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DIABETIC RETINOPATHY.pptx
- 2. INTRODUCTION 2 3174 million people6 Eastern Europe 166,000 North Africa/ Middle East 336,000 South Asia 1450 million Latin America 109,000
- 3. PREVELANCE The leading global causes of blindness in those aged 50 years and older DR affected 0.86/23.76 million cases5 The International Diabetes Federation (IDF) estimated the global population with DM to be 463 million in 2019 and 700 million in 20451 3
- 4. 4
- 5. 5 INDIA (2015-2019) 63000 people4 DR 16.9% STDR 3.6% Mild DR 11.8%
- 6. The age standardized incidence for VI was 11.10% and for blindness was found to be 7.7% in India of PDR (2020)7 6 After 10 yrs 70% Type 1 50% Type 2 After 20 yrs 99% Type 1 80% Type 2
- 7. ETIOLOGY Duration of diabetes Poor control of diabetes Pregnancy Hypertension Obesity Dyslipidaemia Nephropathy Smoking 7
- 8. VISUAL PROBLEMS Early stages of diabetic retinopathy often don't have symptoms As the disease progresses, diabetic retinopathy symptoms may include: Floaters - Spots, dots or cobweb-like dark strings floating in vision Blurred vision Fluctuating Vision – Ups & Downs in blood sugar level Blank or dark areas in visual field Colors appear washed out or different Profound visual loss – PDR – Tractional RD Colour vision defects –Y-B range Reduced side vision after laser Loss of contrast sensitivity & Glare 8
- 9. 9 NPDR PDR Microaneurysms NVD Retinal hemorrhages NVE Hard Exudates NVI Soft exudates (Cotton wool spots) Vitreous traction-Hemorrhages Venous beading Tractional RD IRMA’s
- 10. 10 MICROANEURYSMS: a small swelling that forms in the wall of tiny blood vessels. Most develop in the inner capillary plexus (inner nuclear layer) RETINAL HAEMORRHAGES: Retinal nerve fibre layer haemorrhages, dot/blot haemorrhages, flame shaped haemorrhages
- 11. Exudates: They are composed of lipoprotein and lipid-filled macrophages located mainly within the outer plexiform layer 11
- 12. Venous changes: generalized dilatation and tortuosity, looping, beading (focal narrowing and dilatation) and sausage- like segmentation 12
- 13. INTRARETINAL MICROVASCULAR ABNORMALITIES: are shunt vessels and is seen as abnormal branching/dilatation of capillaries that act to supply areas of hypoperfusion 13
- 14. 14 NVD NVE
- 15. 15
- 16. 16
- 17. 17
- 18. POTENTIAL PROBLEMS Reading insulin syringes and labels Measuring urinary sugar & Blood sugar Labels on food containers to control carbohydrate intake Decreased tactile sensation Night blindness after laser 18
- 19. MEDICAL TREATMENT NPDR-yearly follow-up Macular edema-6month follow interval Focal laser photocoagulation-reduce the risk of vision loss by 50% PDR- panretinal photocoagulation Vitrectomy 19
- 20. LOW VISION MANAGEMENT - OVERVIEW OPTICAL AIDS Complex aids are not prescribed Temporary devices in active stages Clip-on high power loupe Binocular half eye prism glasses or reading add 6 or 8 D in BDR Prisms to correct transitory diplopia CCTV –pts with VA 3/60 9 20
- 21. 21
- 22. NON OPTICAL AIDS Fluorescent or incandescent light To assist with glare difficulties, solid tints may be used Wrap-around style shields that fit over spectacles and provide side protection m Talking books Magniguide Orientation & mobility training 22
- 23. PREVENTION REQUIREMENTS Identification Coverage with diabetic retinopathy screening Outreach of qualified management Early, intensive management Highly qualified monitoring Continuous collaboration with the treating diabetology team Involvement of the family, community6 23
- 24. 24
Editor's Notes
- A study 2019 by Maya: Moderate and severe vision impairment due to DR affected 3174 million
- The GBD study 30 yrs lancet 0.86/23.76 63000
- the risk factors for DR in this study were duration of diabetes, poor glycemic control and insulin treatment. And according to the national blindness and visual impairment survey by NPCB from 2015-2019 out of 31 districts showed that blindness due to DR 1.2%, SVI (<6/60-3/60): 1.1%, MVI (<6/18-6/60): 0.7%, MSVI (<6/18-3/60): 0.7%
- After 10 years of diabetes, nearly 70% of patients with type 1 diabetes and 50% of patients with type 2 diabetes have diabetic retinopathy. After 20 years of diabetes, nearly 99% of patients with type 1 diabetes and 80% with type 2 have some degree of diabetic retinopathy So type 1 is more risk to DR Among patients with diabetes and good vision (20/40 or better) in a real world clinical setting, eyes with severe NPDR and PDR at the time of DR diagnosis were more than two times more likely to develop SB compared with eyes with mild NPDR at initial diagnosis. Risk of blindness among patients with diabetes and newly diagnosed DR
- Tactile sensation – sense of touch