Diabetic Learning Event: Diabetic Eye Screening and Retinopathy- Samantha Mann & Mark Frost

Size: px

Start display at page:

Download "Diabetic Learning Event: Diabetic Eye Screening and Retinopathy- Samantha Mann & Mark Frost"

Alan Boone
6 years ago
Views:

Diabetic Learning Event: Diabetic Eye Screening and Retinopathy- Samantha Mann & Mark Frost Case 1 : 63 yr-old Caucasian woman with type-2 Diabetes for 8 years Ex-smoker Hypertension- 5 years FH:

9% Lipids: Total Cholesterol 7.8, TG 1.8 (0.5-2), LDL 4.6 (0-3), HDL 2.

1 Diabetic Learning Event: Diabetic Eye Screening and Retinopathy- Samantha Mann & Mark Frost Case 1 : 63 yr-old Caucasian woman with type-2 Diabetes for 8 years Ex-smoker Hypertension- 5 years FH: father had DM DH: Metformin 1g BD, gliclazide 80mg BD, Amlodipine 10mg Attended Diabetic Screening and found to have following fundal images below: Visual acuity: 6/9 both eyes BP: 144/82mmHg HbA1c: 9% Lipids: Total Cholesterol 7.8, TG 1.8 (0.5-2), LDL 4.6 (0-3), HDL 2.4 The patient has been referred to the eye clinic (appointment in 6 weeks time) but she has made an appointment with the GP as she is concerned about her eyes. Questions: 1. What grade of retinopathy/ maculopathy does this patient have? 2. What systemic factors affect the progression of retinopathy? 3. What should the target BP and HbA1c be? 4. Would you consider adding a cholesterol lowering drug? What type? 1. Go through NSC grades 2. Talk about effects of BP/glucose/ lipids/duration of diabetes/ethnicity 3. NICE recommendation/ trials 4. Field/Accord Study conclusions

2 The patient attends the eye clinic and has been told he needs laser treatment to the right eye and may need ranibizumab (anti-vegf) treatment to the left eye if it worsens. The patient would like re-assurance about the treatment and wants to know how effective they are? And what they involve? What are the side-effects? 1. What are the benefits and risks of laser treatment for diabetic macular oedema? 2. What are the benefits and risks of anti-vegf treatment? 3. What other treatment options are there? 1. ETDRS trials with risks and benefits of preventing visual loss 2. RESTORE/DRCR.net study showing benefits of anti-vegf Tx over laser 3. Use of steroids in diabetes Reference: Ford, Lois, Royle et al BMJ Open. Current treatments in diabetic macular oedema: systematic review and meta-analysis. 3:e doi: /bmjopen

Diabetic Learning Event: Diabetic Eye Screening and Retinopathy Case 2 : 35 yr-old Caucasian man with type-1 Diabetes for 17 years Occasional smoker FH: father had DM DH: Novorapid and Lantus insulin

3 Diabetic Learning Event: Diabetic Eye Screening and Retinopathy Case 2 : 35 yr-old Caucasian man with type-1 Diabetes for 17 years Occasional smoker FH: father had DM DH: Novorapid and Lantus insulin This patient was an inpatient on the ward having a toe amputation. He had failed to attend his past three diabetic screening appointments and was found to have the following fundal images when reviewed at the eye clinic: Visual acuity: 6/9 Both Eyes. The patient is asymptomatic regarding vision. BP: 124/82mmHg HbA1c: 14% Questions: 1. What grade of retinopathy/ maculopathy does this patient have? 2. What factors have led to progression of the retinopathy? 3. What should the target HbA1c be and how would you achieve it? 4. How can we improve attendance at diabetic eye screening of such patients? 1. Go through NSC grades 2. Talk about effects of duration of diabetes/poor glucose control 3. Target to reduce HbA1c by 1-2% per 6 months. 4. Importance of education/ signposting by other departments/opportunistic screening The patient attends the eye clinic and has been told he needs Macular and urgent Pan retinal laser treatment to both eyes. The patient would like re-assurance about the treatment and wants to know what they involve? What are the side-effects? 5. What are the benefits and risks of laser treatment for proliferative diabetic retinopathy?

4 6. What other treatment would be required if bleeding occurred from the new vessels into the vitreous gel? 7. What is the role of failsafe in diabetic screening? 5. DRS/EDTRS trials with risks and benefits of preventing severe visual loss 6. Diabetic Retinopathy Vitrectomy Study (1988)- showing benefit of early vitrectomy over conventional management in those with severe proliferative DR- After 4 years of follow-up, the percentage of eyes with a visual acuity of 10/20 or better was 44% in the early vitrectomy group and 28% in the conventional management group. Does not increase the risk of poor vision in those with severe NV. Also benefir in type 1 diabetics. 7. Failsafe is vital to prevent patients falling through the net. It is the link between the screening programme, the Hospital Eye Services and the GP and is important to monitor DNA s/ Exclusions. References: Diabetic Retinopathy Study Research Group Indications for photocoagulation treatment of diabetic retinopathy: Diabetic Retinopathy Study Report no. 14. Int Ophthalmol Clin.1987;27(4): Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Ophthalmology. 1991;98 (5 Suppl):

Diabetic Retinopathy

Diabetic Retinopathy Overview This presentation covers the following topics: Definitions Epidemiology of diabetic retinopathy Evidence for public health approaches Screening for diabetic retinopathy Health