1. Prevalence of Diabetic Retinopathy
[ role of BP & glycemic control ]
In Diabetic patients cared for at the Family Care Center at RCRMC
Kam Chan, DO

2. Background
Estimated 18.2 million Americans and one in 20 world-wide lives with diabetes
Type II Diabetes account for 90% of total cases in the US
Diabetic Retinopathy is the most frequent cause of new cases of blindness in diabetic patients aged years in the US

3. Diabetic Retinopathy
Background Retinopathy - microaneurysm formation, capillary leakage causing dot blot hemorrhage & hard exudates
Pre-proliferative retinopathy - cotton-wool spots due to infarction of retinal nerve fiber layers and venous beading
Proliferative retinopathy { PDR } growth of new blood vessels from the optic nerve head OR posterior surface of vitreous

4. Diabetic Retinopathy

6. NON PROLIFERATIVE RETINOPATHY

7. PROLIFERATIVE RETINOPATHY

8. ASSOCIATED RISK FACTORS
Duration / Onset age
Glycemic control
Renal disease
Systemic HTN
Hyperlipidemia
Pregnancy

9. RETINOPATHY vs DURATION
TYPE I diabetes
< 5 years - 17%  years - 74%  > 15 years - 98%
TYPE II diabetes
% years - 29% > 15 years - 78%

10. Data TOTAL # of SUBJECTS = 133 Approx. 70% of patients were Hispanic
Age range years
Mean age = 57 +/- 8 years
68% females

11. 50% patients had some type of eye disorder
26% with diabetic retinopathy
9% with PDR
17% with NPDR
9% cases – cataract alone
2% glaucoma alone
2% both
4 cases NPDR + cataract

14. Impact of uncontrolled HTN
No of patients
Percent of Total
N = 133 subjects

15. No of patients
PDR
NPDR
No Retinopathy

16. A1c
N=12
N=23
N= 98

17. Prevalence of retinopathy in patients with different presenting BP
Diabetes and Diabetic Retinopathy in a Mexican-American Population
Proyecto VER
Sheila K. West, PHD1, Ronald Klein, MD2, Jorge Rodriguez, MD, MPH3,
Beatriz Muñoz, MS1, Aimee T. Broman, MS1, Rosario Sanchez, MD, MPH1 and Robert Snyder, MD, PHD 3
 <140
159
15.1
 140–160 28
14.3
 >160 9
33.3
Prevalence of retinopathy in patients with different presenting BP

19. CONCLUSION
The prevalence of diabetic patients with retinopathy in our clinic is 26%
Tighter control of BP will have immense impact on the progression of retinopathy
More effort should be placed in making sure all diabetics obtain eye exams
This study will help provide a reference point for implementing changes toward improved therapy

20. Bibliography
1. Fong, DS et. al. Diabetic retinopathy. Diabetes Care Jan; 26(1): Review
2. Tooke, JE. Possible pathophysiological mechanisms for diabetic angiopathy in type 2 diabetes.J Diabetes Complications Jul-Aug; 14(4): Review
3. Klein R, et al: The Wisconsin Epidemiologic Study of Diabetic Retinopathy. II.Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 102:520–526, 1984
4. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317:708–713, 1998
5. Estacio RO et al: Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes.
Diabetes Care 23 (Suppl. 2):B54–B64, 2000
Sheila K. West, et al. Diabetes and Diabetic Retinopathy in a Mexican-American Population: Proyecto VER Diabetes Care :
9. Harris MI, et al: Is the risk of diabetic retinopathy greater in non-Hispanic blacks and Mexican Americans than in non-Hispanic whites with type 2 diabetes? A U.S. population study. Diabetes Care 21:1230–1235, 1998