1.2.3 Importance Of Systemic Disease Flashcards
Diabetes Types
T1
T2
Gestational
What is diabetes in layman’s terms
Chronic metabolic disorder when the body is unable to break down glucose either due to reduced insulin production or cells unreactive to insulin
T1 - immune system is attacking and destroying the insulin producing cells within the pancreas
T2 - body is unable to make enough insulin
Diabetes Medications and their ocular side effects
Insulin T1 - blurred vision in the first few weeks beginning insulin therapy - fluctuating vision/conjunctivitis
Metformin T2 - dry eye and increased risk of angle closure
Sulphonylureas T2 - eg glipzide, side effects include crystalline lens changes, refractive error shifts and accommodative insufficiency
Diabetes Ocular impact
Increased risk of
- dry eye
- diabetic keratopathy
- uveitis
- cataract
- vitreous haemorrhages
- diabetic retinopathy/maculopathy
Diabetic Retinopathy Treatment
Laser Photocoagulation - light energy applied to the retina with the aim of stopping the growth and development of new blood vessels. Done in the peripheral retina
Anti-VEGF - has been shown to reduce diabetic retinopathy severity and is associated with lower rates PDR development
- Cease smoking
- referral to GP for blood work work up
- ensure px is attending yearly screening
- make sure BP and cholesterol well controlled
Non-Proliferative DR grading
R0 - no DR, review in 12 months
R1 - mild NPDR, review in 12 months
Micro aneurysms only, review in 12 months
Pre-Proliferative DR Grading - Routine Referral
- cotton wool spots
- venous beading
- IRMA
- deep retinal haemorrhages
- 4 or more blot haemorrhages in both inferior or superior hemifields
- exudates within 2DD of fovea
Proliferative DR grading - Urgent referral
- loss of vision Or reduced VA
- exudates within 1DD of the fovea
- retinal neovascularisation
When would DR be same day referral
Iris rubeosis - new blood vessels on the iris surface
Diabetic macular oedema
What is hypertension
High blood pressure – force of blood pushing on the vessel walls is too high (speeds up development of atherosclerosis – fatty plaques in vessel walls causing narrowing; subsequent clots cause heart attack/stroke.
What is hypertension
High blood pressure – force of blood pushing on the vessel walls is too high (speeds up development of atherosclerosis – fatty plaques in vessel walls causing narrowing; subsequent clots cause heart attack/stroke.
Hypertension Ocular Effects
Uncontrolled high blood pressure can cause damage to the retinal blood vessels, limit the retina function, put pressure on the optic nerve – causing vision problems. The most important thing to do to prevent this from happening to make sure HBP is CONTROLLED with medication – important
to attend regular check up’s with GP for HBP
medications.
Artery and Vein occlusions
Hypertension medication Types
- ACE inhibitors
- Angiotensin Receptor Blockers
- Calcium Chanel Blockers
- Anticoagulants
- Diuretics
ACE Inhibitor action and examples and side effects
Action
- inhibiting narrowing of blood vessels
- reduces blood pressure and improves flow
Examples
- Enalapril
- Ramapril
Side effects
- blurred vision
- photophobia
- conjunctivitis
Angiotensin Receptor Blockers action, examples and effects
Action
- causes blood vessels to relax and widen, making it easier for blood to flow through
- reduces the amount of water your body retains which lowers the pressure
Examples
- candesartan
- Irbesartan
Side effects
- eye yellowing
- eyelid swelling
- blurred vision
