Dr David Squirrell. Consultant Ophthalmologist Greenlane Hospital Auckland. 8:20-8:35 Diabetic Retinopathy - So What's New?
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1 Dr David Squirrell Consultant Ophthalmologist Greenlane Hospital Auckland 8:20-8:35 Diabetic Retinopathy - So What's New?
2 Diabetic Retinopathy: so whats new in 2018?
3 Diabetes no longer leading cause of blindness thanks to screening and new treatments
4 Basics.
5 Pathogenesis. Capillary wall Damage Capillary Closure. ISCHAEMIA Capillary wall Damage Capillary permeability: OEDEMA
6 Pathogenesis. Capillary wall Damage Capillary Closure. ISCHAEMIA Endothelial Growth factors Capillary wall Damage Capillary permeability: OEDEMA
7 Pathogenesis. Capillary wall Damage Capillary Closure. ISCHAEMIA Fibrovascular proliferation Endothelial Growth factors Capillary wall Damage Capillary permeability: OEDEMA
8 Pathogenesis. Capillary wall Damage Capillary Closure. ISCHAEMIA Fibrovascular proliferation ADVANCED RETINOPATHY Endothelial Growth factors Capillary wall Damage Capillary permeability: OEDEMA
9 Proliferative DR Severe Non proliferative DR Moderate Non proliferative DR Mild Non proliferative DR No Diabetic retinopathy
10 Proliferative DR Severe Non proliferative DR Moderate Non proliferative DR Mild Non proliferative DR No Diabetic retinopathy
11 Capillary wall Damage Capillary permeability: OEDEMA Diabetic Maculopathy Endothelial Growth factors
12 Capillary wall Damage Capillary permeability: OEDEMA Diabetic Maculopathy Endothelial Growth factors
13 Capillary wall Damage Capillary permeability: OEDEMA Diabetic Maculopathy Endothelial Growth factors
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19 Treatment Capillary wall Damage Capillary Closure. ISCHAEMIA Fibrovascular proliferation ADVANCED RETINOPATHY Glucose, BP Endothelial Growth factors Capillary wall Damage Capillary permeability: OEDEMA Diabetic Maculopathy
20 Treatment Capillary wall Damage Capillary Closure. ISCHAEMIA Fibrovascular proliferation ADVANCED RETINOPATHY Glucose, BP Endothelial Growth factors LASER Capillary wall Damage Capillary permeability: OEDEMA Diabetic Maculopathy
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28 Traditional Approach: ( ) 1. Optimise control.
29 Traditional Approach: ( ) 1. Optimise control. 2. Laser treatment
30 Diabetic eye clinic. Laser: Yes/No
31 Todays approach: 1. Personalised care (Big Data).
32 Todays approach: 1. Personalised care (Big Data). 2. AntiVEGF treatment
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34 The development of Mild non proliferative diabetic retinopathy is a significant event representing end organ damage.
35 1% Increase in HbA1C 14% increase in risk of progression to PDR. HbA 1 c 12% HbA 1 c HbA 1 c 8%
36 Every 1% HbA 1 c = 10% risk of progression to PDR HbA 1 c 12% HbA 1 c HbA 1 c 8%
37 HbA 1 c 12% AND foot ulcers. HbA 1 c 12%
38 Stage of retinopathy 6% HbA1c 12%
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40 Treatment of diabetic retinopathy and maculopathy. Capillary wall Damage Capillary Closure. ISCHAEMIA Fibrovascular proliferation ADVANCED RETINOPATHY Glucose, BP Endothelial Growth factors LASER Capillary wall Damage Capillary permeability: OEDEMA Diabetic Maculopathy
41 Treatment of diabetic retinopathy and maculopathy. Capillary wall Damage Capillary Closure. ISCHAEMIA Fibrovascular proliferation ADVANCED RETINOPATHY Glucose, BP Endothelial Anti VEGF Growth factors Capillary wall Damage Capillary permeability: OEDEMA Diabetic Maculopathy
42 Vision 6/36
43 4 antivegf injections (avastin). 6/18
44 4 antivegf injections (avastin). 6/18 7 antivegf injections (avastin). 6/9
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47 Which antivegf and Protocol T
48 Which antivegf and Protocol T
49 Protocol I: VA outcomes at 5 years. RbZ groups Median number of injections Year 1 Year 2 Year 3 Year 4 Year 5 Anti VEGF
50 Protocol I: VA outcomes at 5 years. RbZ groups Median number of injections Year 1 Year 2 Year 3 Year 4 Year 5 Anti VEGF
51 Protocol I: VA outcomes at 5 years. RbZ groups Median number of injections Year 1 Year 2 Year 3 Year 4 Year 5 Anti VEGF
52 Protocol I: VA outcomes at 5 years. RbZ groups Median number of injections Year 1 Year 2 Year 3 Year 4 Year 5 Anti VEGF
53 The numbers game. Each patient requires on average 8 treatments in year 1, 2 in year 2 and 1 in year patients: 800 treatment episodes in year treatment episodes year 3 and beyond.
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58 Small improvements in a persons diabetic control can pay big dividends over time. Mild NPDR is not MILD, it represents end organ damage Outcomes from diabetic eye disease have improved hugely in the past 5 years. David Squirrell But treatment is, at least in the first 2 years, more intensive for the patient and the provider.
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We know diabetes is a common and growing problem as well as the leading cause
ebook A GAME-CHANGER IN DIABETIC RETINOPATHY Early diagnosis and management guidance using objective, functional vision testing. by STEVEN M. SILVERSTEIN, MD We know diabetes is a common and growing problem
Study of correlation of severity of diabetic retinopathy with levels of haemogloelbin A1c in patients with type II Diabetes Mellitus
Original article: Study of correlation of severity of diabetic retinopathy with levels of haemogloelbin A1c in patients with type II Diabetes Mellitus 1Dr Apoorva*, 2 Dr Sabhia Jan 1Senior Resident, 2