Welcome to CNIB’s InFocus
Webinar Series
Webinar 1: Diabetic Retinopathy Basics
Presented by: Netan Choudhry M.D. FRCS(C)
Date: 25th October 2012
Start Time: 1:00 pm EST
CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Slide 2:
Diabetic Retinopathy Basics: Objectives
Participants will be able to learn about:
 Anatomy of the eye
 What is Diabetic Retinopathy
 Signs and Symptoms
 Types of Diabetic Retinopathy
 Risk Factors and Prevention
 Diagnostic Tests
 Treatment
 Frequently Asked Questions
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Slide 3:
The Anatomy of the Eye
The Retina – senses light and 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
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Slide 4:
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 macular edema (swelling of the retina)
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Slide 5:
Signs and Symptoms
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Floaters
Blurred vision
Fluctuating vision
Blank or dark areas in field of vision
Poor night vision
Vision loss
Figure 3: Normal Vision
Figure 4: How vision may be
affected by diabetic retinopathy
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Slide 6:
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
Figure 6: Fluorescein
angiogram of macula edema
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Slide 7:
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.
Figure 7: Tractional retinal detachment
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Slide 8:
Risk Factors/Prevention
Uncontrollable
 Diabetes type
 Ethnicity
Controllable
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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
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Slide 9:
Diagnostic Tests
Basic assessment
 Visual acuity test
 Tonometry: Measures pressure inside the eye
Dilated eye exam
Advanced assessment
 Fluorescin angiogram: dye is injected systemically which
demonstrates retinal circulation
Optical coherence tomography (OCT): non-invasive imaging
study that reveals retinal anatomy
Figure 9: Optical coherence
tomography (OCT)
Figure 8: Fluorescein angiogram
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Slide 10:
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
Figure 10: Laser photocoagulation
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Slide 11:
Treatments
Proliferative retinopathy
Intraocular (anti-VEGF) injections
• Reduces swelling in the retina and causes abnormal
vessels to regress
Figure 11: Intraocular injection
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Slide 12:
Treatments
Diabetic macular edema
Lucentis
• Health-Canada-approved anti-VEGF treatment
• Approved for reimbursement in Quebec only
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Slide 13:
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
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Slide 14:
Eye Connect: Diabetic Retinopathy
cnib.ca/dr
- Diabetic retinopathy basics
- Prevention
- Diagnosis and treatment
- Living with diabetic retinopathy
- Health care professionals’ page
- Patient guide
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Final - Slide 15:
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.
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CNIB In Focus Webinar 1: Diabetic Retinopathy Basics
Web: cnib.ca
Email: info@cnib.ca
CNIB Helpline: 1-800-563-2642
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