care Center
Andrew Anderson, OD- design
Gabriele Eye Institute- (574)-254-0700
American Diabetes Association - www.diabetes.org
Center for Disease Control – www.cdc.gov
Diabetes “Sight for Life” - funded by the AOA and Roche Diagnostics
Derek Y. Kunimoto MD, Kunal D. Kanitar MD, Mary S. Makar MD. Editors. Mark A. Friedberg MD, Christopher J. Rapuano MD. Founding Editors: “The Wills Eye Manual.” 4 th ed. Lippincott Williams and Wilkins 2004.
Indiana State Department of Health Diabetes Prevention and Control Program.
Kaiser MD, Peter, K., Neil J. Friedman MD, Roberto Pineda II MD. “The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology.” 2 nd ed. Saunders 2004.
National Eye Institute - www.nei.nih.gov /health/diabetic
New Hampshire “Sight for Life”
QUIZ #1 True or False
People with diabetes are more likely than people without diabetes to develop certain eye diseases.
True. Diabetic eye disease includes diabetic retinopathy—a leading cause of blindness in adults—cataract, and glaucoma. The longer someone has diabetes, the more likely he or she will develop diabetic eye disease.
#2 True or False
Diabetic eye disease usually has early warning signs.
False. Often there are none in the early stages of the disease. Vision may not change until the disease becomes severe.
#3 True or False
People with diabetes should have yearly eye examinations.
True . Everyone with diabetes should get an eye examination through dilated pupils at least once a year. Because diabetic eye disease usually has no symptoms, regular eye exams are important for early detection and timely treatment.
#4 True or False
Diabetic retinopathy is caused by changes in the blood vessels in the eye.
True . In some people, blood vessels in the retina may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina.
#5 True or False
People with diabetes are at low risk for developing glaucoma.
False. Glaucoma is almost twice as likely to occur in people with diabetes than in those without the disease. Glaucoma can usually be treated with medications or laser or other surgery.
#6 True or False
Laser surgery can be used to halt the progression of diabetic retinopathy.
True. In laser surgery, a special beam of light is used to shrink the abnormal blood vessels or seal leaking blood vessels. Laser surgery has been proved to reduce the five-year risk of vision loss from advanced diabetic retinopathy by more than 90 percent.
#7 True or False
People with diabetes should have regular eye examinations through dilated pupils.
True. An eye examination through dilated pupils is the best way to detect diabetic eye disease, in which drops are used to enlarge the pupils. This allows the eye care professional to see more of the inside of the eye to check for signs of the disease.
#8 True or False
Cataracts are common among people with diabetes.
True. People with diabetes are twice as likely to develop cataracts and to develop them at an earlier age than are those without diabetes. Cataracts can usually be treated with surgery.
#9 True or False
People who have good control of their diabetes are not at high risk for diabetic eye disease.
False. Even with good control of blood glucose, there is still a risk of developing diabetic eye disease. However, studies show that careful management of blood sugar levels slows the onset and progression of diabetic retinopathy.
#10-- True or False
The risk of blindness from diabetic eye disease can be reduced.
True. With early detection and timely treatment, the risk of blindness from diabetic eye disease can be reduced.