Ocular Disease as a Result of Diabetes and Aging

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? Look at this
What if it became this?
? Or this?
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Ocular Disease as a Result of Diabetes and Aging

• By Sandra

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Overview of the Eye

• Provides sight
• Eye is a ball a little over one inch in diameter
• Located in the inner orbit of a cone-shaped
  socket in skull
• Has interior and exterior
• Outer parts of the eye include eyelids,
  conjunctiva, lacrimal glands
• Primary function of exterior is to keep eye clean
• Interior of eye controls sight

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Exterior Structures of the Eye

• Eyelids Keep dust and foreign particles out of
  eye
• Conjunctiva Keeps the eye clean and lubricated
• Lacrimal Gland Produce tears to moisten eye
• Lacrimal Sac Location that leads
  to the nose into where
  
  tears drain

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Interior Structures of the Eye

• Sclera Tough tissue that composes outer layer
  of eyeball (white portion)
• Cornea Clear portion of the eye
• Uveal tract Middle layer of the eyeball,
  consisting of iris, ciliary body, and choroid
• Iris Colored portion of the eye
• Ciliary Body Portion of eye that surrounds iris
• Choroid Thin membrane in eye, giving nutrients
  to eye
• Vitreous Humor jelly-like substance that keeps
  the eyes shape
• Retina Innermost layer of eyeball wall
• Pupil Dark dot in middle of the eye that allows
  for vision

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Functions of those Structures

• Eyes power of sight comes primarily from
  interior structures
• Iris houses the pupil
• Muscles in iris cause pupil to contract or expand
  to adjust amount of light that enters eye
• Behind the pupil is a lens that is adjusted for
  clearer vision
• Vision comes from absorption of light
• Rods and cones in retina absorb light that are
  converted to colors, then converted into
  electrical signals
• Electric signals are converted into images by way
  of the optic nerve

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Effect of Diabetes on the Eyes

• Diabetes causes diseases of the bodys blood
  vessels
• Blood is supplied to retina through central
  retinal artery
• When blood vessels do not function correctly,
  nutrients cannot reach retina
• That leads to risk of developing diseases like
  diabetic retinopathy and glaucoma
• May sometimes even lead to blindness
• Diabetes is leading cause of new cases of legal
  blindness in US

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Diabetic Retinopathy

• There are three stages
• Background Diabetic Retinopathy
• Diabetic Macular Edema
• Proliferative Diabetic Retinopathy
• Affects the retina, primarily the macula
• Blood vessels blocked and small hemorrhages in
  retina
• New blood vessels microaneurysms form and
  leak
• Can cause retina to swell and damage vision
• Vessels may block blood to central vision,
  leading to permanent vision loss

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Symptoms Diagnosis of DR

• No symptoms, so early detection is key
• Diagnosis
• flourescein angiogram performed to determine
  source of leakage
• Pigmented dye injected into arm vein
• Dye is photographed 30 times within ten minute
  span
• Dilated Retinal Eye Exam
• Dilation best way to see clearly into eye
• Every two years is best for this exam

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Treatment of DR

• Laser Surgery
• Light aimed into retina to seal leaking blood
  vessels
• Also prevents further formation of abnormal blood
  vessels
• 25 minute procedure
• Only eye drop anesthesia necessary
• For Proliferative Diabetic Retinopathy
• Laser process called focal or
  gridphotocoagulation
• Seals leaking blood vessels
• Prevent further abnormal growth

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Glaucoma

• Causes gradual degeneration of optic nerve cells
  due to pressure
• Several types
• Chronic open-angle, acute closed-angle,
  low-tension, congenital
• Acute glaucoma vision loss comes rapidly, can
  be 24 hours
• Chronic open-angle most common
• Caused by open angle in front chamber of eye
• Vision loss is not as rapid
• Low-tension only the optic nerve is damage,
  pressure is normal
• Congenital inherited and affects infants

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Symptoms Diagnosis of Glaucoma

• Symptoms in the eye include
• Increased intraocular pressure due to poor
  drainage of aqueous humor
• Trabecular meshwork (drainage system) functions
  incorrectly
• Optic nerve suffers increased pressure and nerve
  fibers die
• Visible symptoms
• Short-term dimmed or fogged vision, colored ring
  around artificial lights, pain in forehead, ears,
  teeth, eye looks inflamed
• Diagnosis
• Examination with tonometer from ophthalmologist
• Check pressure in eye
• Slit lamp examines optic nerve after pupil
  dilation
• Optic disk appears indented and looks pale yellow
  lack of blood

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Treatments of Glaucoma

• Traditional medicines
• Reduce intraocular pressure
• Prostaglandins, beta blockers, miotics,
  adrenergics
• Decrease pressure in eye by reducing aqueous
  humor production
• Miotics enhance capacity of drainage system
• Laser surgery
• Laser trabeculoplasty, necessary if too much
  pressure is there
• Sparks fluid drainage by expanding existing holes
  in drainage
• Laser Iriditomy Small opening made outside iris
  for drainage
• Conventional Incisional Surgery
• New drainage system created in eye to replace old
  one

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Effects of Aging on the Eyes

• Aging makes eye more vulnerable to developing
  diseases
• Minor conditions include
• Presbyopia ability to see close objects starts
  to deteriorate
• Lens gets hard and less flexible
• Floaters pieces of vitreous humor break away
  and float in eye
• Usually pretty common in those over age of 50
  years of age
• More serious diseases include
• Cataracts, Age-Related Macular Degeneration,
  Corneal Disease

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Age-Related Macular Degenration

