diabetes treatment
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This document discusses treatment options for diabetic eye disease. It affects most parts of the eye and can cause visual loss through maculopathy, vitreous haemorrhage, or tractional retinal detachment. Treatment involves prevention through surveillance, screening, education, and controlling blood sugar and pressure. Intervention includes laser treatment, intravitreal anti-VEGF drugs or steroids, and retinal surgery. Medical management focuses on improving control of blood sugar, treating hypertension, stopping smoking, and attending regular screenings to reduce risks of visual impairment and other complications.
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Diabetes care and collaboration
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Diabetic retinopathy
This document discusses diabetic retinopathy, which is a leading cause of blindness. It affects the microvasculature of the eye similarly to how diabetes damages other organs. Tight control of blood glucose levels can significantly reduce the risk of developing retinopathy or slow its progression. However, initially tightening glucose control can sometimes cause a transient worsening of existing retinopathy. The duration and severity of diabetes are also risk factors for retinopathy and vision loss. Regular eye exams are important for early detection and treatment.
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This document provides information on the dental management of diabetic patients. It begins by defining diabetes and describing the two main types. It then discusses the local and general complications associated with diabetes, as well as lab findings used for diagnosis. Regarding dental management, it states that for well-controlled diabetics, dental procedures can generally be performed normally. However, for poorly controlled diabetics or those with complications, elective procedures should be postponed. It provides guidelines for pre-operative, intra-operative, and post-operative care of diabetic dental patients to help prevent hypoglycemic reactions.
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Dental treatment of patients with epilepsy requires consideration of seizure triggers and medications. Appointments should be scheduled in the morning to avoid nocturnal seizures. Local anesthetics without vasoconstrictors are preferred and barbiturates and narcotics should be avoided due to seizure risk. In the event of a seizure in the dental office, protecting the patient from injury is the priority until the seizure stops.
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Most diabetes patients (71%) did not receive DR screening. Screening capacity was the major limitation, as screening all diabetes patients would use 99% of available visits. In-clinic eye support doubled screening rates from 22% to 48% and decreased screens done in the ophthalmology clinic from 96% to 45%. Barriers to screening included lack of continuity care, missed appointments, low referral rates, and mental health diagnoses other than depression. Comprehensive DR screening requires dramatically increasing capacity for screening and treatment, engaging more patients in regular diabetes care, developing tracking systems for missed appointments, and considering alternative screening methods.
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This document discusses the dental management of diabetic patients. It begins by defining diabetes and describing the two main types: type 1 resulting from a failure to produce insulin, and type 2 caused by insulin resistance. It then outlines the local and general complications of diabetes, including infections, periodontitis, and retinopathy. Regarding dental management, it stresses the importance of understanding a patient's diabetes status and treatment. For well-controlled diabetics, standard dental care is appropriate while poorly controlled or insulin-dependent patients require special precautions. It also provides guidance on preventing and treating hypoglycemic emergencies during dental visits.
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The document discusses dental management considerations for patients with diabetes. It notes that periodontal disease is more common in patients with poorly controlled diabetes. Other oral complications that may be associated with diabetes include xerostomia (dry mouth), fungal infections, oral burning sensations, and delayed wound healing. The dental provider should assess the severity and control of the patient's diabetes and educate them on oral health risks from their condition.
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The document discusses the role of pharmacists in caring for the elderly and their carers, outlining issues faced by the elderly like medical non-compliance and living conditions. It proposes that pharmacists can help address problems of the elderly through services like home visits, medication management, and education for patients and caregivers to improve health outcomes. The pharmacist's role includes designing treatment plans, providing drug information, and ensuring safe and effective use of medications as the elderly's needs change across care settings.
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- Optometrists perform over 100 million eye exams annually, giving them many opportunities to screen for diabetes that primary care doctors do not have. New technologies allow optometrists to diagnose diabetes even earlier.
- Early diagnosis and treatment of diabetic retinopathy can significantly reduce the risk of vision loss. Optometrists are well-positioned to monitor diabetic retinopathy and coordinate care with
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Diabetic retinopathy is a leading cause of blindness that can develop in people with diabetes. It occurs when high blood sugar levels damage the blood vessels in the retina. Early stages may be asymptomatic, but later stages can cause vision loss. Risk factors include duration of diabetes and poor blood sugar control. Annual dilated eye exams and tight blood sugar management can prevent or delay vision loss from diabetic retinopathy. Treatment options depend on the stage but may include laser surgery or injections to stabilize severe vision loss.
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Diabetic macular edema (DME) is a serious complication of diabetes that affects the eyes. It occurs when the blood vessels in the retina, the part of the eye that senses light and sends images to the brain, become damaged due to high blood sugar levels. This damage can cause fluid to leak into the macula, the central part of the retina responsible for sharp, detailed vision.DME can cause vision loss and can make it difficult to read, drive, or recognize faces. It is a common cause of vision loss in people with diabetes and can occur at any stage of the disease, although it is more common in people with advanced stages of diabetic retinopathy.Early detection and treatment are important in managing DME and preventing vision loss
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Diabetic retinopathy is a complication of diabetes that affects the small blood vessels in the retina. It is a leading cause of blindness in developed countries. As diabetes rates rise globally, diabetic retinopathy cases are projected to increase substantially. Early stages may be asymptomatic, but later stages can cause vision loss or blindness if not treated. Annual dilated eye exams are important for early detection and treatment to prevent vision loss from this progressive disease.
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Diabetic retinopathy is a complication of diabetes that affects the small blood vessels in the retina. It is a leading cause of blindness in developed countries. Strict control of blood sugar and blood pressure as well as annual eye exams are important for preventing vision loss from diabetic retinopathy. The disease progresses through stages from mild nonproliferative retinopathy to more severe proliferative retinopathy. Laser treatment and anti-VEGF drugs can help treat more advanced stages to prevent blindness.
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1) 415 million adults worldwide have diabetes, with over half of cases in low and middle income countries being undiagnosed. Type 2 diabetes accounts for 87-91% of cases and is influenced by lifestyle and environmental factors.
2) Vision loss has significant negative impacts on people's lives, including reduced access to healthcare, loss of income and independence, increased reliance on caregivers, and psychological impacts like depression.
3) Regular eye screenings are important for managing diabetic retinopathy. Screenings should occur every 1-2 years for those with diabetes and involve examinations for visual acuity and retinal abnormalities. Detected retinopathy can be graded and referred for treatment if needed.
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This document discusses diabetes mellitus, including its classification, epidemiology, factors, complications, management, and dental considerations. Diabetes is defined as a blood glucose level over 200 mg/dl or 126 mg/dl fasting and is classified into four main types: type 1, type 2, gestational diabetes, and impaired glucose tolerance. It affects approximately 135 million people worldwide and prevalence increases with age. Complications include both acute issues like hypoglycemia and chronic conditions affecting small blood vessels and tissues. Management involves lifestyle changes, medications, and possibly insulin therapy. Dentists must take precautions and monitor blood sugar levels during treatment for patients with diabetes.
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People with diabetes have an increased risk of eye complications from high blood glucose levels, including retinopathy, macular edema, and cataracts. These complications can lead to vision loss if left untreated, but regular eye exams and early treatment can prevent vision loss in 98% of cases. Early detection and treatment of complications is important to preserve vision, as treatment can usually prevent further deterioration even if vision loss has already occurred.
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Diabetic retinopathy is a complication of diabetes that affects the small blood vessels in the retina. It is the leading cause of blindness in working age adults. Strict control of blood sugar and blood pressure can help prevent and slow the progression of diabetic retinopathy. Annual eye exams are important for early detection and treatment if needed to prevent vision loss. As diabetic retinopathy progresses, it is classified into mild, moderate, and severe non-proliferative stages and proliferative stage. Treatments include laser therapy and anti-VEGF injections to prevent further vision loss.
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This document discusses diabetic retinopathy, including:
- DR is a major cause of blindness and is classified as non-proliferative or proliferative.
- Tight control of blood glucose, blood pressure, and lipids can slow progression of DR.
