Comprehensive Eye Care in Diabetes

SD-5-1

Epidemiology, Classification and Screening of Diabetic Retinopathy

sHIH-Jen CHen

Department of Ophthalmology, Taipei Veterans General Hospital School of Medicine, National Yang-Ming University, Taiwan, R.O.C.

objective: To review and update the epidemiology, classification and screeing of diabetic retinopathy (DR) and diabetic macular edema (DME).

Materials and Methods: Literatures review including epidemiological studies and the national health institute databank studies in Taiwan as well as recent studies of treatment of DME. results: Because of population growth and increase aging, prevalence of glycaemia and diabetes are rising globally. The global prevalence of any DR is 35% and 10% for vision threatening DR. The prevalence varied across different ethnic groups. Risk factors for DR included diabetes duration, HbA1c, blood pressure and type 1 DM. Classification of DR is important in order to establish adequate therapy. The International Clinical Disease Severity Scale was widely accepted for the classification of DR because it is simple to use, easy to remember, and based on scientific trials. It is a clinical examination and does not require special tests such as fluorescein angiography or optical coherent tomography (OCT). Fundus pictures, if available, are used to document, evaluate and follow the severity of DR. For screening purpose, single-field photographs centered at the macula are sufficient to identify patients with retinopathy for referral. Increase the photographic fields to 3 will be effective in determining the critical level of retinopathy for prompt referral. However, the hurdle for prevention of blindness in diabetic patients lies on screening and early detection of DR since 90% of the cases can be prevented from visual loss by proper management. The retina screening rate in patients with diabetes in Taiwan, the ways developed to improve the screening rate and decrease the time for diagnosis will be discussed in this talk.

Conclusions: Visual loss from DR is largely preventable with proper screening based upon timely application of photocoagulation or intravitreal injection of anti-vascular endothelial growth factors. Fundus photography and standardized classification of DR allowed for communication and discussion between the endocrinologists and ophthalmologists. Recent technology of digital nonmydriatic fundus camera, automatic image detection of retinal pathology and telemedicine may facilitate the screening of DR.

SD-5-2

Diabetes Mellitus and Diabetic Eye Disease

Yan-LIng CHen

Division of Endocrinology and Metabolism, Shin Kong Wu Ho-Su Memorial Hospital

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. Diabetic retinopathy is the most frequent cause of new cases of blindness among adults aged 20–74 years. During the first two decades of disease, nearly all patients with type 1 diabetes and >60% of patients with type 2 diabetes have retinopathy. . In the younger-onset group, 86% of blindness was attributable to diabetic retinopathy. In the older-onset group, in which other eye diseases were common, one-third of the cases of legal blindness were due to diabetic retinopathy.

Treatment modalities exist that can prevent or delay the onset of diabetic retinopathy, as well as prevent loss of vision, in a large proportion of patients with diabetes. The DCCT and the UKPDS established that glycemic and blood pressure control can prevent and delay the progression of diabetic retinopathy in patients with diabetes. In mild cases, treatment for diabetic retinopathy is not necessary. Regular eye exams are critical for monitoring progression of the disease. Strict control of blood sugar and blood pressure levels can greatly reduce or prevent diabetic retinopathy. In more advanced cases, treatment is recommended to stop the damage of diabetic retinopathy, prevent vision loss, and potentially restore vision.

SD-5-3

Diabetic Retinopathy – Mechanisms, Treatments, and Neuronal Protections

Ta-CHIng CHen, CHUNG-MAY YANG

Department of Ophthalmology, National Taiwan University Hospital, Taiwan, R.O.C.

Diabetic retinopathy (DR) is one of the most common complications and leading cause of blindness in both developing and developed countries. Visual impairments may origin from diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR). Breakdown of blood-retinal barrier leads to DME. Treatments, including anti-VEGF agents, have achieved better results and some recovery of vision. Progression of neovasculization and fibrosis in PDR would lead to vitreous hemorrhage, macular traction, and retinal detachment. Extended laser and surgical vitrectomy are usually inevitable in these patients. However, these procedures just treat visible vascular changes in retina rather than prevent progressions. Nowadays, more and more evidences indicate that neurodegeneration may be the primary change in DR. Diabetes disturb the interaction of neuron and vasculatures and hamper the homeostasis necessary for retinal function. Subsequent vascular changes happen and the DR progresses. Profound neurodegeneration is often the final result despite adequate treatments. These changes suggest DR as a neurovascular disorder. Potential treatments toward neuroprotection may further regress the progression of disease at an earlier stage and prevent profound vision loss.