FRANZCO, MD, MBBS. Royal Darwin Hospital
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1 Diabetes and Eye By Dr. Nishantha Wijesinghe FRANZCO, MD, MBBS Consultant Ophthalmologist Royal Darwin Hospital
2 98% of Diabetics do not need to suffer from severe visual loss Yet Diabetic eye disease is the leading cause of blindness in working age people
3 Epidemiology in Australia Diabetic retinopathy is present in nearly one third of people with diabetes, and threatens vision in 10% Among those with no retinopathy, 10% will develop it each year. Compared to the general population, people p with diabetes have a 25-fold risk of vision loss.
4 What are the figures in the Top End? Number of patients seen in Out Reach from May 2011-Sept No of patients Series community
5 Specialist Out Reach Program May 2011 Sept 2012 Total number of patients 931 Cataract 223 glaucoma 7 Diabetes 437 NPDR mild 27, moderate 25, severe 2 = 54 PDR 4 Prevalence of Diabetic Retinopathy 13.5%
6 Normal Eye
7 Normal Retina
8 Proliferative Diabetic Retinopathy
9 Ocular Complications of Diabetes Lids Chronic Blepharitis styes
10 Neurotrophic ulcers
11 Lens Cataract
12 Cataract
13 Lens Fluctuating Myopia Doctor, power of my glasses keep changing very frequently. Does it has something to do with diabetes? Case: 38yrs old female patient presents with bilateral sudden onset blurry vision. Refraction with 2.00D improved vision to 6/6
14 Third Nerve Palsy
15 Sixth Nerve Palsy
16 Infections Corneal abscess Orbital cellulitis Endophthalmitis h i Mucormycosis
17 mucormycosis
18 Diabetic Papillopathy
19 Central Retinal Vein Occlusion
20 Non Arteritic Anterior Ischemic Optic Neuropathy
21
22 Diabetic Retinopathy
23 Diabetic Retinopathy (DR) Micro vascular ( small blood vessels) damage Block Leak Bleed Classification Non Proliferative mild, moderate, severe Proliferative ( New Vessels) NVD, NVE Maculopathy CSME
24 Signs of Diabetic Retinopathy Dot Haemorrhages / Microaneursym Flame shaped haemorrhage
25 Micro aneurysms
26 Signs of Diabetic Retinopathy Hard Exudate Macular Oedema
27 Signs of Diabetic Retinopathy Venous Beading Intraretinal microvascular abnormalities(irma)
28 Signs of Diabetic Retinopathy Cotton Wool Spots
29 Macular Ischaemia
30 Patient s Vision
31 Proliferative Diabetic Retinopathy (PDR) Neovascularisation of the retina Neovascularisation of the disc Neovascularisation of iris
32 Retinal Neovascularisation
33 Neovascularisation of the Disc
34 Proliferative Diabetic Retinopathy Why is it such a bad thing?
35 Tractional Retinal Detachment
36 Pre retinal Haemorrhages Vitreous Haemorrhage
37 Rubeotic Glaucoma Endstage Disaster
38 Total Blindness
39 Risk Factors Duration of diabetes Prevent and treat early Poor BSL control (i.e. Raised HbA1c). Pregnancy Hypertension Nephropathy Obesity Hyperlipidaemia.
40 Laser Pan retinal Photocoagulation
41 Laser Macular
42 Intravitreal steroids/ VEGF inhibitors Side Effects of Steroids Cataract Steroid induced Glaucoma
43 OCT scan before and after IVTA
44 Vitrectomy
45 Why do we need a Good Screening programme? Diabetic retinopathy is asymptomatic in its early stages. Laser treatment cannot restore vision that has already been lost. It is essential to detect and treat diabetic retinopathy before any vision loss occurs. NEED TO CHECK EYES EVERY YEAR.
46 Screening Visual Acuity very important Funduscopy GP, Optometrist, Ophthalmologist or use a non mydriatic camera by anybody
47 Barriers for Screening in the Top End Lack of awareness among patients Limited number of professionals Ophthalmologist l t2 Optometrists 20 GPs perceive that optometrists are retailers of glasses Trained, enthusiastic staff won t stay at one place for a long time/ high work load
48 Good Screening programme Estimating the need for screening, Methods of screening, Health professionals involved and their training, Recruiting people with diabetes for screening, Promoting community awareness, Address the barriers to screening, Reminder and recall systems Evaluation.
49 Management Protocol Screening for Diabetic Retinopathy Ophthalmologists Optometrists Physicians/GPs Non mydriatic Retinal Camera No DR Minimal DR Moderate NPDR Fundus not visualised, Deterioration of vision Enabling Factors Health professional Training Non mydriatic fundus camera Medicare rebate Changes Consumer awareness Tele medicine Re screen in 1 year re screen in 6months refer to ophthalmologist
50 Thank You.
51
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