diagnosis & management of diabetic eye disease paul chous, m.a., o.d., f.a.a.o. specializing in...
TRANSCRIPT
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Diagnosis & Diagnosis & Management of Management of
Diabetic Eye DiseaseDiabetic Eye Disease
Paul Chous, M.A., O.D., F.A.A.O.Paul Chous, M.A., O.D., F.A.A.O.Specializing in Diabetes Eye Care & EducationSpecializing in Diabetes Eye Care & Education
Part 3Part 3
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CataractCataract
Hyperglycemia leads to sorbitol Hyperglycemia leads to sorbitol accumulation via aldose reductase accumulation via aldose reductase (the polyol pathway)(the polyol pathway) True diabetic “snowflake” cataractsTrue diabetic “snowflake” cataracts
Typical age-related cataracts Typical age-related cataracts develop prematurely due to AGE develop prematurely due to AGE formationformation Decreased elasticity of lens proteins Decreased elasticity of lens proteins
causes premature presbyopia and, causes premature presbyopia and, eventually, loss of tranparencyeventually, loss of tranparency
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Diabetic “Snowflake” Cortical Cataract
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Nuclear Sclerotic Cataract – 52 yo diabetic
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The Maillard Reaction
Advanced Glycation Endproducts:AGEs – they’re what’s for dinner
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Cataract - ManagementCataract - Management Improve & stabilize blood glucoseImprove & stabilize blood glucose
A1c < 6.5% (ideally)A1c < 6.5% (ideally) Strive for a low standard deviationStrive for a low standard deviation
Phacoemulsification when prudent or Phacoemulsification when prudent or necessarynecessary Much higher risk of post-operative CME Much higher risk of post-operative CME
and worsening retinopathyand worsening retinopathy Always address retinopathy prior to Always address retinopathy prior to
surgerysurgery
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Diabetic KeratopathyDiabetic Keratopathy
Hyperglycemia & corneal sensory Hyperglycemia & corneal sensory neuropathy weaken hemidesmosomal neuropathy weaken hemidesmosomal attachments between the basal epithelium attachments between the basal epithelium and its basement membraneand its basement membrane PEK, Erosions, Neurotrophic Keratitis & PEK, Erosions, Neurotrophic Keratitis &
UlcerationUlceration
Increased tear osmolarity and lacrimal Increased tear osmolarity and lacrimal autonomic neuropathy result in dry eyeautonomic neuropathy result in dry eye
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Photonic Colloidal Crystalline Array
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Diabetic Keratopathy
Prevalence of Dry Eye Syndrome and use of artificial tears is significantly
higher amongst patients with diabetes and with a family Hx of diabetes
Optometry. 2006 Nov;77(11):554-8
Am J Ophthalmol. 2005 Mar;139(3):498-503
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Diabetic Neurotrophic Ulcer
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Keratopathy - ManagementKeratopathy - Management
Improve & stabilize blood glucoseImprove & stabilize blood glucose Be careful with contact lenses & Be careful with contact lenses &
corneal refractive surgeriescorneal refractive surgeries Avoid vigorous eye rubbingAvoid vigorous eye rubbing NP tears, plugs, immunomodulators, NP tears, plugs, immunomodulators,
bandage SCLs, etc. as indicatedbandage SCLs, etc. as indicated Beware infectionBeware infection
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Key PointsKey Points
Diabetes and diabetic eye Diabetes and diabetic eye disease are epidemicdisease are epidemic
Ocular complications are myriad Ocular complications are myriad and associated with large blood and associated with large blood vessel diseasevessel disease
State-of-the-art care is evolving State-of-the-art care is evolving rapidlyrapidly
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“The only thing to dowith good advice is topass it on to others…
It is of absolutely nouse to oneself.”
- Oscar Wilde