Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005 1995 What is going on here? Discuss the possible diabetic history etc …age/type/control/duration What is this prognosis? Does this case differ from case 1? Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005 (Need to compare to case 1 later) Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005 dob 1956 1985 niddm/type 2 UKPDS study patient Obese 18 stone, BMI 36 smoked father blind from diabetic retinopathy 6/9 6/6 How does this history influence the prognosis? Genetic influences critical Obesity and smoking also Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005 1998 stopped smoking, still overweight, HbA1c ~10% What is influencing the prognosis? What is happening now? Weight/control critical Pre-prolif..widepread Nv any any time; later maculopathy Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005 1999 …what is happening here? Does the patient have new vessels? What has happened in between? What will happen next? Diffuse maculopathy & proliferative Yes (still not well controlled) CSME will affect sight, but retinopathy will stabilise Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005 2003 what has happened? What is the VA? Will it get worse? Why has the retinopathy disappeared? haemorrhages and microaneurysms have disappeared (6/60) Will keep current VA Finally achieved good control …but too late, and had lots and lots of laser Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005 What have you learnt from case 1 and 2? What is puzzling you at this stage? Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005

Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005 a similar scenario, new patient, same retinopathy, its now 2005 You got a bad result with a similar patient…would you treat this patient differently Were you ..no different, wait for new vessels Were you …more aggressive with your laser……if so, what would you do (this patient still finds it very difficult to control his diabetes) Discuss the 2 options…many people now laser pre-proliferative Diabeticretinopathyafternoon case 2, Good Hope Hosp, 2005