Eye Conditions: Diabetic Retinopathy and Macular Degeneration PDF

8/25/2024 Eye Conditions: Diabetic Retinopathy and Macular Degeneration NU RS 641 F NP1 Pre pared and Presente d by Lori -Jeanne West ©Lori-Jeanne West, 2024 Rep roduction of th is mater ia l is proh ibited...

8/25/2024 Eye Conditions: Diabetic Retinopathy and Macular Degeneration NU RS 641 F NP1 Pre pared and Presente d by Lori -Jeanne West ©Lori-Jeanne West, 2024 Rep roduction of th is mater ia l is proh ibited w ith out the auth or’s co nsen t. Postin g or sharin g of these mate rials w itho ut the autho r’s con sen t is a copyright vio lation. Diabetic Retinopathy 1  8/25/2024 Overview and Presentation Non inflammatory disorder of the retina in patients with uncontrolled hyperglycemia Complaints: – Asymptomatic in early stages – Later vision changes described as progressive, painless, vision loss Physical Exam Changes in fundoscopic exam – NPDR – Microaneurysms – Intraretinal hemorrhage – Macular edema – Lipid deposits – Cotton wool spots – Venous beading and dilation – Edema – Retinal hemorrhage Diagnostics Thorough eye exam including visual acuity and status of iris, lens, vitreous, and fundus Fluorescein angiography 2  8/25/2024 Differentials History of DM, especially >10 years correlated with observable changes on fundoscopic exam Other causes of retinopathy: – Hypertensive retinopathy – Radiation retinopathy – Retinal venous obstruction Treatment Prevention of further microvascular complications: tight blood sugar control (HgbA1c less than 7%) Patients with DM should be referred to ophthalmologist upon diagnosis and followed with yearly eye exams – Laser photocoagulation for proliferative retinopathy and clinically significant macular edema – Vitrectomy for severe cases Patient with DM and HTN- tight BP control to prevent end organ damage- most often with ACE inhibitors like Lisinopril Patient Education Keep disease under optimal control – DM and HTN Lifestyle changes Importance of ophthalmological evaluation and follow up 3  8/25/2024 Macular Degeneration (AMD) Overview and Presentation Progressive disease of aging and leading cause of blindness in patients > 50 years old. Patients cannot read well, see facial details, have difficulty performing ADLs related to vision – Dry vs Wet: Dry is a slow progressive atrophy of retina, Wet is developments of new blood vessels under the retina in the macula causing sudden distortion or loss of central vision Risk factors: Caucasian, female, over 60, cigarette smoker, family history (macular degeneration gene) Physical Exam and Diagnostics Evaluate visual acuity – Vision less than 20/20 checked by the pinhole test – Evaluate external eye structures – Amsler grid – Measure contrast sensitivity – Gold Standard: Visualize the retina during dilated eye exam and look for macular changes (Drusen on the macula, pigment changes) 4  8/25/2024 Differentials Vitreous hemorrhage Retinal detachment Uveitis Retrobulbar optic neuritis Vascular occlusion Treatment No cure for AMD Referral to ophthalmologist – Thermal laser photocoagulation (wet AMD) – Injections directly into the eye (anti-VEGF) monthly or prn – Age related eye disease study (AREDS): Vitamins and Supplements: Vit C, Vit E, beta carotene, zinc, copper – Clinical trials: submacular surgery, photodynamic therapy, irradiation, antioxidants, phytochemicals Patient Education Recognize signs and symptoms of advancing disease – Self monitor with Amsler grid Smoking cessation, management of HTN and obesity Rehabilitation services Assess daily living needs and optical aids – Fall prevention in the home Discuss quality of life, assess for depression 5  8/25/2024 References Buttaro, T.M., Polgar-Bailey, P., Sandberg-Cook, J., & Trybulski, J. (2021). Primary care: Interprofessional collaborative practice (6th ed.). Elsevier. Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2022). Primary care: The art and science of advanced practice nursing and interprofessional approach (6th ed.). F. A. Davis Company. 6