educator presentation en

8/19/2019 Educator Presentation En

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Diabetes

and theEyePresented toDES chapters by the

Canadian Associationof Optometrists


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An optometrist knows your eyes inside and out OPTO.CA

Diabetes mortality

• Three million Canadians will be liin! with diabetes by the end ofthis decade.

• Diabetes contributes to the death of "#$%&& Canadians each year.

• Type ' diabetes shortens life e(pectancy by %)#& years.


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Diabetes morbidity

• Diabetes doubles the risk of stroke.

• Diabetes *uadruples the risk of heart disease.

• Diabetes is the leadin! cause of non)traumatic lower e(tremityamputations.

• Diabetes causes ++, of the new cases of end sta!e renal disease.

• Diabetes is the leadin! cause of blindness in adults a!ed '%)-%.


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Components of isual function

• li!ht ener!y• dioptric

system

• photoreceptors• neurolo!ical

processin!

• isual perception• co!nitie

functions

PHYSICAL PHYSIOLOGICAL

P S Y C H O L O G I C A L


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Ocular eects of diabetes

/#

+

+

%

0

0

-

-

"'

#. Cornea 1 tears'. A*ueous

+. 2ris

". 3ens

%. 4itreous

/. 5etina

-. 2nternal muscles

0. E(ternal muscles


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Ocular eects of diabetes

• Cornea 6 hypoesthesia$ delayed healin!$ thickness chan!es

• A*ueous 6 !lucose concentration$ refractie inde( chan!es

• 2ris 6 neoasculari7ation$ secondary !laucoma

• 3ens 6 refractie chan!es$ cataract deelopment

• 4itreous 6 lipid deposits$ hemorrha!e

• 5etina 6 edema$ ischemia$ hemorrha!e$ neoasculari7ation

• 2ntraocular muscles 6 paresis$ accommodatie dysfunction

• E(traocular muscles 6 paresis$ sudden onset diplopia


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8luctuatin! ision

• Diabetes can cause lar!e shifts in nearsi!htedness andfarsi!htedness as blood su!ar leels 9uctuate


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Diabetic lens chan!es

Transient hyperopic refractie chan!es in newly dia!nosed :uenilediabetes. ;iusti C. Swiss


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Cortical cataract


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Cataract sur!ery 6 foldable implants


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@A; capsulotomy


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Diabetic iris chan!es

• 2schemia is thou!ht to initiateretinal iris neoasculari7ation

• 4ascular endothelial !rowthfactor B4E;8 likely plays acentral role inneoasculari7ation

• ew essel !rowth at thepupillary border$ iris surfaceand iris an!le leads toformation of broascularmembranes

•


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;laucoma


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Canadian Diabetes Association'&&0 Clinical Practice ;uidelines

5etinopathy key messa!es?

• Screenin! is important for the detection of treatable disease.Screenin! interals for diabetic retinopathy ary accordin! to theindiiduals a!e and type of diabetes.

• Ti!ht !lycemic control reduces the onset and pro!ression of si!ht)threatenin! diabetic retinopathy.

• 3aser therapy reduces the risk of si!nicant isual loss.


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ormal fundus


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5etinopathy

2ndiiduals with type # diabetes

• #&&, will hae some diabetic retinopathy after #%)'& years ofdia!nosis


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5etinopathy

2ndiiduals with type ' diabetes

• '&, will hae some diabetic retinopathy at the time of dia!nosis

• %&, will hae some diabetic retinopathy after - years of dia!nosis

• 0%, will hae some diabetic retinopathy after #% years ofdia!nosis


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Dots$ blots$ microaneurysms


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5etinopathy ) macular edema

• 5emains the leadin! cause of ision loss in people liin! withdiabetes

• Can occur at any time in type # and '


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Fypertensie and diabetic retinopathy


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5etinopathy 4D


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5etinopathy 4E


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+. Screenin! for diabetic retinopathy should be performed bye(perienced professionals$ either in person or throu!hinterpretation of retinal photo!raphs taken throu!h dilated pupils.

". To preent the onset and to delay the pro!ression of diabeticretinopathy$ people with diabetes should be treated to achiee

optimal control of blood !lucose. People with abnormal lipidsshould be considered at hi!h risk for retinopathy.


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%. Patients with si!ht threatenin! diabetic retinopathy should beassessed by a !eneral ophthalmolo!ist or retina specialist. 3asertherapy andGor itrectomy andGor pharmacolo!ic interentionshould be considered.

/. 4isually disabled people should be referred for low ision

ealuation and rehabilitation.


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Diet


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3aser isioncorrection


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8loaters


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Hasal cell carcinoma


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Pteyr!ium


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5etention cyst


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Hacterial con:unctiitis


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4iral con:unctiitis 6 pink eye


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A5


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Early dry A5


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Dry 6 !eo!raphic A5


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=et A

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