Diabetic Eye Disease Treatments

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Questions and Answers

What is the function of photoreceptors in the eye?

Creating shadows in the visual field

Converting light rays to electrical impulses (correct)

Supporting foveal detachments

Blocking vision in certain areas

What visual issue indicates the presence of a macular hole stage 1?

Small macular hole (correct)

Complete blind spots

Distorted vision

Blurry peripheral vision

What is the expected vision for someone with stage 1 macular holes?

20/20

20/80

20/40 (correct)

20/60

In stage 2 of a macular hole, what happens to the vitreous gel?

It continues to pull on the edges of the hole Signup and view all the answers

What type of vision issue is common in someone with advanced macular hole stages?

Severely affected central and detailed vision Signup and view all the answers

What kind of vision issues may worsen over time and require medical assessment?

Drastic changes in vision Signup and view all the answers

Which of the following is a sign of a macular hole?

Wavy or distorted straight lines Signup and view all the answers

What type of macular hole involves a full-thickness defect in the retina?

Stage 3 macular hole Signup and view all the answers

What is a common expected vision outcome for someone with a Stage 4 full-thickness macular hole?

20/200 Signup and view all the answers

Which stage indicates the presence of subretinal fluid around a full-thickness macular hole?

Stage 4 Signup and view all the answers

What characteristic describes a trauma-related macular hole?

Linked to a concussive blow to the head Signup and view all the answers

Which stage of an idiopathic related macular hole shows that the retina is tightly connected to the vitreous?

Stage 1 Signup and view all the answers

What is the primary purpose of bevacizumab (Avastin) in treating diabetic macular edema?

To prevent worsening of the condition Signup and view all the answers

In which scenario might macular edema surgery have a poor prognosis?

If vision is worst from macular edema before surgery Signup and view all the answers

What occurs during the natural aging process of the vitreous gel?

Liquefies and shrinks Signup and view all the answers

What is likely to accompany a full-thickness macular hole in Stage 4?

Painless total loss of central vision Signup and view all the answers

What treatment is typically the choice for cases not responding to anti-VEGF and steroids?

Panretinal photocoagulation (PRP) Signup and view all the answers

What stage indicates a complete separation of the vitreous from the macula?

Stage 4 Signup and view all the answers

What is the role of panretinal photocoagulation (PRP) in the treatment of diabetic retinopathy?

To shrink abnormal blood vessels Signup and view all the answers

What is a defining feature of Stage 3 in idiopathic related macular holes?

Vitreous pulling the retina, creating tension Signup and view all the answers

Which of the following is an important aspect of monitoring patients at risk for diabetic retinopathy?

Comprehensive eye examinations Signup and view all the answers

What is the main benefit of intensive glucose control in type 1 diabetes regarding eye health?

Decreased incidence and progression of diabetic retinopathy Signup and view all the answers

Which condition is indicated for prompt referral during a dilated retinal examination?

Severe nonproliferative diabetic retinopathy Signup and view all the answers

What defines recalcitrant cases of diabetic macular edema?

Stubborn cases that do not respond to treatment Signup and view all the answers

What is the primary cause of central visual function loss in stress and CSR?

Irreversible fibrous scarring or geographic atrophy Signup and view all the answers

Which age group is most commonly affected by hypertension in the macular area?

Patients over 55 Signup and view all the answers

What type of visual distortion may a patient with dry AMD experience?

Metamorphopsia, where straight lines appear wavy Signup and view all the answers

What are drusen associated with regarding dry AMD?

Accumulation under the macula leading to retinal deterioration Signup and view all the answers

What is the relationship between retinal thinning and vision loss in dry AMD?

Vision loss is proportional to the location and degree of retinal thinning Signup and view all the answers

Which of the following symptoms is NOT typically associated with dry AMD?

Sudden complete vision loss Signup and view all the answers

Dry AMD is referred to as a non-exudative condition. What does non-exudative mean?

It does not involve leakage of fluids from blood vessels Signup and view all the answers

What happens to visual acuity in dry AMD as the condition progresses?

It can drastically decrease by two levels or more Signup and view all the answers

What is the most common route for fluid drainage in the eye?

Through the trabecular meshwork Signup and view all the answers

What is a strong risk factor for developing glaucoma?

High eye pressure Signup and view all the answers

Which of the following symptoms is common in advanced stages of glaucoma?

Tunnel vision Signup and view all the answers

Which type of glaucoma is characterized by a closed or narrow angle between the iris and cornea?

Angle-closure glaucoma Signup and view all the answers

What commonly happens to the lens in the eye with age?

It becomes larger Signup and view all the answers

Which of the following is a potential risk factor for glaucoma?

High myopia Signup and view all the answers

What indicates a medical emergency related to eye health?

Intense eye pain and nausea Signup and view all the answers

What defines pigmentary glaucoma?

Accumulation of pigment cells in drainage channels Signup and view all the answers

What is an example of a factor that decreases aqueous secretion in the eye?

Activation of alpha-2 receptors Signup and view all the answers

Which of the following describes traumatic glaucoma?

Triggered by eye injuries causing internal bleeding Signup and view all the answers

Study Notes

Bevacizumab (Avastin)

Is often administered in an outpatient department or eye clinic
If vision is worsened due to macular edema before surgery, prognosis may not be restored. However, it can prevent the worsening of the condition.

Triamcinolone

Administered intravitreally (injected into the eye); a corticosteroid used in the treatment of diabetic macular edema.
Is an intraocular steroid injection.

