Basic Considerations for Prevention of Blindness in Diabetes Care and Education Prof. Morsi Arab Emeritus Professor of Medicine University of Alexandria

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Basic Considerations for Prevention of Blindness
in Diabetes Care and Education Prof. Morsi
Arab Emeritus Professor of Medicine
University of Alexandria
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Age Group 10 20
30 40 50
60
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Causes of visual loss and blindness in
Diabetes - Diabetic Retinopathy ( DR) is
most common - Glucoma less
common - Cataract less common -
Vitreous hemorrhage
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The Burden of diabetes on visual abilityThe WHO
identifies DR as the leading cause of
preventable blindness and visual disability in
adults in economically developed societies
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Significant Observations in DR 1- DR takes a
long time to become manifest. During
this time it is asymptomatic 2- DR. may not be
arrested after establishment of
normoglycaemia ( bec. glycated subs.
can continue to bind to proteins after ) 3-
However , glycaemic control at early stages
is effective in controlling progression of DR

( DCCT)
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Prevalence of Diabetic Retinopathy ( DR)( The
Wisconsin Study )
all DR Prolif.DRin type 1 (onset
of DM gt30 ys) 71 23 in type 2
(onset after 30ys ) - on insulin
70 14 - no insulin
39 2
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Prevalence of DR in relation to GlycaemiaThe
DCCT ( type 1)intensified Rx reduced
progression of DR by 76 in primary
preven. cohort 54 in secondary
preven. cohort 47 progression to
severe NPDR 56 necessity for
Laser RxDCCT results show importance of both
Duration and Glucose exposure ( hyperglyceamia)
for the development of DR
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Preval. of DR in relation to Glycaemia UKPDS (
type 2)intensified Rx with improved
metaboliccontrol - risk of
worsening DR by 21 - need for
Laser Rx by 29 - Cataract
extraction by 24
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Prevalence of DR / Duration of DiabetesThe
prev. of DR is highly correlated with the
duration of DM at 5ys
at 25 ysin type 1
(10 ) ( steep rise) 100 in type
2 (25 ) almost
85
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Retinopathy in correlation with Duration of DM
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Hypertension and DRmost studies show a causal
association UKPDS Tight control of
B.P. 34 of progress DR
47 of moderate
loss
of Vis. Acuity( N.B. independent on
the degree of glycaemic control )
No specific type of anti hypertensive
medication is superior than other
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The Genetic factor in DRThere is evidence that
severity of DR is influenced by familial , and
possibly a genetic factor
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Dyslipidaemia and DRan association is found
between more severe DR and - Total
cholesterol - but not with TG
(lipid modulation by statins?
not conclusive )
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Smoking and DR Although smoking is a risk factor
in albuminuria and nephropathy , its effect
on DR is not clear
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Aspirin in DR - Anti inflam. agents did not
show effect in Rx vasc. complications
- aspirin failed to prevent dev. of DR -
aspirin can be used if indicated ( card)
without adverse effect on DR
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The Risk Factors for DRMost definitive 1-
Duration of DM 2-
High glycaemic levelLess definite 1-
Hypertension 2-
Pregnancy 3- Genetic
factor 4-
Hyperlipidaemia 5-
Close assoc. with
albuminuria
6- ? Smoking
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Screening for and follow up of DRin type 1
screen within 3-5 yrs after diag. ( onset)
( not necessary before age 10 )in
type 2 screen shortly after diagnosis Follow
up - repeat annually if no DR
- more frequently if DR is progressing
N.B. In Pregnancy -- Screen at
planning preg. or during first trimest.
Follow up through preg.
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Education for Prevention of DR ( basic
considerations ) 1- knowledge of the Risk
factors 2- control of glycaemic level
3- control hypertension 4- screen follows
up , and early intervention 5- close
observation in pregnancy 6- control serum
lipids 7- discourage smoking 8- no
restriction on aspirin ( if required for cardiac
)
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Alexandrie Palais du Montazah
Thank You