- Laser photocoagulation is effective for treating diabetic macular edema and proliferative DR. Focal laser is used for edema localized to the macula, while panretinal photocoagulation scatters wider burns throughout the retina to induce regression of new vessels.
- Imaging like OCT and fluorescein angiography help diagnose and monitor DR and guide treatment.
Diabetic Retinopathy
Diabetic retinopathy is a leading cause of blindness that is associated with both type 1 and type 2 diabetes. It results from glycation and damage to the retinal blood vessels over time. Early stages are asymptomatic, but can progress to cause vision loss through edema, hemorrhage, or the growth of abnormal new blood vessels. Risk increases with longer duration of diabetes. Management focuses on tight glycemic control through medication and lifestyle changes, as well as regular eye exams and treatments such as laser photocoagulation or anti-VEGF injections to prevent vision loss.
Diabetic Microvascular Complications
This document discusses diabetic microvascular complications including retinopathy, nephropathy, and neuropathy. It emphasizes the importance of screening and early detection through retinal evaluations, urine microalbumin tests, and neurological exams. Effective treatment includes intensive blood sugar and blood pressure control, as well as renin-angiotensin blockade for nephropathy and foot care education to prevent ulcers and amputation due to neuropathy. With proper screening and treatment, microvascular complications of diabetes can be significantly reduced.
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Optometrists play an important role in public health through patient care, observing broader health issues in their communities, educating patients and at-risk groups, specializing in relevant health areas, and identifying issues like high blood pressure, obesity, and smoking that can impact eye health. They are well-positioned to address public health problems across diverse populations and help prevent disease through education and referrals to other providers.
Diabetic eye disease
Over 112,000 people in Indiana have diabetic retinopathy, which is around 20% of diabetics in the state. About 60% of diabetics receive an annual eye exam, but each year between 12,000 to 24,000 new cases of blindness occur from diabetic retinopathy. Diabetic retinopathy is caused by changes in the blood vessels in the eye and can be detected and treated through annual dilated eye exams and procedures like laser surgery. Maintaining good control of blood sugar and receiving regular eye exams can help reduce the risk of vision loss from diabetic eye disease.
Uric acid and CKD (Consequences, Management and Evidence) - Dr. Gawad
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Management of diabetes in elderly
This document discusses the management of diabetes in elderly patients. It notes that diabetes prevalence is increasing globally and is especially prevalent in aging populations due to increased complexity, comorbidities, and risk of functional decline. Proper management of elderly diabetes requires individualized, holistic care plans focused on safety, risk minimization, and maintaining quality of life. Key aspects of care include education, nutrition, exercise, medication management, screening and prevention of complications, and management of comorbidities like cardiovascular disease.
year 2 poster diabetic eye screening
Diabetic eye screening is important for detecting diabetic retinopathy early. High blood sugar from poorly controlled diabetes can damage blood vessels in the retina over many years. Left undetected and untreated, diabetic retinopathy is a leading cause of blindness among working age adults. Regular screening can identify changes in vision early so they can be treated to prevent further vision loss or blindness. During screening, special eye drops are used to dilate the pupil so the retina can be examined for any signs of damage from diabetic retinopathy.
Diabetic retinopathy
This document discusses diabetic retinopathy, its causes, stages, treatments, and prevention. It is progressive retinal vessel dysfunction caused by long-term hyperglycemia. Key factors that contribute to its development include hypertension, hyperlipidemia, female sex, pregnancy, smoking, obesity, and poor metabolic control. Stages include non-proliferative and proliferative retinopathy. Treatments include anti-VEGF drugs, laser photocoagulation, vitrectomy, and strict control of blood sugar and blood pressure to prevent its progression.
NHHC chapter 20 ppt
This document provides an overview of diabetes mellitus, including types, symptoms, diagnosis criteria, and treatment. It states that diabetes affects over 11% of US adults and is a leading cause of death. There are two main types - type 1 caused by autoimmune destruction of beta cells requiring insulin, and type 2 involving insulin resistance and deficiency. Treatment involves lifestyle changes like diet, exercise and medication to control blood glucose and prevent complications affecting large blood vessels, nerves, eyes, and kidneys. The goal is lifelong management through education and monitoring blood glucose levels and HbA1c to reduce health risks.
