DM complications - Ophthalmologic complications

Question 1

DM is the leading cause of blindness between the ages of ____ in the United States

Answer 1

20 and 74

Question 2

Individuals with DM are ____ times more likely to become legally blind than individuals without DM

Answer 2

25

Question 3

Diabetic retinopathy is classified into two stages:

Answer 3

1. Nonproliferative
2. Proliferative

Question 4

Nonproliferative diabetic retinopathy

• When seen
• Findings

Answer 4

• When seen
  
  • Late in the first decade or early in the second decade of the disease
• Findings
  
  • Retinal vascular microaneurysms
  • Blot hemorrhages
  • Cotton-wool spots

Question 5

The pathophysiologic mechanisms invoked in nonproliferative retinopathy include:

Answer 5

• Loss of retinal pericytes
• Increased retinal vascular permeability
• Alterations in retinal blood flow
• Abnormal retinal microvasculature

Question 6

Hallmark of proliferative diabetic retinopathy

Answer 6

Appearance of neovascularization in response to retinal hypoxemia

• Note:*
• These newly formed vessels appear near the optic nerve and/or macula and rupture easily, leading to vitreous hemorrhage, fibrosis, and ultimately retinal detachment

Question 7

T/F. Not all individuals with nonproliferative retinopathy go on to develop proliferative retinopathy

Answer 7

True

• Note:*
• But the more severe the nonproliferative disease, the greater the chance of evolution to proliferative retinopathy within 5 years

Question 8

What diagnostic tools are useful to detect macular edema, which is associated with a 25% chance of moderate visual loss over the next 3 years?

Answer 8

Fluorescein angiography and optical coherence tomography

Question 9

Best predictors of the development of retinopathy

Answer 9

Duration of DM and degree of glycemic control

• Note:*
• Nonproliferative retinopathy is found in many individuals who have had DM for >20 years

Question 10

The most effective therapy for diabetic retinopathy

Answer 10

• Prevention
  
  • Intensive glycemic and blood pressure control will delay the development or slow the progression of retinopathy in individuals with either type 1 or type 2 DM
• Note:*
• Once advanced retinopathy is present, improved glycemic control imparts less benefit, although adequate ophthalmologic care can prevent most blindnes

Question 11

What is the paradox with improved glycemic control and diabetic retinopathy?

Answer 11

• Paradoxically, during the first 6–12 months of improved glycemic control, established diabetic retinopathy may transiently worsen
  
  • This progression is temporary, and in the long term, improved glycemic control is associated with less diabetic retinopathy

Question 12

Drug that reduces the progression of retinopathy

Answer 12

Fenofibrate

Question 13

T/F. Routine, nondilated eye examinations by the primary care provider or diabetes specialist are adequate to detect diabetic eye disease

Answer 13

• False; inadequate
• Requires a dilated eye exam performed by an optometrist or ophthalmologist, and subsequent management by a retinal specialist for optimal care

Question 14

Treatment of proliferative retinopathy or macular edema with ____ usually is successful in preserving vision

Answer 14

Laser photocoagulation and/or anti-VEGF therapy

• Note:*
• Vascular endothelial growth factor A (VEGF-A) is increased locally in diabetic proliferative retinopathy and decreases after laser photocoagulation

(ocular injection)

Question 15

Role of ASA in diabetic retinopathy

Answer 15

Aspirin therapy (650 mg/d) does not appear to influence the natural history of diabetic retinopathy