“Prevention of Blindness” Is diabetic retinopathy a preventable disease? By Amr ElKamshoushy,...
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Transcript of “Prevention of Blindness” Is diabetic retinopathy a preventable disease? By Amr ElKamshoushy,...
![Page 1: “Prevention of Blindness” Is diabetic retinopathy a preventable disease? By Amr ElKamshoushy, MD.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649c9b5503460f94958a1a/html5/thumbnails/1.jpg)
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““Prevention of Prevention of BlindnessBlindness””
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Is diabetic Is diabetic retinopathy a retinopathy a
preventable disease?preventable disease?
By
Amr ElKamshoushy, MDAmr ElKamshoushy, MD
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Diabetic retinopathy is the Diabetic retinopathy is the leading cause of blindness leading cause of blindness
in industrialized world.in industrialized world.
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• Diabetic retinopathy after 20 Diabetic retinopathy after 20 years of DM:years of DM:
Type 1 Type 1 99%99%
Type 2 Type 2 60%60%
(WESDR)(WESDR)
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• After 20 years of DM:After 20 years of DM:
Younger onset patients (<30 yrs at Younger onset patients (<30 yrs at diagnosis) diagnosis) 3.6%3.6% Legally blindLegally blind
Older onset patients (≥30 yrs at Older onset patients (≥30 yrs at diagnosis) diagnosis) 1.6%1.6% Legally blindLegally blind
(WESDR)(WESDR)
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Legal blindness attributable to Legal blindness attributable to DR:DR:
Younger-onset group Younger-onset group 86%86%
Older-onset group Older-onset group 33%33%
(WESDR)(WESDR)
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Is diabetic Is diabetic retinopathy a retinopathy a preventable preventable
disease?disease?
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YESYES
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With early detection and timely applied laser treatment we can intervene in the natural course of diabetic retinopathy and prevent 95-98% of the vision loss due to diabetes.
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HOWHOW??
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Through simple yet very important health messages
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First Message
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““It is mandatory to have a It is mandatory to have a fundus examination of every fundus examination of every diabetic patient taken every diabetic patient taken every year with proper referral”year with proper referral”
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WhereWhere??
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Screening examination in the office of the GP or the diabetologist where the patient already goes regularly.
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Timing of first dilated ophthalmologic examination:
Age of onset of Age of onset of diabetesdiabetes
First examinationFirst examination
0-30 yrsBy 5 years after onset
Not before puberty
Over 30 yrsOnce diagnosed
While pregnantDuring first trimester
Following AAO preferred practice pattern
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Recommended follow up schedule:
Findings on first examinationFollow upNone to minimal retinopathyAnnual
Mild-to-moderate NPDR / no macular edema6-12 m
Mild-to-moderate NPDR / early macular edema
4-6 m
Mod-to-severe NPDR3-4 m
During pregnancyEach trimester
Very severe NPDR or early PDRConsider treatment
High-risk PDR or CSMERecommend treatment
Following AAO preferred practice pattern
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• A fully dilated examination* Sensitivity decreases by 50% if the eyes are
undilated.
• Photography through dilated or (undilated) pupils
* Easy – Acceptable – Mobile teams
* Offers twice the utilization as a usual referral based system of care.
Method of examination:
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Second Message
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“Prevention of diabetic retinopathy is attainable once the diagnosis of diabetes mellitus is made and intensive treatment instituted”
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Diabetes Control and Complication Diabetes Control and Complication Trial (DCCT)Trial (DCCT)
In 9 years, a 76% reduction of diabetic retinopathy progression was found in intensive group compared with the conventional treatment group.
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Third Message
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““Treat associated Treat associated hypertension tightly”hypertension tightly”
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United Kingdom Prospective United Kingdom Prospective Diabetes Study (UKDPS)Diabetes Study (UKDPS)
After 7.5 years, the group with tight control of hypertension (<105/85 mmHg) showed a 34% reduction in the risk of progression of retinopathy compared to the less tight control group (<180/105 mmHg).
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Is it feasible?
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The Iceland experienceThe Iceland experience
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Yes it is possible to greatly Yes it is possible to greatly reduce the incidence of blindness reduce the incidence of blindness from diabetic retinopathy through:from diabetic retinopathy through:
1.1. Early detection of DREarly detection of DR
2.2. A tighter control of diabetesA tighter control of diabetes
3.3. A tight control of associated A tight control of associated hypertensionhypertension
4.4. Patient education and compliancePatient education and compliance
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