Diabetic Eye Disease

Diabetic+Eye+Disease%0d%0aEye+Care+about+My+ABCs%0d%0aA+Healthy+Eyes+Healthy+People+Project+Sponsored+in+part+by+the+AOA+and+VSP%0d%0a%0d%0a%0cDiabetic+Eye+Disease+in+Indiana%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%ef%81%ac%0d%0a%0d%0aOver+112%2c000+people+in+Indiana+alone+have+diabetic+retinopathy.+%e2%80%93+That%e2%80%99s+%7e20%25+of+diabetics.+In+Indiana%2c+%7e60%25+of+diabetics+receive+an+annual+eye+exam.+Each+year+-+%7e12%2c000+%e2%80%93+24%2c000+new+cases+of+blindness.%0d%0a%0d%0a%0cDiabetes+in+Indiana%0d%0a%0d%0a%0cDiabetic+Retinopathy+in+Indiana%0d%0a%0d%0a%0cWhere+does+it+affect+the+eye%3f%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aLens%3a+variations+in+blood+sugar+can+cause+variations+in+the+power+of+the+lens.+Uncontrolled+diabetics+are+prone+to+intermittent+blurry+vision.+Retina%3a+Diabetic+Retinopathy+is+when+the+eye%e2%80%99s+blood+vessels+become+leaky+and+can+ultimately+bleed+profusely.%0d%0a%0d%0a%0cOcular+Symptoms%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aBlurred+Vision-+As+the+power+of+the+lens+changes%2c+patients+experience+unstable+blurred+vision+that+fluctuates+over+weeks+to+months.+Diplopia-+Retinal+(macular)+edema+can+produce+a+myriad+of+optical+nuances.+Vision+Loss-+If+retina+is+damaged%2c+vision+can+be+lost+permanently.%0d%0a%0d%0a%0cWhen+does+Diabetes+start+affecting+the+Eye%3f%0d%0a%ef%81%ac%0d%0a%0d%0aTwo+determining+factors%3a+%e2%80%93+Blood+Glucose+Control%0d%0a%e2%80%93%0d%0a%0d%0aDuration+of+Diabetic+Status+%ef%81%ac+As+childhood+obesity+increases%2c+type+2+diabetes+begins+earlier.%0d%0a%0d%0a%0cWhen+does+Diabetic+Retinopathy+arise%3f%0d%0a%ef%81%ac%0d%0a%0d%0aPrevalence+of+Diabetic+Retinopathy%3a+%e2%80%93+At+Diagnosis%3a+%e2%80%93+10+years+after+Diagnosis%3a+%e2%80%93+20+years+after+Diagnosis%3a+%ef%81%ac+Type+I+%ef%81%ac+Type+II%0d%0a%0d%0a20%25+40-50%25+100%25+60%25%0d%0a%0d%0a%0cThe+Diabetic+Eye+Exam%0d%0a%ef%81%ac+%ef%81%ac+%ef%81%ac+%ef%81%ac+%ef%81%ac+%ef%81%ac+%ef%81%ac%0d%0a%0d%0aHistory+Visual+Acuity+Eye+Movement+Refraction+Intraocular+Pressure+measurement+Visual+Field+evaluation+Dilated+Retinal+examination%0d%0a%0d%0a%0cDilated+Retinal+Examination%0d%0a%0d%0aFundus+Lens+and+Slit+Lamp+Evaluation%0d%0a%0d%0aBinocular+Indirect+Opthalmoscope%0d%0a%0d%0a%0c%0cThe+importance+of+Dilation%0d%0a%0d%0aUndilated+pupil%0d%0a%0d%0aSame+Eye--+pupil+dilated%0d%0a%0d%0a%0cClinical+Classification%0d%0aMild+Nonproliferative+Diabetic+Retinopathy+%ef%81%ac+Moderate+Nonproliferative+Diabetic+Retinopathy+%ef%81%ac+Severe+Nonproliferative+Diabetic+Retinopathy+%ef%81%ac+Proliferative+Diabetic+Retinopathy%0d%0a%ef%81%ac%0d%0a%0d%0a%0cMild+and+Moderate+Nonproliferative+Diabetic+Retinopathy+Dot+and+blot+hemorrhaging+%ef%81%ac+Aneurysms+%ef%81%ac+Hard+exudates+%ef%81%ac+Clinically+Significant+Macular+Edema+(CSME)+%e2%80%93+decreased+vision%0d%0a%ef%81%ac%0d%0a%0d%0a%0cMild+Nonproliferative+Diabetic+Retinopathy%0d%0a%0d%0aDot+Hemorrhage%0d%0a%0d%0a%0cModerate+Nonproliferative+Diabetic+Retinopathy%0d%0aHard+Exudates%0d%0a%0d%0aBlot+Hemorrhages+Dot+Hemorrhages%0d%0a%0d%0a%0cSevere+Nonproliferative+Diabetic+Retinopathy+Intra+Retinal+Microvascular+Abnormalities+(IRMA)+%ef%81%ac+Cotton+wool+spots-+focal+retinal+ischemia+%ef%81%ac+Beading+and+looping+of+the+capillaries%0d%0a%ef%81%ac%0d%0a%0d%0a%0cSevere+Nonproliferative+Diabetic+Retinopathy-+Early%0d%0a%0d%0aBlot+Hemorrhages+Flame+Hemorrhages%0d%0a%0d%0aCotton+Wool+Spot%0d%0a%0d%0a%0cSevere+Nonproliferative+Diabetic+Retinopathy-+%e2%80%95pre-proliferative%e2%80%96%0d%0aBlot+Hemorrhages%0d%0aVenous+Beading%0d%0a%0d%0aIRMAs%0d%0a%0d%0aExudates+Looping+capillaries%0d%0a%0d%0a%0cProliferative+Diabetic+Retinopathy%3a%0d%0a%ef%81%ac%0d%0a%0d%0aNeovascularization-+New+blood+vessel+growth+%e2%80%93+NVI+-+Rubeosis+Iridis+%e2%80%93+NVD-+optic+disk+%e2%80%93+NVE-+elsewhere+in+the+retina%0d%0a%0d%0a%0cProliferative+Diabetic+Retinopathy%3a+NVI+%e2%80%93+neovascularization+of+the+iris%0d%0a%0d%0a%0cNVE+%e2%80%93+neovascularization+elsewhere%0d%0a%0d%0a%0cNVD+%e2%80%93+neovascularization+of+the+disk%0d%0a%0d%0a%0cSerious+Diabetic+Retinopathy%0d%0a%ef%81%ac%0d%0a%0d%0aIf+%e2%80%95neo%e2%80%96+goes+unnoticed+and+untreated%2c+it+will+ultimately+bleed.%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aBleeding+means+Blindness!%0d%0a%0d%0a%0cNew+Diagnostic+Modalities%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac+%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aOcular+Coherence+Tomography+%e2%80%93OCT+is+revolutionizing+eye+care+in+many+instances+it+can+be+used+in+place+of+IVFA+OCT+is+less+invasive+Allows+for+earlier+and+more+sensitive+diagnosis+Takes+less+time+Demonstrates+greater+anatomical+details%0d%0a%0d%0a%0cIVFA%0d%0a%0d%0a%0cIVFA%0d%0a%0d%0a%0cIVFA%0d%0a%0d%0a%0cNormal+OCT%0d%0a%0d%0a%0cDiabetic+Retinopathy+OCT%0d%0a%0d%0a%0cOCT-Printout%0d%0a%0d%0a%0cHow+is+neovascularization+treated%3f+Focal+laser+treatment+is+used+to+ablate+neo+before+bleeding+occurs.+%ef%81%ac+If+bleeding+has+occurred%2c+lasers+can+be+used+to+attempt+to+stop+the+bleeding+and+minimize+loss+of+vision.+%ef%81%ac+Laser+surgery+does+not+usually+improve+vision%2c+it+tries+to+stop+vision+from+worsening.%0d%0a%ef%81%ac%0d%0a%0d%0a%0cLaser+treatment+strategies%0d%0a%0d%0a%0cPan+retinal+laser%0d%0a%ef%81%ac%0d%0a%0d%0aLaser+treatment+is+used+to+destroy+peripheral+retina+and+decrease+the+chance+of+neo+by+decreasing+the+need+for+blood+supply.%0d%0a%0d%0a%0cNew+Treament+Options+for+PDR%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aOral+Angiogenic+agents+are+being+developed+to+be+used+in+conjunction+with+laser+treatment+There+are+two+categories+of+oral+angiogenic+treatment-one+is+for+the+prevention+of+PDR+and+the+other+for+early+PDR-PKC+inhibition+Currently+on+the+market-Arxxant+(Eli-Lilly)-a+protein+kinase+C+beta(PKC+beta)+inhibitor%0d%0a%0d%0a%0cOther+surgical+treatment%0d%0a%ef%81%ac%0d%0a%0d%0aVitrectomy%e2%80%93+Non-clearing+vitreal+bleeds+may+need+to+be+removed.