Ocular Complications of Diabetes MellitusDr. Hj Abdul Mutalib OthmanConsultant Ophthalmologist and Head of Department Department of Ophthalmology Queen Elizabeth HospitalKota Kinabalu

Common eye problem in diabeticsFluctuation in vision- Indicates poorly control blood sugar

Cataract

Diabetic retinopathyMaculopathy

Glaucoma

Cataract

Normal retina

Background: Diabetic RetinopathyWorldwide prevalence: 3 6%Malaysia (NES-1996) prevalence: 14.6%Major cause of blindnessNo early visual symptomsScreening at primary health care levelAwareness, skills and coordination

Background: What is the natural history of Diabetic Eye Disease?Hyperglycemia -> microangiopathySeveral Stages -> frequently highly complicated situation / multisystemic Major Risk Factors: Duration of diabetes, poor control, end-organ damageAffect the arterioles -> ischemic manifestations & its complications

Non proliferative diabetic retinopathy(NPDR)leaking vessels

Gradual reduction of vision

Distorted image

Treatment focal laser

Moderate NPDR

Severe NPDR

maculopathy

Proliferative diabetic retinopathyOften no symptoms till the blood vessels rupture (considered late)

Floaters, spider web, fly

Sometimes severe darkness of vision

Rarely pain (in advanced late stage)

Proliferative diabetic retinopathy (PDR)Occlusion of vesselsLoss of nourishment to the retinaRespond by building new, abnormal FRAGILE vesselBurst easily Vitreous hemorrhageCreate scar tissue in the eye tractional retinal detachment

PDRNew vessels

PDRNew vessels

Tractional retinal detachment

Tractional retinal detachment

New vessels at iris

PREVENTION IS BETTER THAN CURE

Management of Proliferative diabetic retinopathy and MaculopathyLASER Treatment (panretinal photocoagulation)

PREVENTIONTo preserve vision, not to improve it

Multiple sessions

Laser Surgery the purposeNPDR stop leaking prevent further damage by edema

PDR stop growth of bad new vessels prevent vitreous hemorrhage

Laser SurgeryOut patient procedure

No need to fast

After completion can go home and resume normal activity

Laser Surgery

Sit in front of a machineEye will be numbed by anaesthetic eye dropA special lens will be inserted on top of eyeLaser is then delivered hear a clicking soundMay take few minutes to one hour

Laser surgery objectivesMain aim of treatment to protect deterioration of vision

If retinopathy left untreated, progression to blindness is higher

Recommendations for ScreeningAll patients with diabetes mellitus: At diagnosis and annually basisAll patients with visual symptoms

Proper documentation of screening scheduleCombined clinicsComprehensive care

Detection of Diabetic Retinopathy

Asymptomatic in the early stage

Comprehensive screening:primary health care levelmeasurement of VAfunduscopy

High sensitivity and specificity

Criteria for referral to OphthalmologistAny evidence of DR i.e. dot and blot hemorrhages, hard exudates or cotton-wool spotsEstablished visual symptomsTreated by Ophthalmologist beforeAbsconded Ophthalmologist f/u

Urgency for referralDR with associated cataractMaculopathy with or without visual reductionPDR with or without visual reductionPDR with complicationsAny unexplained reduction in visual acuity or symptoms

Medical Management of DRControl of blood sugarHypertensionKidney diseasePregnancy PubertySmokingExerciseWeight reductionLipidsAnaemia

Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer

Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer

Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer

Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer

Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer

Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer

Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is importantDont forget the eyeDont hesitate to refer

Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer

Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer

Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer

Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer

Take Home MessageDiabetes can cause blindnessNo symptom in its early stageBlindness is preventable and may be irreversibleDuration of DM is the most important risk factorsLife time eye check upRegular ScreeningLaser may be neededLaser is mainly to prevent further progressionControl of blood sugar is important Dont forget the eyeDont hesitate to refer

Thank you