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Superficial punctate keratitis by optometry fans site, definition of SPK, causes of superficial punctate keratitis, symptoms of superficial punctate keratitis, treatment of superficial punctate keratitis, management and treatment of SPK
Strutcture of eye
The document discusses the anatomy of the eyeball, including its dimensions, coats, segments, chambers, muscles, and muscle origins and insertions. It notes that the eyeball has three coats - fibrous, vascular, and nervous - which provide protection, nutrition, and nerve transmission. It also lists the six extraocular muscles - four recti and two oblique muscles - and provides the distances of origin and insertion from the limbus for four of the muscles.
Ocular injuries
The document discusses ocular injuries, their common causes, examination, and treatment. It covers various types of anterior segment trauma including corneal foreign bodies, abrasions, recurrent epithelial erosions, hyphema, traumatic uveitis, iris trauma, and lid and orbital injuries. Common causes are abrasion, foreign bodies, penetrating injuries, blunt trauma, and chemicals. Examination involves assessing visual acuity, lids, conjunctiva, cornea, anterior chamber, iris, lens, and intraocular pressure. Treatment depends on the type of injury but may include removal of foreign bodies, antibiotics, patching, lubricants, steroids, bed rest, and surgery to repair lacerations or reattach tissues.
Amblyopia (lazy eye)
Amblyopia, also known as lazy eye, is a vision development disorder where vision in one eye is reduced if not treated early in childhood. There are several types of amblyopia including strabismus, stimulus deprivation, anisometropic, isoametropic, and meridional amblyopia. Risk factors include premature birth, small size at birth, family history, and developmental disabilities. Treatment involves occlusion therapy to force use of the weaker eye, removing any opacity in the media, and correcting any refractive errors. If left untreated, amblyopia can cause permanent vision loss.
Red eye
This document provides guidance on evaluating and treating red eye. It lists important questions to ask patients about symptoms, duration, and medical history. Potential causes of red eye are grouped into categories like infection, inflammation, allergy and trauma. Based on characteristics like pain, vision changes, and whether the issue is unilateral or bilateral, the document provides differential diagnoses. It outlines examination steps and suggests considering referral for issues causing visual loss, pain, corneal involvement or no response to treatment, especially for immunocompromised patients.
Retinopathy of prematurity
This document provides an overview of Retinopathy of Prematurity (ROP), which is a vascular disorder of the retina that occurs primarily in preterm infants. ROP can potentially lead to permanent blindness if not treated properly. The document discusses who is at risk for ROP, including preterm infants born before 34 weeks gestation or weighing less than 2kg. It outlines recommended screening guidelines to detect ROP, including screening all high-risk infants by one month of age. Timely screening and treatment can prevent blindness in most cases of ROP.
Test eye structure
The document outlines the main structures of the eye including the lids and conjunctiva, cornea, iris, lens, retina, choroid, and sclera. It also lists the extraocular muscles that control eye movement including the lateral and medial rectus, superior and inferior rectus, and superior and inferior oblique muscles. Finally, it notes that the third cranial nerve activates the pupil, levator muscle, and some of the extraocular muscles.
Retina exam
This document discusses symptoms of retinal disease such as blurred vision, visual distortions, and flashes of light. It also outlines examination techniques for evaluating the retina, including using direct and indirect ophthalmoscopes, slit lamps with specialized lenses, retinal photos, ultrasound, and angiography to visualize the retina and assess diseases.
Ocular trauma
This document discusses the evaluation and management of various types of ocular trauma. It begins by outlining the learning objectives of identifying, evaluating and providing first aid to patients with eye injuries. It then covers the assessment of visual acuity and ocular examination. Various types of eyelid, orbital and globe injuries are described, along with their presentations and treatment approaches. Chemical injuries and their long term effects are also reviewed. Throughout, it emphasizes the importance of immediate evaluation and management to prevent further vision loss and proper use of personal protective equipment to prevent ocular injuries.
