Diabetic and the Eye: An Introduction
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1 Diabetic and the Eye: An Introduction Lawrence Iu FRCSEd (Ophth), FCOphthHK, FHKAM (Ophthalmology) Department of Ophthalmology, Grantham Hospital & Queen Mary Hospital
2 Background Diabetes mellitus (DM) affects 422 millions of people in the world 1 Diabetic retinopathy (DR) causes 1.9% of moderate-to-severe visual impairment and 2.6% of blindness 1 1 World Health Organization. Global report on diabetes
3 How common is diabetic retinopathy? Among individuals with DM: 30-35% has diabetic retinopathy 1,2 5-10% has vision-threatening diabetic retinopathy 2 Life-time risk of diabetic retinopathy: 50-60% in type 2 DM 2 90% in type 1 DM 2 1 World Health Organization. Global report on diabetes Wong TY et al. Diabetic retinopathy. Nature Reviews Disease Primers. 2016;2:16012.
4 Pathophysiology of diabetic retinopathy 3 Hyperglycaemia 3 Cheung N et al. Diabetic retinopathy. Lancet. 2010;376: Oxidative stress Advanced glycation endproducts Protein kinase C activation Inflammation Sorbitol Mild NPDR Vascular endothelial dysfunction Mod NPDR Severe NPDR Retinal ischaemia Vascular permeability Diabetic Macular Oedema VEGF, IGF Retinal neovascularization PDR
5 Mild NPDR Microaneuryms
6 Mild NPDR Microaneuryms
7 Dot retinal haemorrhage / microaneurysm Mild NPDR Hard exudates Blot retinal haemorrhage
8 Moderate NPDR Cotton wool spot
9 Moderate NPDR More diffuse dot-blot retinal haemorrhages and hard exudates Hard exudates
10 Moderate NPDR Multiple cotton wool spots
11 Severe NPDR Extensive dot-blot retinal haemorrhages and hard exudates
12 Severe NPDR Venous dilatation and tortuosity
13 Severe NPDR Intraretinal microvascular abnormalities
14 Vision-threatening diabetic retinopathy Diabetic macular oedema Proliferative diabetic retinopathy
15 Vision-threatening condition 1: Diabetic Macular Oedema
16 Pathophysiology of diabetic retinopathy 3 Hyperglycaemia 3 Cheung N et al. Diabetic retinopathy. Lancet. 2010;376: Oxidative stress Advanced glycation endproducts Protein kinase C activation Inflammation Sorbitol Vascular endothelial dysfunction Retinal ischaemia Vascular permeability Diabetic Macular Oedema VEGF, IGF Retinal neovascularization
17 Diabetic Macular Oedema Incidence: % type 2 DM 20% of type 1 DM developed macular oedema within 10 years 4 Klein R et al. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XV. The long-term incidence of macular edema. Ophthalmology. 1995;102(1):7-16.
18 Optical Coherence Tomography (OCT) image Normal macula Visual acuity: 20/20
19 Diabetic Macular Oedema
20 Diabetic Macular Oedema
21 Year 2015 Visual acuity: 20/40 Poor glycaemic control (HbA1c 8.3%) Year 2017 Visual acuity: Count-finger HbA1c 10.8% Fasting glucose 27.1 mmol/l
22 Vision-threatening condition 2: Proliferative diabetic retinopathy
23 Pathophysiology of diabetic retinopathy 3 Hyperglycaemia 3 Cheung N et al. Diabetic retinopathy. Lancet. 2010;376: Oxidative stress Advanced glycation endproducts Protein kinase C activation Inflammation Sorbitol Vascular endothelial dysfunction Retinal ischaemia Vascular permeability VEGF, IGF Retinal neovascularization PDR
24 Proliferative diabetic retinopathy Prevalence: 1 Proliferative diabetic retinopathy has a prevalence of 7% in individuals with DM 1 World Health Organization. Global report on diabetes
25 PDR Neovascularization Neovascularization
26 PDR Neovascularization
27 PDR Neovascularization
28 Pre-retinal haemorrhage Visual acuity: Count-finger
29 Vitreous haemorrhage Visual acuity: 20/400
30 Fibrovascular proliferation Visual acuity: Count-finger
31 Visual acuity: Count-finger
32 Tractional retinal detachment Visual acuity: Count-finger
33 Other than diabetic retinopathy
34 Diabetic cataract 5 Pollreisz A et al. Diabetic cataract pathogenesis, epidemiology and treatment. J Ophthalmol. 2010;2010: Prevalence: 5 3 to 4-fold increased prevalence of cataract in diabetics under age 65 2-fold increased prevalence of cataract in diabetics above age 65 2 forms: Diabetic snowflake cataract Age-related senile cataract
35 Neovascular Glaucoma Rubeosis iridis (neovascularization of iris) Visual acuity: No Light Perception
36 Corneal persistent epithelial defect
37 Corneal infection (keratitis)
38 Corneal abscess
39 Summary Diabetes affects different parts of the eyes Diabetic retinopathy is a common and important cause for visual impairment Diabetic macular oedema and proliferative diabetic retinopathy are two major visionthreatening conditions related to diabetes Regular eye screening, good glycaemic control, and prompt and effective interventions are keys to successful management
40 Thank you
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