This document discusses diabetic ophthalmopathy, a common sight-threatening complication of diabetes. It begins by stating that diabetes affects about 3% of the global population. Next, it describes the various extra-retinal effects diabetes can have on the eye, including cataracts, glaucoma, retinal vascular diseases, and infections. A major section then focuses on diabetic retinopathy, including its pathogenesis, risk factors, various stages from non-proliferative to proliferative, and management through careful monitoring, laser treatment, and in advanced cases, vitreo-retinal surgery. The document aims to outline the ocular effects of diabetes and treatment approaches for associated conditions like diabetic retinopathy.

1. YOUSAF ALIYOUSAF ALI
LECTURER(DOCTOR OF OPTOMETRY)LECTURER(DOCTOR OF OPTOMETRY)

2. Objectives of presentationObjectives of presentation
 Diabetes is one of the global health challenges,Diabetes is one of the global health challenges,
affecting about 3 % population of the world.affecting about 3 % population of the world.
 Diabetic ophthalmopathy – a common, sight-Diabetic ophthalmopathy – a common, sight-
threatening complication of diabetes.threatening complication of diabetes.

3. DIABETES MELLITUS:
TYPE 1 (IDDM) ------- Insulin dependent diabetes
mellitus
TYPE 2 (NIDDM) ---- Non Insulin dependent
diabetes mellitus

4. SYSTEMIC EFFECTS OF DIABETES
STROKE
CORONARY ARTERY DISEASE
NEPHROPATHY
PERIPHERAL VASCULAR DISEASE
PERIPHERAL NEUROPATHY
DIABETIC OPHTHALMOPATHYDIABETIC OPHTHALMOPATHY

5. EXTRA RETINAL EFFECTS
OF
DIABETES ON EYE
Lids
Styes
Chalazion
Xanthelasmas

6. Lens
Cataract
EXTRA RETINAL EFFECTS OF
DIABETES ON EYE

7. Cornea
Keratitis
Recurrent corneal erosion
Persistent epithelial defects
EXTRA RETINAL EFFECTS OF
DIABETES ON EYE

8. Refractive Error
Osmotic swelling of lens causes myopic shift.
EXTRA RETINAL EFFECTS OF
DIABETES ON EYE

9. Glaucoma
Angle closure glaucoma
Neovascular glaucoma
Blood associated glaucoma
EXTRA RETINAL EFFECTS OF
DIABETES ON EYE

10. Vitreous
humor
Asteroid hyalosis
EXTRA RETINAL EFFECTS OF
DIABETES ON EYE

11. Occlusive retinal vascular
diseases
CRAO
CRVO
BRAO
BRVO
EXTRA RETINAL EFFECTS OF
DIABETES ON EYE

12. CRVO

13. BRVO

14. BRAO

15. CRAO

16. OPTIC NERVE
Acute disc oedema
Mild acute AION
Optic nerve hypoplasia
Optic atrophy
EXTRA RETINAL EFFECTS OF
DIABETES ON EYE

17. Cranial nerve palsies
Focal small vessel occlusion & ischaemic demyelination----
cause
Occulomotor
Trochlear
&
Abducent nerves palsies.
EXTRA RETINAL EFFECTS OF
DIABETES ON EYE

18. 3RD
NERVE PALSY

19. Infectious diseases
 ENDOPHTHALMITIS
 MUCORMYCOSIS
cause internal and external ophthalmoplegia, Proptosis, ptosis.
 HERPES ZOSTER INFECTION
may affect the trigeminal nerve. Cause Uveities and keratits.
EXTRA RETINAL EFFECTS OF
DIABETES ON EYE

20. DiabeticDiabetic
RetinopathyRetinopathy

21. TYPES OF DIABETES MELLITUS
AND
OCULAR INVOLVEMENT
Diabetic Retinopathy
Type 1 Diabetics 40%
Type 2 Diabetics 20%

22. Diabetic Retinopathy
EPIDEMIOLOGY
 Prevalence increases with duration of diabetes & age.
 After 20 years of diabetes, 99% pts with IDDM &
60% with NIDDM—have some degree of retinopathy.
 70-80 million people affected worldwide.
 5-8% population of Pakistan is affected.
 5-10% of all diabetics have sight-threatening retinopathy.

23. CLINICAL CLASSIFICATION OF DR
Disease Severity Scale
• No Retinopathy
• NPDR
Mild
Moderate
Severe
• PDR
• ADED
• EDED
AMERICAN ACADEMY OF OPHTHALMOLOGY

24. RISK FACTORS
 Onset / Duration of Diabetes:
DM before 30yrs of age —---- incidence 50%
DM after 10yrs ----- incidence 90%
 Type of Diabetes ( IDDM --- 40%, NIDDM-----20%)
 Age -----higher risk of PDR in younger diabetics.
 Sex ------Men with IDDM have ↑ risk of developing PDR.

25.  Diabetic Control
 Nephropathy
 Hypertension
 Hyperlipidemias
 Cigarette smoking
 Pregnancy
RISK FACTORS
CONT’D

26. DIABETIC MICROANGIOPATHY
High Blood Sugar
COMPLICATIONS:
• Ocular / Retinal
• Renal
• Neuropathic
• Peripheral Vascular
Capillary Leakage Capillary Closure
Structural damage &
Functional failure

27. Pathogenesis of diabetic retinopathy

28. Consequences of retinal ischaemia

29. Consequences of chronic leakage

30. BGDR
CLINICAL FEATURES
Micro-aneurysm
Intra retinal haemorrhages
Hard exudates
Retinal oedema
Micro-aneurysm
Intra retinal haemorrhages Hard exudates Retinal oedema

31. MANAGEMENT (BGDR)
 Proper diabetic control
 Proper management of hypertension, anaemia
and renal disease.
 Observations for
 Maculopathy
 Ischaemia
 New vessels

32. DIABETIC MACULOPATHY
“Involvement of fovea by oedema & hard exudates
or Ischaemia.”

33. MACULOPATHY
Focal
Diffuse
Ischaemic
Mixed

34. Focal diabetic maculopathy

35. Diffuse diabetic maculopathy

36. Ischemic diabetic maculopathy

37. Mixed Maculopathy

38. PRE-PROFLIFERATIVE DR
CLINICAL FEATURES
Large blot haemorrhages
Venous changes--- dilatation, beading, looping
IRMA
Capillary non-perfusion
MANAGEMENT
Close observation
Laser on progression

39. Preproliferative diabetic retinopathy

40. PROLIFERATIVE DR
NVD
NVE
Vitreous/Pre-retinal hemorrhage

41. Proliferative diabetic retinopathy
Neovascularization of disc = NVD
• Affects 5-10% of diabetics
• IDDM at increased risk (60% after 20 years)
Neovascularization elsewhere = NVE

42. NVD NVD + NVE

43. LASER TREATMENT FOR PDR

44. Neo-vascularization in DR

45. Principle of PRP

46. PRP

47. ADVANCED DIABETIC EYE
DISEASE
 Persistent new vessels
 Tractional retinal detachment
 Neovascular glaucoma

48. Persistent new vessels

49. Tractional RD

50. Neo-vascular Glaucoma

51. END STAGE DIABETIC EYE DISEASE
Phthisical eye

52. INDICATIONS FOR VITREO-RETINAL SURGERY
Retinal detachment involving
macula
Severe persistent vitreous
haemorrhage
Dense, persistent premacular
haemorrhage
Progressive proliferation
despite laser therapy

53. PPV for DR

54. FOR YOUR TIME & ATTENTION