Introduction to Sports Injuries by- Dr. Anjali Rai
Diabetes melitis & eye part 2 presentation at www.eyenirvaan.com
1. DIABETES MELLITUS
& EYE – PART 2
Pradnya Gogate B. Optom,
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2. Diabetic retinopathy has four
stages:
Background diabetic retinopathy
Pre-proliferative diabetic retinopathy
Proliferative diabetic retinopathy
Advanced diabetic eye disease
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3. Background diabetic retinopathy
Microaneurysms-
In inner nuclear layer
Appear as small, round, red dots
Hard exudates-
In outer plexiform and inner nuclear layer
Distributed in circinate pattern
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4. Background diabetic retinopathy
Flame shaped
haemorrhages- follow
the course of retinal
nerve fiber layer
Dot-blot haemorrhages
– within compact
middle layers
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6. Management of background
diabetic retinopathy
Proper control of sugar level
Regular follow up
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7. Preproliferative diabetic
retinopathy
Cotton wool spots (Soft exudates)
due to capillary occlusion in retinal nerve fiber layer and
the subsequent build-up of transported material within
the nerve axons causes white and opaque appearance
IRMA’S(Intra Retinal Microvascular
Abnormalities)
Venous changes like dilatation, beading, looping
and sausage-like segmentation
Arteriolar narrowing and may cause central
retinal artery occlusion(CRAO)
large dark blot hemorrhages
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9. Management Preproliferative
diabetic retinopathy
Close follow up
Photocoagulation is usually unnecessary
unless FFA shows extensive areas of
peripheral capillary non-perfusion
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10. Proliferative diabetic
retinopathy
Neovascularisation is hallmark of PDR
NVD(new vessels at disc)
More than one quarter of retina has to be non-
perfused for NVD
NVE (new vessels elsewhere)
Starts as endothelial proliferations arising from
veins
They pass through the defects in the ILM to lie in
potential vitro-retinal space
Forms fibrovascular epiretinal membrane
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11. Proliferative diabetic
retinopathy
Recurrent vitreous haemorrhages
Fibrovascular component becomes adherent
to posterior vitreous and leaks plasma
constituents
Contraction of vitreous results in elevation of
blood vessels above the plane of retina
New vessels may regress if vitreous detaches
completely at this stage
Pulling from Partially detached vitreous
causes vitreous haemorrhage
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14. Management proliferative
diabetic retinopathy
Pan retinal photocoagulation(PRP)
Thousands(2000-3000) of spots are burned around the
peripheral retina.
Destroys the ischemic retina, decreasing the angiogenic
stimulus, leads to regression and even the complete
disappearance of the new vessels.
side effects,
peripheral vision loss
decreased night vision (from the rod photoreceptor
loss)
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16. Early Treatment Diabetic
Retinopathy Study Group (EDTRS)
Non-Proliferative Diabetic Retinopathy
Minimal NPDR
Mild NPDR
Moderate NPDR
Severe NPDR
Very Severe NPDR
Proliferative Diabetic Retinopathy (PDR)
Early PDR
High Risk (HR) PDR
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17. Early Treatment Diabetic
Retinopathy Study Group (EDTRS)
Minimal NPDR
Presence of microaneurysms only
Mild NPDR
Microaneurysms plus one or more of the
following:
Intra-retinal hemorrhages
Hard exudates away from the macula
CWS
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18. Early Treatment Diabetic
Retinopathy Study Group (EDTRS)
Moderate NPDR
Microaneurysms/ hemorrhages in at least one
quadrant plus one or more of the following:
CWS
IRMA
Venous beading
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19. Early Treatment Diabetic
Retinopathy Study Group (EDTRS)
Severe NPDR
Any one of the following (4-2-1 rule):
Intra-retinal hemorrhages - severe, in 4 quadrants
Venous beading in 2 quadrants
Moderately severe IRMA in 1 quadrant
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20. Early Treatment Diabetic
Retinopathy Study Group (EDTRS)
Very Severe NPDR
Any two of the following:
Intra-retinal hemorrhages - severe, in 4 quadrants
Venous beading in 2 quadrants
Moderately severe IRMA in 1 quadrant
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21. Early Treatment Diabetic
Retinopathy Study Group (EDTRS)
Early PDR
One or more of the following:
NVD < ¼ DD
NVE without hemorrhage
Pre-retinal or vitreous hemorrhage and NVE < ½
DD without NVD
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22. Early Treatment Diabetic
Retinopathy Study Group (EDTRS)
High Risk PDR
One or more of the following:
NVD > ¼ DD
NVD with hemorrhage
NVE > ½ DD with hemorrhage
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23. Advanced diabetic eye disease
Pre-retinal
haemorrhage(boat-shaped
haemorrhage)
Tractional retinal
detachment
Pulling away of
neurosensory retina from
RPE by avascular or
fibrovascular vitreous
membranes.
Nonvascular glaucoma
(90 days glaucoma)
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24. Management of Advanced
diabetic eye disease
Pan Retinal Photocoagulation(PRP)
Three port pars plana vitrectomy
Involves removing the vitreous humor
replacing it with saline.
removes hemorrhaged blood, inflammatory cells, and other
debris
removes any fine strands of vitreous attached to the retina
to relieve traction
Endo-laser is done
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25. Three port pars plana
vitrectomy
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26. Retinal Occlusive Diseases
Central Retinal Vein Occlusion (CRVO)
Branch Retinal Vein Occlusion (BRVO)
Central Retinal Artery Occlusion (CRAO)
Branch Retinal Artery Occlusion (BRAO)
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27. Optic Disc
Anterior Ischemic Optic Neuropathy
Diabetic Papillitis
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28. Anterior Ischemic Optic
Neuropathy(AION)
Interference with the
posterior cilliary artery supply
to anterior part of optic disc
Sudden painless loss of
vision
Altitudinal field defect
Swelling of optic disc
Flame shaped hemorrhages
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29. Diabetic Papillopathy
Mild to moderate visual loss
Ranges from mild disc swelling without
haemorrhages to
Florid swelling with capillary telangeiectesis,
nerve fiber haemorrhages, exudates, CME
with or without macular star
Treatment
Good diabetic control
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31. Glaucoma
Primary open angle glaucoma(POAG)
Neovascular glaucoma(NVG)
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32. Cranial nerves
III, IV,VI,VII
III is the commonest affected
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33. Role of optometrists
Screening and counseling of patients
Referring the patient to ophthalmologist for
investigations and treatment
Referring the patient to diabetologist for
diabetes control
Prescribing the appropriate low vision
devices,if required
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