Preventing Vision Preventing Vision Loss Loss in Diabetic in Diabetic Retinopathy Retinopathy Rick Trevino, OD VA Outpatient Clinic Evansville, Indiana
Jun 13, 2015
Preventing Vision LossPreventing Vision Lossin Diabetic Retinopathyin Diabetic Retinopathy
Rick Trevino, OD
VA Outpatient Clinic
Evansville, Indiana
Diabetic Retinopathy
Background Retinopathy Microaneurysms Hemorrhages Lipid Exudates Cotton Wool Spots (infarcts)
Preproliferative Retinopathy Multiple Cotton Wool Spots Numerous Hemorrhages Venous Dilation and Beading IRMA
Proliferative Retinopathy Neovascularization (New vessel formation) Vitreous Hemorrhage
Diabetic Macular Edema
Background Retinopathy
Background Retinopathy
Background Retinopathy
Preproliferative Retinopathy
Preproliferative Retinopathy
Proliferative Retinopathy
Proliferative Retinopathy
Diabetic Macular Edema
Diabetic Macular Edema
Diabetic Macular Edema
Diabetic Macular Edema
Preventing Vision Loss
Primary Prevention Physical Activity Weight Reduction
Secondary Prevention Glycemic Control BP Control
Tertiary Prevention Laser Therapy Angiogenesis Inhibitors
Tertiary Prevention
Laser Therapy DRS: PRP ETDRS: CSME
Angiogenesis inhibitors (Avastin)
Drawbacks Access to Care Late Disease Stage Side Effects
Role of Glycemic Control
GLYCEMIC CONTROLIS THE SINGLE MOST EFFECTIVE MEDICAL
TREATMENT FOR DIABETIC
RETINOPATHY
Role of Glycemic Control
DCCT (1993)1441 subjects with IDDM followed for 6.5yrsRandomized into strict and conventional txStrict control group had average HbA1c 7.2% Conventional: 8.8%
Strict control resulted in… Reduced risk of retinopathy by 76% Reduced risk of progression by 54%
Role of Glycemic Control
DCCT (1993)There is a continuous nonlinear relationship between risk of retinopathy and mean level of HbA1c
Role of Glycemic Control
Conclusions of the DCCT (1993)
Total lifetime exposure to glycemia was the principal determinant of the risk of retinopathy Earlier intervention decreases risk
There is no level of glycemic control below which a reduction in risk does not occur Improved control always reduced risk of
retinopathy
Role of Blood Pressure
Hypertension is an independent risk factor for DR and its progression Use of anti-
hypertensive medications may decrease risk independent of lowering blood pressure
Role of Blood Pressure
UKPDS (1998)1148 hypertensive type-2 diabetics randomized into tight and less-tight BP control and followed for 8.4 yrs
Average BP: Tight: 144/82 Less tight: 154/87
Tighter BP control resulted in… 34% reduction in
progression of DR 47% reduced risk of loss of 3 lines VA
Role of Cholesterol
WESDR (1991): Higher serum cholesterol increased risk of hard exudates in type-1 DM
ETDRS (1996): Higher serum lipids increased risk of hard exudates and loss of VA
Elevated lipids may increase the morbidity of diabetic macular edema
Preventing Vision Loss
Primary Prevention Physical Activity Weight Reduction
Secondary Prevention Glycemic Control BP Control
Tertiary Prevention Laser Therapy Angiogenesis Inhibitors
Thank You!