Glucose Control

The Diabetes Control and Complications Trial found that intensive glucose control for patients with type 1 diabetes reduced the occurrence and progression of diabetic retinopathy.
The same principles may apply to type 2 diabetes.

Grid Laser Photocoagulation

Treatment of choice for cases not responding to anti-VEGF and steroids
Used for diffuse clinically significant diabetic macular edema.
Used for “recalcitrant” (Stubborn) cases, DM Ret

Panretinal Photocoagulation (PRP)

Laser treatment, also known as scatter laser treatment, can shrink abnormal blood vessels.
Areas of the retina away from the macula are treated with scattered laser burns.
The light-sensitive tissue in the back of the eye contains specialized cells called photoreceptors.
Photoreceptor cells are responsible for converting light rays to electrical impulses to the brain.

Optometric Management

Comprehensive Eye Examination should include close monitoring for patients suspected to have or at risk of developing diabetic retinopathy.
Dilated retinal examination is also recommended.
Refer patients with any level of macular edema, severe nonproliferative diabetic retinopathy (a precursor of proliferative diabetic retinopathy) or complete blind spots, large shadows, or something “blocking” the vision in a certain area.

Noticeable Vision Issues That Worsen Over Time

Drastic changes in a short period of time are cause for concern.

Macular Hole

Stages of Macular Hole

Stage 1: Known as foveal detachments, the first indication of a small macular hole. About half of all stage 1 macular holes will progress into a worsened state without treatment. Expected vision 20/40.
Stage 2: Partial-thickness holes. The vitreous gel continues to pull on the edges of the hole; it's more likely to continue and require medical intervention. Distorted vision.
Stage 3: A full-thickness hole exists. The central and detailed vision has become severely affected. See a small black patch “missing patch” in the center of the vision. It is still attached with partial vitreomacular adhesion/traction. Expected vision 20/160.
Stage 4: A full-thickness macular hole exists with a complete separation of the vitreous from the macula and the optic disc. The posterior vitreous detaches. Expected vision 20/200.

Types of Macular Hole and Etiology

Trauma-Related Macular Hole: Thought to be linked to a concussive blow delivered from the opposite site of the head. As a result, the macula ruptures at its thinnest point.
Idiopathic Related Macular Hole: The retina is connected tightly to the vitreous, a layer surrounding the interior of the eye that is filled with vitreous gel. The vitreous is constructed of millions of very fine intertwined fibers. As we age, the vitreous gel begins to liquefy and/or clump and shrink. This causes the vitreous to pull to the side as the gel and vitreous sac contracts. The retina is attached to the vitreous, and when the vitreous shrinks, it pulls the retina and creates a hole at the thinnest part of the macula.

Central Serous Retinopathy (CSR)

Usually occurs in patients over age 55
Results in progressive, irreversible loss of central visual function from either fibrous scarring or diffuse, geographic atrophy of the macula.

Classification

Dry AMD (non-vascular/non-exudative type): Deterioration of the retina associated with the formation of small yellow deposits, known as drusen (under the macula). This leads to a thinning and drying out of the macula causing it to lose its function. The amount of central vision loss is directly related to the location and amount of retinal thinning caused by the drusen. Dry AMD is called non-neovascular AMD and non-exudative AMD because it does not involve the exuding that is leakage of fluids from blood vessels.

Symptoms

Dry AMD (non-vascular/non-exudative type): Distorted (fuzzy) vision in the form of metamorphopsia. A grid of straight lines appears wavy and parts of the grid may appear blank. Extreme glare, photophobia, and visual acuity drastically decreasing (two levels or more), from 20/20 to 20/80.
Nonexudative macular degeneration: Blurred vision.
Open-Angle Glaucoma: “Open-angle” means that the angle where the iris meets the cornea is as wide and open.
Angle-Closure Glaucoma: A less common form of glaucoma. Caused by blocked drainage canals. Has a closed or narrow angle between the iris and cornea. Occurs when the drainage angle in the eye (formed by the cornea and the iris) closes or becomes blocked.

Open-Angle Glaucoma

Strong Risk Factors: High eye pressure, Family history of glaucoma, Age 40 and older for African Americans.
Potential Risk factors: High myopia (very severe nearsightedness), Diabetes, Eye surgery or injury, High blood pressure, Use of corticosteroids.
Symptoms: Gradual loss of peripheral vision, Tunnel vision in the advanced stages.

Angle-Closure Glaucoma (Medical Emergency)

Demands immediate medical attention: Intense pain in your eye, Nausea, Red eyes, Blurred vision.
Risk Factors: Age 40 and older, Family history of glaucoma.

Pigmentary Glaucoma

This is a type of open-angle glaucoma that typically develops during early or middle adulthood.
It involves changes in the pigment cells that give color to the iris.
Cells build up in the channels that drain fluid from the eye, they can affect the normal flow of fluids in the eye.

Traumatic Glaucoma

Caused by injuries that “bruise” the eye (called blunt trauma) and injuries that penetrate the eye.
Causes bleeding inside the eye. An excess amount of blood, plasma and debris can accumulate and clog the drainage system.

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Description

This quiz covers various treatment options for diabetic eye disease, including medications such as Bevacizumab and Triamcinolone, as well as procedures like laser photocoagulation. Understand the importance of glucose control and the implications of different therapies for managing diabetic macular edema. Test your knowledge of these critical interventions!