%0d%0a%0d%0a%0cDiabetic+Macular+Edema%0d%0a%ef%81%ac%0d%0a%0d%0aCan+occur+at+any+stage+of+diabetic+retinopathy%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aIs+caused+by+the+leakage+of+microaneurysms%0d%0aIs+the+main+cause+of+visual+impairment+in+patients+with+Diabetic+retinopathy%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a%0cClassification+of+Diabetic+Macular+Edema%0d%0a%ef%81%ac+%ef%81%ac+%ef%81%ac%0d%0a%0d%0aPresents+as+hard+yellow+exudates+(HYE)+or+thickening+in+the+posterior+pole+Mild-some+thickening+or+HYE+in+the+posterior+pole+but+distant+from+the+center+Moderate-approaching+the+center%2c+but+not+involving+the+center%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aSevere-Involving+the+center+of+the+macula%0d%0a%0d%0a%0cDiabetic+Macular+Edema%0d%0aHard+Exudates+and+Macular+Edema%0d%0a%0d%0a(CSME)%0d%0a%0d%0aIntraocular+steroid+injections+attempt+to+reduce+edema%0d%0a%0d%0a%0cTreatment+Options+for+Macular+Edema%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aLaser+Treatment+Steroid+Implants+and+devices+to+the+posterior+segment+New+Treatment+options+for+Macular+edema+Intravitreal+injection+of+triamcinolone+acetonide-for+diffuse+diabetic+macular+edema+Fluocinolone+acetonide+intravitreal+implants%0d%0a%0d%0a%0cVision+Loss+from+Diabetic+Retinopathy%0d%0a%0d%0aNormal+or+Mild+Diabetic+Retinopathy%0d%0a%0d%0aSevere+Diabetic+Retinopathy%0d%0a%0d%0a%0cAdditional+effects+on+the+eyes%0d%0a%ef%81%ac%0d%0a%0d%0aIn+addition+to+the+damaging+effects+of+diabetes+on+the+retina%2c+diabetic+eye+disease+also+increases+the+risk+for+developing%3a%0d%0a%e2%80%93+%e2%80%93%0d%0a%0d%0aCataractsGlaucoma%ef%81%ac+NVI+can+lead+to+elevated+intraocular+pressure%0d%0a%0d%0a%0cHow+is+Diabetic+Eye+Disease+avoided%3f%0d%0a%ef%81%ac%0d%0a%0d%0aEye+Care+About+My+ABCs%0d%0a%e2%80%93+%e2%80%93%0d%0a%0d%0aHgA1c%2c+Blood+pressure%2c+Cholesterol+Eye+Exams+Diabetics+with+excellent+control+of+blood+sugar.%0d%0a%0d%0a%ef%81%ac%0d%0a%ef%81%ac%0d%0a%0d%0aAnnual+dilated+eye+exams!%0d%0a%e2%80%93%0d%0a%0d%0aUncontrolled+diabetics%e2%80%a6%0d%0a%e2%80%93%0d%0a%0d%0aDiabetics+who+have+fluctuating+blood+sugar+or+who+have+shown+signs+of+diabetic+retinopathy+may+require+more+frequent+exams.%0d%0a%0d%0a%0cHow+to+find+an+Optometrist%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aMedicare+beneficiaries+can+receive+assistance%3a+%e2%80%93+%e2%80%95Diabetes+Hotline%e2%80%9d+800-826-3947+Eye+Care+Community+Outreach+(ECCO)+%e2%80%93+Helping+Hoosiers+find+and+afford+eye+care.