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Ophthalmology Myron Handoff MD and Jay S. Duke Basic and Clinical Science Course, Section 12: Retina and Vitreous AAOhttp://www.aao.org/eyecare/news/upload/Eye-Health-Fact-Sheet.pdf -
• Recognize the importance of diabetic
retinopathy as a public health problem
• Discuss diabetic retinopathy as a leading cause
of blindness in developed countries
• Identify the risk factors for diabetic retinopathy
• Describe and distinguish between the stages of
Diabetes Mellitus is a group of diseases characterized by high blood
glucose levels. Diabetes results from defects in the body's ability to
produce and/or use insulin.
• Type 1 diabetes is usually diagnosed in children and young
adults, and was previously known as juvenile diabetes. In type 1
diabetes, the body does not produce insulin. 5% of people with
diabetes have this form of the disease.
• In Type 2 diabetes, either the body does not produce enough
insulin or the cells ignore the insulin. This is the most common
form of diabetes.
Anyone with diabetes is at risk of diabetic
Approximately 45% of diabetic have diabetic
The severity of hyperglycemia is the key
alterable risk factor associated with the
development of diabetic retinopathy
Progressive dysfunction of the retinal blood vessels
caused by chronic hyperglycemia.
• DR can be a complication of diabetes type
1 or diabetes type 2.
• Initially, DR is asymptomatic, if not
treated though it can cause low vision and
Diabetic retinopathy is responsible for 1.8
million of the 37 million cases of blindness
throughout the world .
Diabetic retinopathy (DR) is also the
leading cause of blindness
• After 20 years of diabetes, nearly 99% of
patients with type 1 diabetes and 60% with
type 2 have some degree on diabetic
• 33% of patients with diabetes have signs of
Having difficulty with fine details (e.g. when reading or
Having difficulty with outdoor travel
Experiencing visual fluctuations from hour to hour or day
Seeing images as rippled (e.g. straight lines appear bent)
Experiencing blurred, hazy or double vision
Losing some visual field
Having difficulty seeing at night or in low light
Being particularly sensitive to glare and light
Having difficulty focusing.
Any of the following:
• More than 20 intraretinal hemorrhages in each of four
• Definite venous beading in two or more quadrants
• Prominent Intraretinal Microvascular Abnormalities
(IRMA) in one or more quadrants
• And no signs of proliferative retinopathy
-Blood supply is blocked causing the eye to
signal the need for new blood vessels.
The retina sends signals so new blood vessels are created.
These blood vessels are abnormal and more likely to
hemorrhage due to the thin walls of the vessel. The walls
of these vessels are weak and soon begin to hemorrhage
At risk for serious vision loss
Any combination of three of the following four
• Presence of vitreous or preretinal hemorrhage.
• Presence of new vessels (neovascularization, NV)
• Location of NV on or near the optic disc.
• Moderate to severe extent of new vessels.
• Diabetic macular edema is the leading
cause of legal blindness in diabetics.
• Diabetic macular edema can be present
at any stage of the disease, but is more
common in patients with proliferative
The macula is responsible for central vision.
Diabetic macular edema may be
asymptomatic at first. As the edema moves
in to the fovea (the center of the macula)
the patient will notice blurry central vision.
The ability to read and recognize faces will
• Thickening of the retina at or within 500
µm of the center of the macula.
• Hard exudates at or within 500 µm of the
center of the macula, if associated with
thickening of the adjacent retina.
• Area of retinal thickening 1 disc area or
larger, within 1 disc diameter of the
center of the macula.
The best measure for prevention
of loss of vision from diabetic
retinopathy is strict glycemic
90 percent of diabetic eye disease can
be prevented simply by proper regular
examinations, treatment and by
controlling blood sugar.
Strict glycemic control
Blood pressure control
Annual eye exams
Laser photocoagulation is a therapy for
numerous retinal diseases.
Photocoagulation uses light to coagulate
tissue. When energy from a strong light source is
absorbed by tissue and is converted into thermal
energy, coagulation necrosis occurs with
denaturation of cellular proteins as temperature
rises above 65 degrees C
Laser Photocoagulation is recommended for
• Clinical significant macular edema (CSME)
• High risk Proliferative diabetic
• Ocular tumors
Laser therapy to seal leaking blood
vessels (focal laser)
Laser therapy to reduce retinal
oxygen demand (scatter laser)
Surgical removal of blood from the
Vitrectomy is surgery to remove some or all of
the vitreous humor from the eye. Anterior
vitrectomy entails removing small portions of
the vitreous from the front structures of the eye
Pars plana vitrectomy is a general term for a
group of operations accomplished in the deeper
part of the eye, all of which involve removing
some or all of the vitreous—the eye's clear
Diabetic Retinopathy is
preventable through strict
glycemic control and annual
dilated eye exams by an