DIABETES AND YOUR EYES. Presented by Dr. Andrea Hagler

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1 DIABETES AND YOUR EYES Presented by Dr. Andrea Hagler

3 Tahlequah, OK

4 Forest Grove, OR

5 Brief Review of Diabetes The body s endocrine system is responsible for regulating growth, reproduction, and tissue functions such as cellular metabolism (energy use). Diabetes mellitus is a chronic endocrine disorder in which the pancreas produces no insulin or not enough insulin Insulin: the hormone that controls the amount of glucose (sugar) in the blood. Glucose is the body s main source of fuel for cellular metabolism.

6 Brief Review of Diabetes Type 1 Diabetes Generally develops during childhood and requires insulin for treatment, since the body produces little or none of its own.

7 Brief Review of Diabetes Type 2 Diabetes Usually develops in adulthood n Although it s becoming more prevalent among children. This form of diabetes is strongly associated with obesity and overweight. In this type of diabetes, the body either becomes resistant to the effects of insulin or does not produce enough of it.

8 Brief Review of Diabetes People with Type 1 or Type 2 diabetes can develop diabetic retinopathy, although it is more prevalent and tends to be more severe among people with type 1 disease.

9 Diabetes Background Diabetic retinopathy is the leading cause of blindness in the United States, yet about half of Americans with diabetes have never had a retinal examination, leaving them unaware of this serious complication or failing to take steps to prevent it.

10 Diabetic Retinopathy Statistics CDC 2017 report The number of people in the United States with diabetes is increasing million Americans (nearly 1 in 10) have diabetes 84.1 million adults (approximately 1 in 3) have prediabetes For adults diabnosed with diabetes, highest prevalence was among American Indians and Alaskan Natives

11 Diabetic Retinopathy Statistics Duration of diabetes is a major risk factor associated with the development of diabetic retinopathy (in other words, the longer a person has diabetes, the more likely he or she is to develop diabetic retinopathy). -American Academy of Opthalmology 2011.

12 Diabetic Retinopathy Statistics If uncontrolled, diabetes can lead to an eye disease called diabetic retinopathy This can lead to blindness. Diabetes can also put you at higher risk for cataracts, glaucoma, and macular degeneration.

13 Basic Eye Anatomy

19 Vision What does 20/20 mean? What happens when your vision is not 20/20?

29 Dilated Eye Examinations

32 Stages of Diabetic Retinopathy The longer you have diabetes, the more likely you are to develop signs of retinopathy. Periods of poorly controlled glucose increase your risk of developing the disease earlier and of having more severe disease. Generally, diabetic retinopathy is divided into Nonproliferative (without new blood vessel formation) Proliferative (with new blood vessel formation) stages

34 Nonproliferative Diabetic Retinopathy Nonproliferative In its early stages, nonproliferative retinopathy (also called simple or background retinopathy) usually does not diminish your vision and may cause no symptoms.

36 Nonproliferative Diabetic Retinopathy Mild nonproliferative At this stage, the tiny vessels of the retina weaken, causing small, balloon-like outpouchings called microaneurysms.

39 Nonproliferative Diabetic Retinopathy Moderate nonproliferative As red blood cells and proteins accumulate along the walls of the damaged vessels, blood flow through some of them becomes blocked. The vessels may rupture, creating blots or flame-like splinter hemorrhages (tiny areas of bleeding).

40 Nonproliferative Diabetic Retinopathy Severe nonproliferative During this stage, microaneurysms and hemorrhages become widespread, occurring in all four anatomical quadrants (quarters) of the retina. n >20 intraretinal hemorrhages in each quadrant

44 Proliferative Diabetic Retinopathy Lack of blood flow (because vessels are bleeding out into the vitreous rather than reaching the retina) starves the retina of oxygen and nutrients. As more and more vessels fail to deliver nourishment, abnormal new blood vessel growth begins. This process is called neovascularization.

45 Proliferative Diabetic Retinopathy During the proliferative stage, hemorrhaging that causes inflammation may trigger the development of scar tissue. If this tissue contracts, it can pull at the edges of the retina, causing it to detach from the underlying vascular coat, the choroid. The retina can t function when separated from its blood supply, and irreversible blindness will result.

49 Neovascularization of the Iris

52 Neovascularization of the Disc

54 Laser Photocoagulation Photos

58 Cataracts

69 Cataract Surgery Video qwyoxbwfsi

70 How to Prevent Cataracts Keep blood sugars under control Wear a hat Wear sunglasses!

74 Neovascularization of the Angle

77 Glaucoma

86 Glaucoma

88 Macular Degeneration

100 Take Home Points Diabetes puts you at a higher risk for getting: Cataracts, Glaucoma, Macular Degeneration Diabetics need to have yearly DILATED eye examinations (sometimes more frequently) Wear your sunglasses to help prevent cataracts and macular degeneration Follow-up with your primary care doctor and diabetes educator to keep your diabetes under control

101 Questions? Comments?

Diabetes Eye Q Quiz. 1) Diabetes is the leading cause of new blindness among adults in the US under the age of 74.

Diabetes Eye Q Quiz. 1) Diabetes is the leading cause of new blindness among adults in the US under the age of 74. Diabetes Eye Q Quiz From 1997 to 2011, the number of adults with diagnosed diabetes who reported visual impairment, that is, trouble seeing even with their glasses or contact lenses, increased from 2.7