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DIABETIC
RETINOPATHY
RESHMA S SURESH
INTRODUCTION 2
3174 million people6
Eastern
Europe
166,000
North
Africa/
Middle
East
336,000
South
Asia
1450
million
Latin
America
109,000
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
5
INDIA (2015-2019) 63000 people4
DR 16.9%
STDR
3.6%
Mild DR
11.8%
 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
ETIOLOGY
 Duration of diabetes
 Poor control of diabetes
 Pregnancy
 Hypertension
 Obesity
 Dyslipidaemia
 Nephropathy
 Smoking
7
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
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
 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
 Exudates: They are composed of
lipoprotein and lipid-filled macrophages
located mainly within the outer
plexiform layer
11
 Venous changes:
generalized dilatation
and tortuosity, looping,
beading (focal
narrowing and
dilatation) and sausage-
like segmentation
12
 INTRARETINAL
MICROVASCULAR
ABNORMALITIES: are
shunt vessels and is
seen as abnormal
branching/dilatation of
capillaries that act to
supply areas of
hypoperfusion
13
14
NVD NVE
15
16
17
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
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
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
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
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

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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
  • 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

  1. A study 2019 by Maya: Moderate and severe vision impairment due to DR affected 3174 million
  2. The GBD study 30 yrs lancet 0.86/23.76 63000
  3. 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%
  4. 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
  5. Tactile sensation – sense of touch