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

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 20-74 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 15 years - 98% TYPE II diabetes 0 - 10% 0 - 5 years - 29% > 15 years - 78%

10. Data TOTAL # of SUBJECTS = 133 Approx. 70% of patients were Hispanic Age range - 31-85 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. PDR NPDRNo Retinopathy No of patients

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

17. <14015915.1 140–1602814.3 >160933.3 Diabetes and Diabetic Retinopathy in a Mexican-American Population Proyecto VER Sheila K. West, PHD 1, Ronald Klein, MD 2, Jorge Rodriguez, MD, MPH 3, Beatriz Muñoz, MS 1, Aimee T. Broman, MS 1, Rosario Sanchez, MD, MPH 1 and Robert Snyder, MD, PHD 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. 2003 Jan; 26(1): 226-9. Review 2. Tooke, JE. Possible pathophysiological mechanisms for diabetic angiopathy in type 2 diabetes.J Diabetes Complications. 2000 Jul-Aug; 14(4): 197-200. 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 2001 24: 1204-1209 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