This document discusses diabetic retinopathy, including its pathogenesis, types, clinical features, diagnosis, and treatment. Diabetic retinopathy is a microangiopathy caused by hyperglycemia that can lead to blindness. It progresses from non-proliferative to proliferative stages and is diagnosed through retinal examination. Treatment involves laser photocoagulation or intravitreal injections to prevent vision loss from macular edema or retinal detachment. Close monitoring and control of blood sugar and other risk factors can help prevent blindness from this common complication of diabetes.
Most retinal surgeons are trained to create formal retinal drawings of the fundus.
Retinal drawings are useful to document pathology, although more and more people now prefer fundus photographs.
Can be used for serial follow up of patients to document changes in the pathology.
Most retinal surgeons are trained to create formal retinal drawings of the fundus.
Retinal drawings are useful to document pathology, although more and more people now prefer fundus photographs.
Can be used for serial follow up of patients to document changes in the pathology.
Role of imaging in glaucoma management gunjan chadha
Glaucoma is chronic progressive optic neuropathy in which structural damage( Optic Nerve Head and Retinal Nerve Fiber Layer) proceeds the functional deterioration( Visual Field loss).
Hence structural imaging plays an important role in early diagnosis and follow up of a patient of glaucoma
Ischemic condition affecting the eye.
The ischemia can occur secondary to systemically problem [or] particulary the eye.
Many retinal vascular disorders {like CRAO,CRVO,Diabetic retinopathy,Hypertensive Retinopathy} shows ischemic signs.
Role of imaging in glaucoma management gunjan chadha
Glaucoma is chronic progressive optic neuropathy in which structural damage( Optic Nerve Head and Retinal Nerve Fiber Layer) proceeds the functional deterioration( Visual Field loss).
Hence structural imaging plays an important role in early diagnosis and follow up of a patient of glaucoma
Ischemic condition affecting the eye.
The ischemia can occur secondary to systemically problem [or] particulary the eye.
Many retinal vascular disorders {like CRAO,CRVO,Diabetic retinopathy,Hypertensive Retinopathy} shows ischemic signs.
pathology and Complications of type 2 diabetes mellitusAiswarya Thomas
explains in detail abou various complications of diabetes mellitus and its pathophysiology. Described about the peripheral, microvascular, macrovascular comlpication
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
2. Learning Aim
• Retina: Retinal topography, and Histology
• Clinical features of diabetic retinopathy
• Diabetic retinopathy and visual impairment
• Treatment of diabetic retinopathy
• Prevention of visual impairment and blindness
due to diabetic retinopathy.
7. Diabetic Retinopathy
Globally , diabetic retinopathy accounts for
about 1 % of blindness. In India, diabetic
retinopathy accounts for about 0.1 % of
blindness.
8. Diabetic Retinopathy
• The best predictor of diabetic retinopathy is the
duration of the disease.
• Type I diabetes The first 5 years of type 1 diabetes has a
very low risk of retinopathy. All patients develop
retinopathy in 15 years.
• Type II diabetes: Risk of retinopathy increases with
duration of diabetes , hypertension and smoking, and
renal pathology.
9. Diabetic Retinopathy
Risk factors:
• Diabetic age and age of the patient
• Glycemic control
• Hypertension
• Poor renal status
• Smoking
• Pregnancy, obesity, hyperlipidemia, anemia
10. Pathogenesis
DR is predominantly a microangiopathy resulting
from hyperglycemia.
Vascular Endothelial Growth Factor (VEGF)
appears to be of particular importance in
development of proliferative changes .
11. Pathogenesis
Capillaropathy: loss of pericytes, thickening of
basement membrane , and proliferation of
endothelium.
Haematological changes
Microvascular occlusion leading to hypoxia
16. Clinical Features
• Asymptomatic in the beginning
• Symptoms depend upon the retinal changes.
• Painless diminution of vision
• Dilated fundus examination shows typical
features.
17. Fundus Findings
Features of NPDR
● Microaneurysms
● Dot and blot hemorrhage
● Retinal edema and exudates
● Dilatation and beading of
retinal veins
● Intra retinal Microvascular
Abnormalities (IRMA)
Features of PDR
Neovascularization disc (NVD)
Neovascularization elsewhere(NVE)
In addition to other changes of NPDR
20. Proliferative Diabetic Retinopathy
Extra retinal fibrovascular proliferation
extends beyond the internal limiting
membrane (ILM).
• It’s the commonest cause of spontaneous
vitreous hemorrhage in adults.
• About 2/3rd of Type I diabetics are likely to
develop PDR over 3 decades.
23. Summary of Fundus Findings
• Microaneurysms ,hemorrhage , hard
exudates
• Capillary non-perfusion , Intra Retinal
Microvascular Abnormalities (IRMA)
• Neovascularisation: NVD,NVE
• Vitreous hemorrhage , retinal detachment
24. Cause of Visual Impairment
NPDR
● Macular edema (capillary
leakage)
● Macular ischemia (capillary
occlusion)
● Sequelae from ischemia
related neovascularization
PDR
• Vitreous hemorrhage, retinal
detachment.
• Diabetic macular edema
• Ischemic macular changes
25. Diagnosis of Diabetic Retinopathy
Clinical Exam
• Direct ophthalmoscopy under mydriasis
• Slit lamp biomicroscopy using +90 D lens
• Fluorescein angiography
26. Screening Schedule
• : Normal fundus , rare microaneurysms:
Annual review
• Mild NPDR: Every 9 months
• Moderate NPDR: Every 6 months
• Severe NPDR, CSME: Every 2-4 months
• PDR: Every 2-4 months
27. Treatment of
Diabetic Macular Edema (DME)
Laser Photocoagulation
• Grid laser :For diffuse retinal thickening outside FAZ.
• Focal laser : microaneurysms in centre of hard exudates.
Medical Treatment:
-intravitreal injection: Triamcinolome acetonide / anti-
VEGF
- posterior sub-tenon injection of corticosteroid
Surgery: Parsplana vitrectomy
28. Treatment of PDR
• Panretinal Laser photocoagulation (PRP) : For
NVD And NVE
• Vitreoretinal surgery and PRP :
- Severe persistent vitreous hemorrhage
- Dense, persistent premacular hemorrhage
- Progressive proliferation despite laser therapy
- Retinal detachment involving macula
29. • Spot size (200-500 m)
• Follow-up 4 to 8 weeks
• Area covered by complete PRP
• Initial treatment is 1200
+ burns
Laser Panretinal Photocoagulation(PRP)
30. Prevention Visual Loss
• Patient education and good diabetic control
• Control of hypertension, hyperlipidemia, renal
disease, anaemia, and avoidance of smoking
• Periodic dilated fundus examination
• Early treatment of macular edema and PDR
• Treatment of complications
31. Points to remember
• Pathogenesis, types, clinical features and
diagnosis of diabetic retinopathy
• Cause of visual impairment in diabetic
retinopathy
• Prevention of visual loss due to diabetic
retinopathy
• Schedule of examination in diabetics
32. Frequently-Asked Questions
• Pathogenesis of diabetic retinopathy
• Fundus findings in diabetic retinopathy
• Diagnosis of diabetic retinopathy
• Patient education for prevention of blindness
from diabetes.
