|
[ Up ] [ Management drug therapy ] [ Management foot problems ] [ Management kidney problems ] [ Management eye complications ] [ Management Hypertension ] [ Management lipid disorders ] [ Management hypoglycemia ] [ Management neuropathy ]
MANAGEMENT
EYE
COMPLICATIONS
 |
Sight threatening eye disease is a serious complication of
diabetes and can often be present without visual symptoms.
| |
Early detection and appropriate management can greatly
reduce risk of visual loss.
|
All Patients with Type
2 Diabetes must have a Baseline Visual Examination
This must include :
History of visual
symptoms.
Measurement of :
-
Visual acuity
.
-
Intraocular pressure .
-
Refractive errors should always
be corrected after a period of stable
control .
-
Cataract and Glaucoma (with special focus on open angle glaucoma) are more
common in diabetics and should be actively looked for.
-
Ophthalmoscopic examination through dilated pupils.
-
Annual
fundal (retinal) photography has been recommended but this may not be necessary, or feasible in
most patients. This examination should be done at the time of diagnosis
and repeated on an annual basis. It should be carried out by a person killed in diagnosing
diabetic eye involvement.
Patients at special risk, and those who show the presence
of abnormalities, may require more frequent checkups; these
patients should be seen along with a specialist.
Patients
at special risk include.
-
Women who are
planning a pregnancy, must have a detailed eye examination.
-
All pregnant women must have a detailed eye examination for the
presence of retinopathy
at the time of diagnosis and then as frequently as warranted.
-
Patients with unexplained visual
symptoms, deterioration in visual
acuity, increased
intraocular pressure, any retinal abnormalities any other ocular
abnormality that threatens vision.
-
Patients with preproliferative retinopathy (multiple cotton wool
spots, multiple intraretinal hemorrhages, intraretinal micro vascular
abnormalities venous beading.)
-
Patients with proliferative retinopathy (retinal
neovascularisation, preretinal or vitreous hemorrhage, fibrosis,
traction retinal detachment.)
-
Macular edema (hard lipid exudates and/or retinal thickening in
side the temporal vascular arcades).
-
Presence of microalbuminuria, hypertension and smoking.
Maculopathy
 |
macular (central vision area of
retina) involvement in diabetic retinopathy is an
emergency;
| |
unless diagnosed in the very early stages and managed
adequately, it can lead to significant visual loss (central
vision loss).
| |
It is recommended that all Patients use an Amslers
Recording Chart which allows early detection of maculopathy.
|
Management strategies
for Diabetic Retinopathy.
-
Meticulous glycemic
(sugar) control.
-
Maintenance of normotension
(normal blood pressure); although association
not proven, will help in the associated
cardiovascular and renal disease states.
-
Treat
Dyslipidemias. (Lipid abnormalities)
-
Close
surveillance and early referral for
photocoagulation.
-
There are no known specific drugs which have
been proven to be of help in reducing the
progression of retinopathy, although some recent studies have shown that
ACEI
(a class of antihypertensive drug) may be some help in retarding the progression of
diabetic retinopathy.
-
Laser photocoagulation therapy is effective in reducing the
risk of further visual loss and is generally useful in
preventing blindness in diabetics with high risk proliferative
retinopathy and macular edema. There is now evidence that early
treatment with laser photocoagulation, without waiting for the
development of severe changes, may lead to a better prognosis in
preventing vision loss.
-
Vitrectomy may restore vision in some patients with recent
traction retinal detachment or vitreous hemorrhage
|
