The document summarizes key points from a conference on diabetes and insulin. It discusses the various ocular manifestations of diabetes, including retinopathy, neuropathy, glaucoma and cataracts. It notes that up to 95% of those with type 1 diabetes and 60% of those with type 2 diabetes develop retinopathy. Risk factors include blood sugar levels, blood pressure, duration of diabetes, blood lipids, ethnicity and pregnancy. Screening guidelines are provided based on diabetes type and risk level. Imaging techniques like OCT and treatments like anti-VEGF injections plus laser therapy are reviewed. Novel research areas are also highlighted.
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Ocular Manifestation of Diabetes Mellitus
1. D I A B E T E S A N D I N S U L I N E C O N F E R E N C E
2 N D F E B / 2 0 1 7
B I R J A N D U N I V E R S I T Y O F M E D I C A L S C I E N C E
( B I U M S )
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
1
Ocular Manifestations of
Diabetes
3. How Often Diabetic Retinopathy is?
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
3
Among leading cause of adults blindness in general
population
In Diabetics:
Type1/95%
Type2/60%
4. Genetic or Environmental Factors
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
4
Not All diabetics develope to DR!
5. Who Is at Risk for Diabetic Retinopathy?
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
5
Simple answer; Every diabetics!
6. Diabetic retinopathy risk factors
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
6
Blood sugar levels
Blood pressure (<130/80 mmHg)
Duration of diabetes
Type 1/15 years/80 %
Type 2/19 years/84 %
Blood lipid levels
greater accumulation of exudates, protein deposits
higher risk of moderate visual loss.
Ethnicity
Pregnancy
7. Other RF investigations is needed
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
7
Common RF with Diabetic Nephropathy
Elevated Cystatin C can predict DR
8. How does non-proliferative diabetic
retinopathy affect your vision?
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
8
9. How does proliferative diabetic
retinopathy affect your vision?
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
9
10. Examination Schedule
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
10
Type 2 Diabetes
The patient should be referred for ophthalmologic evaluation
at the time of diagnosis.
The time of onset of Type 2 diabetes is often difficult to
determine and may precede the diagnosis by a number of
years.
Up to 3% of patients whose diabetes is first diagnosed at age
30 or later will have CSME or high-risk features at the time of
the initial diagnosis of diabetes.
About 30% of patients will have some manifestation of diabetic
retinopathy at diagnosis.
11. Examination Schedule
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
11
Type 1 Diabetes
Ophthalmic examinations are recommended beginning 5 years
after the diagnosis of Type 1 diabetes and annually thereafter,
which will detect the vast majority of Type 1 patients who require
therapy.
Adirect relationship between the prevalence and severity of
retinopathy and the duration of diabetes.
The development of vision-threatening retinopathy is rare in
children prior to puberty.
Among patients with Type 1 diabetes, substantial retinopathy may
become apparent as early as 6 to 7 years after onset of the disease.
Patient education about the visual impact of early glucose control is
important and should begin with the onset of disease.
for ophthalmologic evaluation at the time of diagnosis.
13. Diabetes Associated with Pregnancy
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
13
diabetics > an examination prior to pregnancy
During the first trimester, with follow-up visits
14. Women who develop gestational
diabetes do not require an eye
examination during pregnancy
and do not appear to be at
increased risk for diabetic
retinopathy during pregnancy.
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
14
15. Physical Examination
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
15
Visual acuity
Slit-lamp biomicroscopy
Intraocular pressure (IOP)
Gonioscopy before dilation, when indicated. Iris
neovascularization is best recognized prior to dilation.
When neovascularization of the iris is present or
suspected, or if the IOP is elevated, undilated gonioscopy
can be used to detect neovascularization in the anterior
chamber angle.
Pupillary assessment for optic nerve dysfunction
funduscopy
16. Importance of Dilated Fundus exam
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
16
A dilated pupil is preferred to ensure optimal
examination of the retina, because only 50% of eyes
are correctly classified for the presence and severity
of retinopathy through undilated pupils.
Slit-lamp biomicroscopy is the recommended
method to evaluate retinopathy in the posterior pole
and midperipheral retina.
Examination of the peripheral retina is best
performed using indirect ophthalmoscopy or slit-
lamp biomicroscopy.
29. Effects Related to Other Treatments
Source; AAO GuidelineJoobin Khadamy. MD; Diabetes & Insuline
conferece
29
There have been case reports of idiosyncratic
macular edema that is temporally associated with
use of the glitazone class of oral
antihyperglycemic agents.
