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- December 1, 2008 |
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| Presentation |
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"Management of Diabetic Retinopathy: What’s New?"Prof. Paul Mitchell (biography)
English - 2006-04-06 - 50 minutes
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 | (58 slides) |
Summary :
In this presentation Prof. Mitchell gives an evidence-based review of the current literature on the management of diabetic retinopathy up to the present time.
The pathogenesis of diabetic retinopathy is multifactorial, involving many pathways linked to glycaemia, and about 25 to 45 percent of diabetic patients currently have some signs of diabetic retinopathy - about 300,000 Australians have diabetic retinopathy at this time. The most important cause of decreased vision in people with diabetes is macular edema, which represents a thickening near the fovea at the back of the eye.
Regular screening of all people with diabetes is now mandatory, and in terms of managing diabetic retinopathy it is important to undertake a multidisciplinary approach in all people with diabetes to achieve optimal glycaemic control, and to adequately manage blood pressure and serum lipids (evidence level 2).
There are a range of therapies for diabetic retinopathy however randomised controlled trial evidence is still being awaited for many agents. It is still under question for example whether ACE inhibition can be used for diabetic retinopathy in patients without elevated blood pressure, as the findings are inconclusive. An important recent therapy is intravitreal injections of triamcinolone, which appears to be promising for people with severe macular edema, however its long-term safety and efficacy remains to be proven. Dyslipidemia increases the risk of macular hard exudate deposits and clinically significant macular edema in people with diabetes; lipid lowering agents may reduce the severity of this and have visual acuity benefits. Other promising new therapies include those targeting the pathogenic pathways of diabetic retinopathy, such as VEGF and PKC inhibitors.
Prof. Mitchell reviews the grading and screening guidelines for diabetic retinopathy, the guidelines for cataract surgery in diabetes, the guidelines for laser treatment and for vitrectomy for diabetic retinopathy, and guidelines for the use of fluorescein angiography. Finally, a new scan called optical coherence tomography is extremely useful as it gives a cross-sectional view of the macula, allowing screening for early macular thickening and to follow the progression or regression of macular edema over the course of treatment.
Copyright © 2006 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The underlying pathogenesis of diabetic retinopathy
- The risk factors for diabetic retinopathy
- What's new in the medical management of diabetic retinopathy
Bibliographic references :
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Retinopathy and Nephropathy in Patients with Type 1 Diabetes Four Years after a Trial of Intensive Therapy NEJM 2000; 342:381-389.
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) The Lancet, Volume 352, Issue 9131, 12 September 1998, Pages 837-853.
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38 BMJ 1998;317:703-713.
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