Diabetic Retinopathy Basics

Report
Welcome to CNIB’s InFocus
Webinar Series
Webinar 1: Diabetic Retinopathy Basics
Netan Choudhry M.D. FRCS(C)
25 October 2012
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Diabetic Retinopathy Basics: Objectives
Participants will learn about:
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Anatomy of the eye
Diabetic retinopathy defined
Signs and symptoms
Types of diabetic retinopathy
Risk factors and prevention
Diagnostic tests
Treatment
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Anatomy of the Eye
The retina – senses light &
transmits images to the brain
The macula – central part of
the retina used to read and see
fine details clearly
The vitreous – clear gel fills
the back of the eye and sits in
front of the retina
Figure 1: The human eye
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What Is Diabetic Retinopathy?
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Occurs when elevated blood sugar levels cause blood
vessels in the eye to swell and leak into the retina.
Figure 2: Diabetic macula edema
(swelling of the retina)
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Signs and Symptoms
Figure 3: Normal Vision
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Figure 4: How vision may
be affected by diabetic retinopathy
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Floaters
Blurred vision
Blank or dark areas in field of vision
Poor night vision
Vision loss
Types of Diabetic Retinopathy
Early stages:
Non-proliferative diabetic retinopathy (NPDR)
• Damaged blood vessels in the retina begin to leak fluid
and small amounts of blood and cholesterol.
• Mild NPDR may not necessarily affect vision.
• Results of blurred vision:
Fluorescein dye leaking in macula
Figure 5: Macula edema
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Figure 6: Fluorescein angiogram
of macular edema
Types of Diabetic Retinopathy
Late stages:
Proliferative diabetic retinopathy (PDR)
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Retinal vessels close causing significant reduction
in blood flow.
The retina responds by growing new abnormal
vessels.
Can affect both central and peripheral vision.
Vitreous hemorrhage
New blood vessels bleed into vitreous cavity.
Tractional retinal detachment
Scar tissue can shrink causing the retina to
detach and result in vision loss. More severe
vision loss occurs if the macula is detached.
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Figure 7: Tractional retinal
detachment
Risk Factors/Prevention
• Diabetes type
• Ethinicity
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High blood sugar
Smoking
High blood pressure
High cholesterol
Obesity
Early detection via eye exams is paramount
Type 1 diabetes: within 5 years of diagnosis, then annually
Type 2 diabetes: at time of diagnosis, then annually
Gestational diabetes: within 1st trimester
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Diagnostic Tests
Basic assessment
• Visual acuity test
• Tonometry: Measures pressure
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inside the eye
Dilated eye exam
Advanced assessment
• Fluorescein angiogram: dye is
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injected systemically which
demonstrates retinal
circulation
Optical coherence tomography
(OCT): non-invasive imaging study
that reveals retinal anatomy
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Figure 8: Fluorescein angiogram
Figure 9: Optical coherence
tomography (OCT)
Treatments
Proliferative retinopathy
Laser surgery
• Microscopic thermal laser burns
are made in the retina
• Shrinks and prevents abnormal new
blood vessel growth, and stops
leaking of blood vessels
• Can reduce risk of further
vision loss by 50%
• Also recommended to treat
macular edema
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Figure 10: Laser photocoagulation
Treatments
Proliferative retinopathy
Intraocular (anti-VEGF) injections
• Reduces swelling in the retina and
causes abnormal vessels to regress
Figure 11: Intraocular injection
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Treatments
Diabetic macular edema
Lucentis
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Health-Canada-approved anti-VEGF treatment
Approved for reimbursement in Quebec only
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Treatments
Advanced proliferative retinopathy
Vitrectomy
• Cloudy vitreous is removed and replaced with a clear solution
that mimics the normal eye fluids
• Allows light rays to focus on the retina again
Figure 12: Pars plana vitrectomy
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Eye Connect: Diabetic Retinopathy
cnib.ca/dr
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Diabetic retinopathy basics
Prevention
Diagnosis and treatment
Living with diabetic retinopathy
Health care professionals’ page
Patient guide
CNIB Contacts and Resources
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CNIB website: cnib.ca
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Toll-free
CNIB Helpline:
1-800-563-2642
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Email: [email protected]
Production of this material has been made possible through a financial
contribution from the Public Health Agency of Canada. The views expressed
herein do not necessarily represent the views of the Public Health Agency of
Canada.
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Q&A Session
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CNIB In Focus Webinar Series
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Webinar 2: Diabetes Management with Vision Loss
When: 13th November @ 1:00pm EST
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Webinar 3: Supporting Your Patients with Vision Loss:
Practical Tips and Strategies
When: 15th November @ 1:00pm EST
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Webinar 4: Adjusting to Vision Loss
When: 21st November @ 1:00pm EST
cnib.ca/dr
[email protected]
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