Welcome to CNIB’s InFocus Webinar Series Webinar 1: Diabetic Retinopathy Basics Netan Choudhry M.D. FRCS(C) 25 October 2012 seeing beyond vision loss Diabetic Retinopathy Basics: Objectives Participants will learn about: • • • • • • • Anatomy of the eye Diabetic retinopathy defined Signs and symptoms Types of diabetic retinopathy Risk factors and prevention Diagnostic tests Treatment seeing beyond vision loss Anatomy of the Eye The retina – senses light & transmits images to the brain The macula – central part of the retina used to read and see fine details clearly The vitreous – clear gel fills the back of the eye and sits in front of the retina Figure 1: The human eye seeing beyond vision loss What Is Diabetic Retinopathy? • Occurs when elevated blood sugar levels cause blood vessels in the eye to swell and leak into the retina. Figure 2: Diabetic macula edema (swelling of the retina) seeing beyond vision loss Signs and Symptoms Figure 3: Normal Vision • • • • • Figure 4: How vision may be affected by diabetic retinopathy seeing beyond vision loss Floaters Blurred vision Blank or dark areas in field of vision Poor night vision Vision loss Types of Diabetic Retinopathy Early stages: Non-proliferative diabetic retinopathy (NPDR) • Damaged blood vessels in the retina begin to leak fluid and small amounts of blood and cholesterol. • Mild NPDR may not necessarily affect vision. • Results of blurred vision: Fluorescein dye leaking in macula Figure 5: Macula edema seeing beyond vision loss Figure 6: Fluorescein angiogram of macular edema Types of Diabetic Retinopathy Late stages: Proliferative diabetic retinopathy (PDR) • • • Retinal vessels close causing significant reduction in blood flow. The retina responds by growing new abnormal vessels. Can affect both central and peripheral vision. Vitreous hemorrhage New blood vessels bleed into vitreous cavity. Tractional retinal detachment Scar tissue can shrink causing the retina to detach and result in vision loss. More severe vision loss occurs if the macula is detached. seeing beyond vision loss Figure 7: Tractional retinal detachment Risk Factors/Prevention • Diabetes type • Ethinicity • • • • • High blood sugar Smoking High blood pressure High cholesterol Obesity Early detection via eye exams is paramount Type 1 diabetes: within 5 years of diagnosis, then annually Type 2 diabetes: at time of diagnosis, then annually Gestational diabetes: within 1st trimester seeing beyond vision loss Diagnostic Tests Basic assessment • Visual acuity test • Tonometry: Measures pressure • inside the eye Dilated eye exam Advanced assessment • Fluorescein angiogram: dye is • injected systemically which demonstrates retinal circulation Optical coherence tomography (OCT): non-invasive imaging study that reveals retinal anatomy seeing beyond vision loss Figure 8: Fluorescein angiogram Figure 9: Optical coherence tomography (OCT) Treatments Proliferative retinopathy Laser surgery • Microscopic thermal laser burns are made in the retina • Shrinks and prevents abnormal new blood vessel growth, and stops leaking of blood vessels • Can reduce risk of further vision loss by 50% • Also recommended to treat macular edema seeing beyond vision loss Figure 10: Laser photocoagulation Treatments Proliferative retinopathy Intraocular (anti-VEGF) injections • Reduces swelling in the retina and causes abnormal vessels to regress Figure 11: Intraocular injection seeing beyond vision loss Treatments Diabetic macular edema Lucentis • • Health-Canada-approved anti-VEGF treatment Approved for reimbursement in Quebec only seeing beyond vision loss Treatments Advanced proliferative retinopathy Vitrectomy • Cloudy vitreous is removed and replaced with a clear solution that mimics the normal eye fluids • Allows light rays to focus on the retina again Figure 12: Pars plana vitrectomy seeing beyond vision loss Eye Connect: Diabetic Retinopathy cnib.ca/dr - seeing beyond vision loss Diabetic retinopathy basics Prevention Diagnosis and treatment Living with diabetic retinopathy Health care professionals’ page Patient guide CNIB Contacts and Resources • CNIB website: cnib.ca • Toll-free CNIB Helpline: 1-800-563-2642 • Email: info@cnib.ca Production of this material has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada. seeing beyond vision loss Q&A Session seeing beyond vision loss CNIB In Focus Webinar Series • Webinar 2: Diabetes Management with Vision Loss When: 13th November @ 1:00pm EST • Webinar 3: Supporting Your Patients with Vision Loss: Practical Tips and Strategies When: 15th November @ 1:00pm EST • Webinar 4: Adjusting to Vision Loss When: 21st November @ 1:00pm EST cnib.ca/dr info@cnib.ca seeing beyond vision loss