By Dnyaneshwar bhagwan potfode

1. Treatment options for
Diabetic Eye Disease
Michael Eckstein
Pune 2019

2. Complications affect most parts of the
eye
•Cornea
•Lens
•Optic Nerve
•Cranial nerves
•Secondary effects- e.g. rubeotic glaucoma

4. Why does it cause visual loss
and how does it present?
•Maculopathy
•Vitreous haemorrhage
•Tractional retinal detachment
•Other- cataract, glaucoma

5. Management of diabetic
retinopathy
PREVENTION
•Surveillance / screening / education
•Medical management- diet, sugar and BP control
INTERVENTION
•Laser
•Intravitreal Anti VEGF drugs / steroids
•Retinal Surgery

6. Medical management
• Improve control of blood sugar
• treat hypertension
• treat obesity, dietary advice
• stop smoking
• Extra vigilance during pregnancy
• attend screening

7. Health Education, Diet and Control
•improved blood glucose / blood pressure
control
•reduced risk of diabetic eye disease by 1/4
•reduced risk of severe visual impairment by
more than 1/2
•kidney damage by 1/3
•stroke by 1/3

8. Treatment options
•Monitor with dilated eye exam and check
vision
•Capture fundal image and use telemedicine
•Know when to refer and what patient should
expect
•Options once referred
•Laser
•Anti VEGF agents
•Surgery
•Control of secondary problems e.g. glaucoma

9. Treatment options
• Monitor / screen with dilated eye exam and check vision

10. Treatment options
• Capture fundal image and use telemedicine

11. Focal laser

12. Panretinal laser

13. Intravitreal anti-VEGF and steroids for
maculopathy

14. Surgery

16. When to refer?
•Do you have any mechanism for telemedicine?
•Sudden onset reduced vision- look for red reflex- if
none then refer within weeks. If good red reflex
consider other causes and refer as soon as possible
•Gradual progressive reduced vision not corrected
with glasses/pinhole - refer within months

17. Summary
•Have I educated the patient and relatives?
•Have I checked the vision?
•Have I explained they need to have the eyes
checked every year?
•If I find something wrong what are my options?
•Once they have had treatment don’t forget to
follow them up