• Damages central vision at macula
• Most common cause of blindness in United States
• Affects Retina
• Two forms Wet AMD and Dry AMD
• Dry AMD less serious and more common 90 of
  all cases
• Fatty deposits seen under retinas light-sensing
  cells
• Supportive layer becomes smaller
• Wet AMD more serious and also more rare case
• Neovascularization occurs new blood vessel
  growth
• They can break or leak to cause damage to eye

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Symptoms Diagnosis of AMD

• Generally affect Caucasian males over age of 50
  and smokers
• Dry AMD
• Cause is unknown
• Symptoms include Distorted reading vision,
  blurred vision, distorted vision
• Wet AMD
• Symptoms include Distorted vision, quick vision
  loss, seeing colors that appear faded
• Blind spot at center of field of vision
• Symptoms of dry AMD evident, at greater extent
• Diagnosis Pupil dilation and Amsler Grid Test

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Treatments of AMD

• No treatment for dry AMD
• Treatment for wet AMD includes
• Laser photocoagulation laser heat beam seals
  broken vessels
• May lead to vision loss from blind spots
• Visudyne Therapy Two-part process
• Visudyne injected into arm and goes to spot of
  eye where blood vessels do not belong
• Laser then activates visudyne to kill abnormal
  cells
• Slows damage to retina

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Cataracts

• Characterized by clouding of eyes lens
• Almost like looking through frosted /
  yellow-tinted window
• Not a film, not caused by overuse of eye, does
  not cause irreversible blindness
• Caused by sclerosis in lens
• Lens is less transparent and thickened
• Could be caused by lifetime of exposure to
  ultra-violet radiation
• Smoking and alcohol also increase risk
• Medical problems, diabetes, and family history
  also increases risk

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Symptoms Diagnosis of Cataracts

• Symptoms
• Blurred vision, bad night vision, double vision
  in one eye
• Increased sensitivity to light
• Need brighter light for reading
• Seeing faded colors
• Diagnosis
• Check sharpness of vision with Snellen Chart
• Pupil dilation test examine lens and optic
  fibers
• Slip lamp look inside eye to see cataract up
  close

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Treatment of Cataracts

• Less severe cases
• Increased eyeglass prescription
• Eye drops can allow more light to enter eye
• More serious cases
• Three types of cataract removal surgery
• Extracapsular surgery intracapsular surgery
• Incision is made in eye, cataract is then removed
  and plastic lens, called intraocular lens,
  inserted
• Phacoemulsification
• Uses high-frequency ultrasound
• Breaks cataract apart for easy removal

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Fuchs Corneal Dystrophy

• More prevalent in women than men
• Progresses slowly and affects both eyes
• Inherited
• Affects 50 60 year-olds, but can be detected in
  30 40 year-olds
• Caused by deterioration of endothelial cells
• Lack of endothelial cells leads to bad water
  drainage
• Leads to swelling and shape-change of cornea
• Exact cause of endothelial cell loss is unknown
• Could be caused by inflammation in eye

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Symptoms Diagnosis of FCD

• No visible symptoms until later in stage of
  disease
• Vision becomes blurred and distorted
• Typically wake up with distorted and blurred
  vision
• When eyes are closed, liquid cannot be evaporated
• As day progresses, vision clears up
• Diagnosis
• Slit lamp used to magnify cornea
• Like an optical microscope
• Small bumps seen on cornea

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Treatment of Fuchs Corneal Dystrophy

• Treatments vary depending on severity of disease
• Early stages
• Salt-water eye drops to soak up excess water
  before entering cornea
• Blow hot air into eye to dehydrate it
• Soft-bandage contacts lens relieve corneal
  blisters
• More serious cases
• Corneal surgery may be necessary
• Cornea transplant to restore vision

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Prevention

• Eyes are important and provide precious sense of
  sight
• Though eye disease cannot fully be prevented, you
  can lower the risk
• Keep good health and good nutrition
• Get lots of vitamins, beta-carotene,
  anti-oxidants
• Protect eyes from sunlight and ultra-violet
  radiation
• Get eye checks frequently
• Every two years in young age
• Every year at age 30 or older
• Every six months if family history of certain
  diseases

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Works Cited
Aging and Your Eyes. Sep. 2002. AgePage.
National Institute on Aging. 19 Oct. 2004.
lthttp//www.niapublications.org/engagepages/eyes.a
spgt. Cataract. Medical Library. Jan 2003. 9
Nov 2004. lthttp//www.medem.com/medlb/article_de
taillb.cfm?article_IDZZZS XEVUF4Csub_cat119gt. C
hang, Maragret, M.B. Personal Interview. 28
Oct. 2004. Ocular Symptoms and Diagnosis.
Diabetic Eye Disease. Richmond Eye Associates.
19 Oct. 2004 lthttp//www.richmondeye.com/diab1.ht
mgt. Forrest, James, M.B. The Recognition of
Ocular Disease. 7th ed. London The Hatton
Press Ltd, 1952. Fuch's Corneal Endothelial
Dystrophy. 23 Nov. 2004. lthttp//www.wa- eyemd.
org/W_Fuch's_corneal_dystrophy.htmgt. Fuch's
Dystrophy. 2001. VisionWorks, Inc. 19 Nov.
2004. lthttp//www.visionworksusa.com/disease.as
p?d_num31gt. Harvard Medical School. The Aging
Eye. New York Simon Schuster, 2000. If You
Thought Eyeglasses Could Solve All Eye Problems,
Read On. Eye Disease. The WhyFiles. 25 Oct.
2004. lthttp//whyfiles.org/003eye/statistics.htmgt
. Vision Problems in the United States.
Bethesda National Eye Institute, 2002.