+%e2%80%93+Dewana-317-321-1413+%e2%80%93+Kelli-317-321-1424+Indiana+Optometric+Association+%e2%80%93+317-237-3560+American+Optometric+Association+%e2%80%93+www.aoa.org+%e2%80%95Doctor+Locator%e2%80%96%0d%0a%0d%0a%0cThanks+and+Credits%0d%0a%ef%81%ac+%ef%81%ac+%ef%81%ac%0d%0a%0d%0aAmerican+Optometric+Association+-+www.aoa.org+Vision+Service+Plan+(VSP)+%e2%80%93+www.vsp.com+Eye+Care+Community+Outreach+(ECCO)%e2%80%94%0d%0a%e2%80%93+%e2%80%93%0d%0a%0d%0aKelli+Barker%2c+MSW+and+Dewana+Allen%2c+MPH+Helping+Hoosiers+find+and+afford+eye+care.+Chief+of+Ophthalmic+Disease+Services+at+Indiana+University+School+of+Optometry+Indiana+University+-+Associate+Dean+for+Academic+Affairs+and+Student+Administration%2c+Professor+of+Optometry%2c+and+Adjunct+Professor+of+Public+Health%2c+School+of+Medicine+Indianapolis+Eye+Care+Center+Gabriele+Eye+Institute-+(574)-254-0700%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aVic+Malinovsky%2c+OD%2c+FAAO+-+photography%0d%0a%e2%80%93%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aEdwin+C.+Marshall%2c+OD%2c+MS%2c+MPH-+design%0d%0a%e2%80%93%0d%0a%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aJack+Downey%2c+OD-+Consultant%0d%0a%e2%80%93+%e2%80%93%0d%0a%0d%0aAndrew+Anderson%2c+OD-+design%0d%0a%0d%0a%0cReferences%0d%0a%ef%81%ac+%ef%81%ac+%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%ef%81%ac%0d%0a%0d%0aAmerican+Diabetes+Association+-+www.diabetes.org+Center+for+Disease+Control+%e2%80%93+www.cdc.gov+Diabetes+%e2%80%95Sight+for+Life%e2%80%96+-+funded+by+the+AOA+and+Roche+Diagnostics+Derek+Y.+Kunimoto+MD%2c+Kunal+D.+Kanitar+MD%2c+Mary+S.+Makar+MD.+Editors.+Mark+A.+Friedberg+MD%2c+Christopher+J.+Rapuano+MD.+Founding+Editors%3a+%e2%80%95The+Wills+Eye+Manual.%e2%80%96+4th+ed.+Lippincott+Williams+and+Wilkins+2004.+Indiana+State+Department+of+Health+Diabetes+Prevention+and+Control+Program.+Kaiser+MD%2c+Peter%2c+K.%2c+Neil+J.+Friedman+MD%2c+Roberto+Pineda+II+MD.+%e2%80%95The+Massachusetts+Eye+and+Ear+Infirmary+Illustrated+Manual+of+Ophthalmology.%e2%80%96+2nd+ed.+Saunders+2004.+National+Eye+Institute+-+www.nei.nih.gov%2fhealth%2fdiabetic+New+Hampshire+%e2%80%95Sight+for+Life%e2%80%96%0d%0a%0d%0a%0cQuestions%3f%3f%3f%0d%0a%0d%0aPOP+QUIZ!!!%0d%0a%0d%0a%0cQUIZ%0d%0a%ef%81%ac%0d%0a%0d%0a%231+True+or+False%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aPeople+with+diabetes+are+more+likely+than+people+without+diabetes+to+develop+certain+eye+diseases.+True.+Diabetic+eye+disease+includes+diabetic+retinopathy%e2%80%94a+leading+cause+of+blindness+in+adults%e2%80%94cataract%2c+and+glaucoma.+The+longer+someone+has+diabetes%2c+the+more+likely+he+or+she+will+develop+diabetic+eye+disease.%0d%0a%0d%0a%0c%232+True+or+False%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aDiabetic+eye+disease+usually+has+early+warning+signs.+False.+Often+there+are+none+in+the+early+stages+of+the+disease.+Vision+may+not+change+until+the+disease+becomes+severe.