Leucocorias
This document discusses pediatric cataract and leucocoria (white pupil). It defines leucocoria as a white reflection seen in the pupil that could indicate an underlying condition like cataract, retinoblastoma, or persistent hyperplastic primary vitreous. The document outlines the causes, presentations, classifications, management, and visual prognosis of pediatric cataracts. It emphasizes the importance of early referral for any detected leucocoria to rule out retinoblastoma or other serious conditions and prevent amblyopia. Overall management of pediatric cataracts aims to restore vision through early surgery and amblyopia treatment for the best possible visual outcomes.
GLAUCOMA
Glaucoma can be open angle or closed angle. Open angle glaucoma includes ocular hypertension, glaucoma suspect, primary open angle, exfoliative, pigmentary, normal/low tension, and congenital/juvenile types. It is assessed using visual field testing, intraocular pressure measurement, gonioscopy, optic disc examination, and imaging like OCT. Treatment involves eye drops like prostaglandin analogs, beta blockers, and surgeries like trabeculectomy. Monitoring intervals depend on whether pressure and disease are controlled. Primary angle closure glaucoma is less common but riskier, requiring treatment like laser iridotomy.
Eye structure and function
The document outlines the basic structures and functions of the human eye. It describes the main eye structures including the lids, cornea, iris, lens, retina, choroid, and sclera. It also details the extraocular muscles that control eye movement and their corresponding cranial nerves, as well as layers of the retina such as the pigment epithelium, rods and cones, nerve fiber layer, and optic nerve. Protection of the eyes is provided by surrounding structures like the orbit, lids, sclera, cornea, and tears.
EXAMINATION OF ANTERIOR SEGMENT OF EYE
The document outlines the steps for examining the anterior segment of the eye, including taking a patient history, performing a systematic examination from front to back using magnification, light, and diagnostic drops. Key areas examined are the lids, lacrimal system, orbit, eye movements, pupil reactions, conjunctiva, cornea, anterior chamber, iris, lens, and anterior vitreous, along with refraction and tests for intraocular pressure and visual fields. Photos show examples of pathological findings that may be observed, such as giant papillae on the eyelid and corneal staining.
COMPLICATION OF CATARACT SURGERY
This document summarizes potential complications from cataract surgery, grouped into those occurring at surgery, within a week, and longer term. Complications at surgery include posterior capsule rupture, dropped nucleus, and small pupil. Within a week, potential issues are infection, high eye pressure, corneal swelling, and inflammation. Longer term risks include cystoid macular edema, retinal detachment, and unexpected conditions found on postoperative exam. The document provides examples and treatment approaches for several common complications.
ANATOMY OF CORNEA
The cornea has several layers:
1. The epithelium is the outermost layer consisting of 5-6 layers of stratified squamous cells that renew from stem cells located around the periphery.
2. The stroma makes up 90% of the cornea and contains collagen fibrils for strength and elasticity.
3. Descemet's membrane is the basement membrane of the endothelium and contains collagen and glycoprotein that can regenerate. It shows Henle fibers on its posterior surface.
4. The endothelium is the innermost single cell layer that decreases in cell density with age. Gap junctions allow for fluid regulation to maintain corneal clarity.
anatomy of eyeball
The eyeball has three concentric layers and is approximately 21-26mm in diameter. It is connected to the brain by the optic nerve and protected by the bony orbit and eyelids. The cornea is transparent and located at the center of the eyeball's anterior surface, comprising 5 layers and measuring approximately 12mm by 11mm. The sclera covers the posterior four-fifths of the eyeball and provides attachment points for the extraocular muscles. Six extraocular muscles control eye movement, with the four recti muscles originating from a common tendinous ring and inserting into the sclera, while the two oblique muscles originate from bones in the orbit.
