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1. Introduction
2. Complications from diabetes
3. Diabetic Retinopathy (DR)
4. Other eye complications of diabetes
5. Classification of DR (1)
6. Classification of DR (2)
7. An eye with mild NPDR – MAs only
8. An eye with proliferative DR
9. Vitreous hemorrhage - proliferative DR (1)
10. Vitreous hemorrhage - proliferative DR (2)
11. Advanced DR with scarring
12. Classification of DME
13. Diabetic Macular Edema (DME)
14. Clinical assessment
15. Clinical assessment of DR
16. Severe NPDR or PDR?
17. From FFA to PDR
18. Assess vascular leakage from DME
19. Micro-aneurysm - an angiogram
20. Optical Coherence Tomography (OCT)
21. OCT findings of DME
22. Epidemiology of DR
23. Prevalence of DR and vision-threatening DR
24. Global prevalence of DR/DME
25. Longer diabetes duration is a major risk factor
26. Management
27. Strategies of DR management
28. Systemic treatment strategies of DR
29. Glucose control remains critical
30. Relationship between glucose and DR
31. Achieving “normoglycemia” appears beneficial
32. Good glucose control has a long-term benefits
33. “Metabolic memory” of glucose
34. Blood pressure just as important as glucose
35. Effect of “tight” glucose and BP control
36. Blood pressure
37. Lack of “memory” effect of BP control
38. Blockage of Renin-Angiotensin System (RAS)
39. Effect of ARB on DR regression
40. There appears to be a role of lipids
41. Two major RCTs
42. Fenofibrate reduced risk of DR progression
43. Multi-factorial interventions
44. Key messages for systemic therapy
45. Ocular treatment strategies of DR
46. Laser was a “gold standard” in DR management
47. Management of PDR
48. PRP reduced severe vision loss by 50%
49. Extent of initial laser treatment session
50. PRP is effective for PDR
51. Post-PRP
52. Management of DME
53. Focal laser reduced risk of moderate visual loss
54. There are three unmet needs of laser treatment
55. Visual acuity gain with laser is uncommon
56. Many people lose vision with laser
57. In many DME eyes laser is not effective/possible
58. Laser not possible
59. Diffuse DME
60. Novel therapy: intraocular steroids
61. Intraocular steroids and DME
62. Novel therapy: anti-VEGF agents
63. What is VEGF?
64. Role of VEGF in DR
65. Anti-VEGF agents and DME
66. Anti-VEGF agents effective for DME treatment
67. Five major RCTs of ranibizumab for DME
68. RESOLVE mean vision change
69. RESTORE mean vision change
70. Anti-VEGF addresses unmet needs of laser
71. Is systemic safety of anti-VEGF a concern?
72. Equivalent risk of CVD as non-diabetic patient
73. Many questions remain
74. Key messages for ocular therapy
75. Screening and awareness
76. Current guidelines
77. Awareness and control of systemic risk factors
78. Conclusion

Topics Covered

• Complications from diabetes
• Diabetic retinopathy
• Classification of diabetic retinopathy
• Classification of diabetic macular edema
• Clinical assessment of diabetic retinopathy
• Optical coherence tomography
• Epidemiology of diabetic retinopathy
• Strategies of diabetic retinopathy management
• Glucose control remains critical – Blood pressure just as important as glucose
• Role of lipids
• Multi-factoral interventions
• Ocular treatment strategies of diabetic retinopathy
• Novel therapy: Intraocular steroids
• Anti-VEGF agents
• Screening and awareness

Links

Series:

• Diabetes in Perspective

Categories:

• Clinical Practice
• Metabolism & Nutrition

Therapeutic Areas:

• Cardiovascular & Metabolic
• Ophthalmology

Talk Citation

Publication History

• Published on May 22, 2013

Financial Disclosures

• Prof. Tien Wong, Consultant: Abbott, Allergan, Bayer, Novartis, Pfizer and Roche ; Speaker’s Bureau: Abbott, Allergan, Bayer and Novartis ; Grant/Research Support (Principal Investigator): Allergan, Bayer and Novartis.