A presentation to analyze the effect of obesity on the ocular system, obesity, diabetes melitus, hypertension, hypertension, ophtalmic eye care, residency presentation, federal medical centre, lokoja, kogi state, consequence of fatty meals to the eyes

1. PRESENTED
BY
DR. AVURU CHUKWUNALU JAMES

2. Introduction
Classification
Epidemiology
Systemic associations of Obesity
Ocular associations
Conclusion
References

3. Prevalence of obesity, now endemic in
many countries
WHO defines obesity as a BMI of 30kg/m2
or greater and overweight is BMI of 25-
29.9kg/m2
In children(percentile used), BMI >95th
percentile for age and sex is considered
overweight.

5. Grade 1 overweight(simply overweight)-
BMI of 25-29.9kg/m2
Grade 2 overweight(commonly called
obesity)- BMI of 30-39.9kg/m2
Grade 3 overweight(commonly called
severe or morbid obesity)-BMI of 40kg/m2
and above

6.  Affects a wide range of age group from young
to the elderly
 In USA, 30% obese.
 1.1 Billion people are overweight and 312
million people obese world wide
 SEX; Higher in women than men
 RACE: Worldwide but more among pima
Indians of Arizona , North Americans, Pacific
Islanders, African Americans and Hispanic
populations
 AGE: Childhood/Adolescents Obesity have a
high probability of becoming adults who are
obese

7.  Cancers
 Coronary heart disease
 Type 2 DM
 CVA
 Dyslipidaemia
 Osteoarthritis
 Sleep apnoea
 Depression
 Polycystic ovarian syndrome
 Fatty liver

8. Decreases visual acuity through
 Cataract
 Age related maculopathy
 Diabetic retinopathy
 Glaucoma

9. Associated with increased risk of PSC and
CO( the blue mountain eye studies in white
Australian)
Mechanism is poorly understood

10. 1. Leptins are expressed and secreted
mainly by adipocytes
 Hyperleptinaemia and leptin resistance occur in
obesity
 Leptin increases accumulation of reactive
oxygen species in cells
 Oxidative stress leads to cataract formation
2. Elevated levels of C-reactive proteins
and plasma fibrinogen-Increases cataract
formation

11. 3. Diabetes(glucose intolerance, insulin
resistance), hyperlipidaemia and
hypertension which are associated with
obesity increase risk of cataract formation
 NB: Low BMI also increases
cataract(cortical opacity) formation due to
malnutrition

12. Obesity has a strong positive relationship
with intraocular pressure(ocular
hypertension)….Beaver Dam eye study
MECHANISMS
1. Excessive intraorbital adipose tissue,
increase blood viscosity, increase
episcleral venous pressure and
impairment of aqueous outflow facility

14. 2. Obesity related systemic diseases such as
hypertension, diabetes, hyperlipidaemia, insulin
resistance also causes ocular hypertension
 Systemic hypertension causes increased filtration
fraction of aqueous humor through elevated cilliary
artery pressure
 Hyperglycaemia induces osmotic fluid shift into the
intraocular space
 Impaired vascular supply and perfusion instability
due to alterations in autonomic and endotherlial
functions(Vascular theory of glaucomatous optic
neuropathy)

15. 3. Hyperleptinaemia causes increased
oxidative stress. Oxidative stress causes
proteasome failure and induce trabecular
meshwork degeneration(Open angle
glaucoma)

17. Positive relationship exist between obesity
and age related macular degeneration-
higher BMI associated to more advanced
ARM [Blue mountain eye study, Beaver
Dam Eye study(women only), POLA study]
Mechanisms not clear

19. MECHANISMS PROPOSED
1. Oxidative stress(from hyperleptinemia)
damages lipid in bruch membrane which
leads to choroidal neovascularization
2. Oxidative stress causes RPE cells
detachment and migration into subretinal
space or outer retina where it secretes
excessive VEGF(neovascularization in
bruch membrane)

20. 3. Plasma fibrinogen and C-reactive protein
may be associated with late ARM
4. Secondary effects: Hypertension,
hyperlipidaemia are other systemic factors
which are associated with obesity and also
risk factors for ARM

21. Positive association between obesity and
Diabetic retinopathy(EURODIAB
Prospective complications study)
Metabolic syndrome encompassing
hyperlipidaemia , hypertension etc are risk
factors for retinopathy in Diabetics. Both
conditions are common risk factors for
obesity

25.  MECHANISMS
1. Serum angiogenic factors(VEGF) are elevated in
obesed people and increased VEGF in vitreous is
associated to retinopathy in DM
2. Oxidative stress(hyperleptinemia) induces over
expression of VEGF and cause features of DM
retinopathy(retinal neovascularization and
macular edema)
3. Leptin also can worsen hypertension by
activation of the sympathetic nervous system,
accelerating the development of hypertensive
retinopathy

26. Degeneration and loss of
pericytes
Plasma leakage
Hard exudate
(Circinatepattern)
Capillary wall weakening
microaneurysm
Retinal edema
Intraretinalhemorrhage

27. Neovascularization
andfibrovascular
proliferation
VEGF
Increased plasma viscosity
Deformation of RBC
Increased platelets stickiness
Decreased capillary blood flow
and perfusion
Endothelial cell damage and proliferation
Capillary basement membrane thickening
Retinal hypoxia
A-V shunt
IRMA
Cotton wool spots
Proliferative
retinopathy
Rubeosis
iridis

28. Obesed people have increased risk of
retinal vein occlusion(ARIC and
Cardiovascular health study)
Obesity increases risk of oculomotor nv
palsy
Recurrent lower eye lid entropion
Obstructive sleep apnoea syndrome which
is common in obesity is associated with
papilloedema and floppy eyelid syndrome.

29. Obesity is a risk factor for benign
intracranial hypertension(pseudotumor
cerebri)-
 MECHANISM-central obesity increases
intra-abdominal pressure which increases
intra-thoracic pressure which then
increases cardiac filling pressure impeding
venous return from the brain.

30. Obesity is associated with prader-willi
syndrome( a genetic disorder with obesity,
intellectual disability and shortness in
height) which is found to be related to
myopia, astigmatism, amblyopia,
strabismus and exotropia

31. Obesity is a major public health problem
and its impact on ocular health is
increasing
The efficacy of obesity treatment in
reducing the risk of eye diseases is
important
More study is however required in this
direction

32. Clinical ophthalmology;Kanski and
Brawling, 8thEd
Tien Wong et’al 2nd Ed
Obesity and eye diseases,
www.ncbi.nih.gov
Obesity;Essentials, background ,
pathophysiology-Medscape

33. THANK YOU