ENUCLEATION WITH CSR
The document describes the procedures for enucleation and corneo-scleral rim excision. Enucleation involves removing the entire eye globe while preserving surrounding structures, usually due to a painful blind eye, staphyloma, or malignancy. The procedure involves aseptic preparation, peritomy, identification and cutting of extraocular muscles and optic nerve, and orbital packing. Corneo-scleral rim excision is done to harvest the cornea and scleral rim for transplantation. It involves peritomy, scleral incision 4mm from the limbus, separating the corneo-scleral rim from underlying uveal tissue, and storing in preservation medium. Both require consent
Strabismus and squint
This document discusses strabismus and squint, including the anatomy of the extraocular muscles, ocular motility, binocular vision, heterophoria, manifest squint, evaluation of strabismus cases, and treatment options. It describes the extraocular muscles, types of eye movements, binocular single vision and anomalies. It also defines and classifies heterophoria and manifest squint, discusses their etiology, symptoms, examination and treatment. Evaluation of strabismus cases and different surgical techniques are also outlined.
Strabismus and squint
This document discusses strabismus and squint, including the anatomy of the extraocular muscles, ocular motility, binocular vision, heterophoria, manifest squint, evaluation and treatment of strabismus. It describes the extraocular muscles, their nerve supply and actions. It defines uniocular and binocular eye movements. It discusses binocular single vision, fusion, stereopsis and anomalies. It defines and classifies heterophoria and manifest squint. Evaluation techniques like cover tests and estimation of angle of deviation are outlined. Causes, symptoms and treatment of heterophoria and manifest squint are described. Surgical techniques for strabismus are also summarized.
Corneal ulcer
This document summarizes information about corneal ulcers. It discusses the anatomy of the cornea and common causes of corneal infections like bacteria, viruses, fungi and parasites. Corneal ulcers occur when there is damage to the corneal epithelium allowing infection to set in. Symptoms include pain, watering, photophobia and blurred vision. Signs include swelling, hypopyon in the anterior chamber. Management involves identifying the causative organism, using topical antibiotics and cycloplegics for uncomplicated cases. More severe cases may require debridement, bandage contact lenses or keratoplasty. Complications can include glaucoma, perforation and scarring.
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diabetes treatment
- 1. Treatment options for Diabetic Eye Disease Michael Eckstein Pune 2019
- 2. Complications affect most parts of the eye •Cornea •Lens •Optic Nerve •Cranial nerves •Secondary effects- e.g. rubeotic glaucoma
- 4. Why does it cause visual loss and how does it present? •Maculopathy •Vitreous haemorrhage •Tractional retinal detachment •Other- cataract, glaucoma
- 5. Management of diabetic retinopathy PREVENTION •Surveillance / screening / education •Medical management- diet, sugar and BP control INTERVENTION •Laser •Intravitreal Anti VEGF drugs / steroids •Retinal Surgery
- 6. Medical management • Improve control of blood sugar • treat hypertension • treat obesity, dietary advice • stop smoking • Extra vigilance during pregnancy • attend screening
- 7. Health Education, Diet and Control •improved blood glucose / blood pressure control •reduced risk of diabetic eye disease by 1/4 •reduced risk of severe visual impairment by more than 1/2 •kidney damage by 1/3 •stroke by 1/3
- 8. Treatment options •Monitor with dilated eye exam and check vision •Capture fundal image and use telemedicine •Know when to refer and what patient should expect •Options once referred •Laser •Anti VEGF agents •Surgery •Control of secondary problems e.g. glaucoma
- 9. Treatment options • Monitor / screen with dilated eye exam and check vision
- 10. Treatment options • Capture fundal image and use telemedicine
- 11. Focal laser
- 12. Panretinal laser
- 13. Intravitreal anti-VEGF and steroids for maculopathy
- 14. Surgery
- 16. When to refer? •Do you have any mechanism for telemedicine? •Sudden onset reduced vision- look for red reflex- if none then refer within weeks. If good red reflex consider other causes and refer as soon as possible •Gradual progressive reduced vision not corrected with glasses/pinhole - refer within months
- 17. Summary •Have I educated the patient and relatives? •Have I checked the vision? •Have I explained they need to have the eyes checked every year? •If I find something wrong what are my options? •Once they have had treatment don’t forget to follow them up