Preventing Vision Loss in Diabetic Retinopathy

5,121 views
4,614 views

Published on

A short presentation outlining key strategies for preventing vision loss in diabetes

Published in: Health & Medicine
1 Comment
1 Like
Statistics
Notes
No Downloads
Views
Total views
5,121
On SlideShare
0
From Embeds
0
Number of Embeds
1,014
Actions
Shares
0
Downloads
313
Comments
1
Likes
1
Embeds 0
No embeds

No notes for slide
  • Preventing Vision Loss in Diabetic Retinopathy

    1. 1. Preventing Vision Loss in Diabetic Retinopathy Rick Trevino, OD VA Outpatient Clinic Evansville, Indiana
    2. 2. Diabetic Retinopathy <ul><li>Background Retinopathy </li></ul><ul><ul><li>Microaneurysms </li></ul></ul><ul><ul><li>Hemorrhages </li></ul></ul><ul><ul><li>Lipid Exudates </li></ul></ul><ul><ul><li>Cotton Wool Spots (infarcts) </li></ul></ul><ul><li>Preproliferative Retinopathy </li></ul><ul><ul><li>Multiple Cotton Wool Spots </li></ul></ul><ul><ul><li>Numerous Hemorrhages </li></ul></ul><ul><ul><li>Venous Dilation and Beading </li></ul></ul><ul><ul><li>IRMA </li></ul></ul><ul><li>Proliferative Retinopathy </li></ul><ul><ul><li>Neovascularization (New vessel formation) </li></ul></ul><ul><ul><li>Vitreous Hemorrhage </li></ul></ul><ul><li>Diabetic Macular Edema </li></ul>
    3. 3. Background Retinopathy
    4. 4. Background Retinopathy
    5. 5. Background Retinopathy
    6. 6. Preproliferative Retinopathy
    7. 7. Preproliferative Retinopathy
    8. 8. Proliferative Retinopathy
    9. 9. Proliferative Retinopathy
    10. 10. Diabetic Macular Edema
    11. 11. Diabetic Macular Edema
    12. 12. Diabetic Macular Edema
    13. 13. Diabetic Macular Edema
    14. 14. Preventing Vision Loss <ul><li>Primary Prevention </li></ul><ul><ul><li>Physical Activity </li></ul></ul><ul><ul><li>Weight Reduction </li></ul></ul><ul><li>Secondary Prevention </li></ul><ul><ul><li>Glycemic Control </li></ul></ul><ul><ul><li>BP Control </li></ul></ul><ul><li>Tertiary Prevention </li></ul><ul><ul><li>Laser Therapy </li></ul></ul><ul><ul><li>Angiogenesis Inhibitors </li></ul></ul>
    15. 15. Tertiary Prevention <ul><li>Laser Therapy </li></ul><ul><ul><li>DRS: PRP </li></ul></ul><ul><ul><li>ETDRS: CSME </li></ul></ul><ul><li>Angiogenesis inhibitors (Avastin) </li></ul><ul><li>Drawbacks </li></ul><ul><ul><li>Access to Care </li></ul></ul><ul><ul><li>Late Disease Stage </li></ul></ul><ul><ul><li>Side Effects </li></ul></ul>
    16. 16. Role of Glycemic Control <ul><li>GLYCEMIC CONTROL IS THE SINGLE MOST EFFECTIVE MEDICAL TREATMENT FOR DIABETIC RETINOPATHY </li></ul>
    17. 17. Role of Glycemic Control <ul><li>DCCT (1993) </li></ul><ul><li>1441 subjects with IDDM followed for 6.5yrs </li></ul><ul><li>Randomized into strict and conventional tx </li></ul><ul><li>Strict control group had average HbA1c 7.2% </li></ul><ul><ul><li>Conventional: 8.8% </li></ul></ul><ul><li>Strict control resulted in… </li></ul><ul><ul><li>Reduced risk of retinopathy by 76% </li></ul></ul><ul><ul><li>Reduced risk of progression by 54% </li></ul></ul>
    18. 18. Role of Glycemic Control <ul><li>DCCT (1993) </li></ul><ul><li>There is a continuous nonlinear relationship between risk of retinopathy and mean level of HbA1c </li></ul>
    19. 19. Role of Glycemic Control <ul><li>Conclusions of the DCCT (1993) </li></ul><ul><li>Total lifetime exposure to glycemia was the principal determinant of the risk of retinopathy </li></ul><ul><ul><li>Earlier intervention decreases risk </li></ul></ul><ul><li>There is no level of glycemic control below which a reduction in risk does not occur </li></ul><ul><ul><li>Improved control always reduced risk of retinopathy </li></ul></ul>
    20. 20. Role of Blood Pressure <ul><li>Hypertension is an independent risk factor for DR and its progression </li></ul><ul><ul><li>Use of anti-hypertensive medications may decrease risk independent of lowering blood pressure </li></ul></ul>
    21. 21. Role of Blood Pressure <ul><li>UKPDS (1998) </li></ul><ul><li>1148 hypertensive type-2 diabetics randomized into tight and less-tight BP control and followed for 8.4 yrs </li></ul><ul><li>Average BP: </li></ul><ul><ul><li>Tight: 144/82 </li></ul></ul><ul><ul><li>Less tight: 154/87 </li></ul></ul><ul><li>Tighter BP control resulted in… </li></ul><ul><ul><li>34% reduction in progression of DR </li></ul></ul><ul><ul><li>47% reduced risk of loss of 3 lines VA </li></ul></ul>
    22. 22. Role of Cholesterol <ul><li>WESDR (1991): Higher serum cholesterol increased risk of hard exudates in type-1 DM </li></ul><ul><li>ETDRS (1996): Higher serum lipids increased risk of hard exudates and loss of VA </li></ul><ul><li>Elevated lipids may increase the morbidity of diabetic macular edema </li></ul>
    23. 23. Preventing Vision Loss <ul><li>Primary Prevention </li></ul><ul><ul><li>Physical Activity </li></ul></ul><ul><ul><li>Weight Reduction </li></ul></ul><ul><li>Secondary Prevention </li></ul><ul><ul><li>Glycemic Control </li></ul></ul><ul><ul><li>BP Control </li></ul></ul><ul><li>Tertiary Prevention </li></ul><ul><ul><li>Laser Therapy </li></ul></ul><ul><ul><li>Angiogenesis Inhibitors </li></ul></ul>
    24. 24. Thank You!

    ×