Ocular Complications of Diabetes Mellitus Dr. Hj Abdul Mutalib Othman Consultant Ophthalmologist and Head of Department Department of Ophthalmology Queen Elizabeth Hospital Kota Kinabalu
Sep 25, 2015
Ocular Complications of Diabetes MellitusDr. Hj Abdul Mutalib OthmanConsultant Ophthalmologist and Head of Department Department of Ophthalmology Queen Elizabeth HospitalKota Kinabalu
Common eye problem in diabeticsFluctuation in vision- Indicates poorly control blood sugar
Cataract
Diabetic retinopathyMaculopathy
Glaucoma
Cataract
Normal retina
Background: Diabetic RetinopathyWorldwide prevalence: 3 6%Malaysia (NES-1996) prevalence: 14.6%Major cause of blindnessNo early visual symptomsScreening at primary health care levelAwareness, skills and coordination
Background: What is the natural history of Diabetic Eye Disease?Hyperglycemia -> microangiopathySeveral Stages -> frequently highly complicated situation / multisystemic Major Risk Factors: Duration of diabetes, poor control, end-organ damageAffect the arterioles -> ischemic manifestations & its complications
Non proliferative diabetic retinopathy(NPDR)leaking vessels
Gradual reduction of vision
Distorted image
Treatment focal laser
Moderate NPDR
Severe NPDR
maculopathy
Proliferative diabetic retinopathyOften no symptoms till the blood vessels rupture (considered late)
Floaters, spider web, fly
Sometimes severe darkness of vision
Rarely pain (in advanced late stage)
Proliferative diabetic retinopathy (PDR)Occlusion of vesselsLoss of nourishment to the retinaRespond by building new, abnormal FRAGILE vesselBurst easily Vitreous hemorrhageCreate scar tissue in the eye tractional retinal detachment
PDRNew vessels
PDRNew vessels
Tractional retinal detachment
Tractional retinal detachment
New vessels at iris
PREVENTION IS BETTER THAN CURE
Management of Proliferative diabetic retinopathy and MaculopathyLASER Treatment (panretinal photocoagulation)
PREVENTIONTo preserve vision, not to improve it
Multiple sessions
Laser Surgery the purposeNPDR stop leaking prevent further damage by edema
PDR stop growth of bad new vessels prevent vitreous hemorrhage
Laser SurgeryOut patient procedure
No need to fast
After completion can go home and resume normal activity
Laser Surgery
Sit in front of a machineEye will be numbed by anaesthetic eye dropA special lens will be inserted on top of eyeLaser is then delivered hear a clicking soundMay take few minutes to one hour
Laser surgery objectivesMain aim of treatment to protect deterioration of vision
If retinopathy left untreated, progression to blindness is higher
Recommendations for ScreeningAll patients with diabetes mellitus: At diagnosis and annually basisAll patients with visual symptoms
Proper documentation of screening scheduleCombined clinicsComprehensive care
Detection of Diabetic Retinopathy
Asymptomatic in the early stage
Comprehensive screening:primary health care levelmeasurement of VAfunduscopy
High sensitivity and specificity
Criteria for referral to OphthalmologistAny evidence of DR i.e. dot and blot hemorrhages, hard exudates or cotton-wool spotsEstablished visual symptomsTreated by Ophthalmologist beforeAbsconded Ophthalmologist f/u
Urgency for referralDR with associated cataractMaculopathy with or without visual reductionPDR with or without visual reductionPDR with complicationsAny unexplained reduction in visual acuity or symptoms
Medical Management of DRControl of blood sugarHypertensionKidney diseasePregnancy PubertySmokingExerciseWeight reductionLipidsAnaemia
Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer
Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer
Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer
Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer
Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer
Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer
Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is importantDont forget the eyeDont hesitate to refer
Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer
Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer
Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer
Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer
Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer
Thank you