%0d%0a%0d%0a%0c%233+True+or+False%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aPeople+with+diabetes+should+have+yearly+eye+examinations.+True.+Everyone+with+diabetes+should+get+an+eye+examination+through+dilated+pupils+at+least+once+a+year.+Because+diabetic+eye+disease+usually+has+no+symptoms%2c+regular+eye+exams+are+important+for+early+detection+and+timely+treatment.%0d%0a%0d%0a%0c%234+True+or+False%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aDiabetic+retinopathy+is+caused+by+changes+in+the+blood+vessels+in+the+eye.+True.+In+some+people%2c+blood+vessels+in+the+retina+may+swell+and+leak+fluid.+In+other+people%2c+abnormal+new+blood+vessels+grow+on+the+surface+of+the+retina.%0d%0a%0d%0a%0c%235+True+or+False%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aPeople+with+diabetes+are+at+low+risk+for+developing+glaucoma.+False.+Glaucoma+is+almost+twice+as+likely+to+occur+in+people+with+diabetes+than+in+those+without+the+disease.+Glaucoma+can+usually+be+treated+with+medications+or+laser+or+other+surgery.%0d%0a%0d%0a%0c%236+True+or+False%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aLaser+surgery+can+be+used+to+halt+the+progression+of+diabetic+retinopathy.+True.+In+laser+surgery%2c+a+special+beam+of+light+is+used+to+shrink+the+abnormal+blood+vessels+or+seal+leaking+blood+vessels.+Laser+surgery+has+been+proved+to+reduce+the+five-year+risk+of+vision+loss+from+advanced+diabetic+retinopathy+by+more+than+90+percent.%0d%0a%0d%0a%0c%237+True+or+False%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aPeople+with+diabetes+should+have+regular+eye+examinations+through+dilated+pupils.+True.+An+eye+examination+through+dilated+pupils+is+the+best+way+to+detect+diabetic+eye+disease%2c+in+which+drops+are+used+to+enlarge+the+pupils.+This+allows+the+eye+care+professional+to+see+more+of+the+inside+of+the+eye+to+check+for+signs+of+the+disease.%0d%0a%0d%0a%0c%238+True+or+False%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aCataracts+are+common+among+people+with+diabetes.+True.+People+with+diabetes+are+twice+as+likely+to+develop+cataracts+and+to+develop+them+at+an+earlier+age+than+are+those+without+diabetes.+Cataracts+can+usually+be+treated+with+surgery.%0d%0a%0d%0a%0c%239+True+or+False%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aPeople+who+have+good+control+of+their+diabetes+are+not+at+high+risk+for+diabetic+eye+disease.+False.+Even+with+good+control+of+blood+glucose%2c+there+is+still+a+risk+of+developing+diabetic+eye+disease.+However%2c+studies+show+that+careful+management+of+blood+sugar+levels+slows+the+onset+and+progression+of+diabetic+retinopathy.%0d%0a%0d%0a%0c%2310--+True+or+False%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aThe+risk+of+blindness+from+diabetic+eye+disease+can+be+reduced.+True.+With+early+detection+and+timely+treatment%2c+the+risk+of+blindness+from+diabetic+eye+disease+can+be+reduced.%0d%0a%0d%0a%0c