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Diagnosis & Management of Diabetic Eye Disease A. Paul Chous, M.A., O.D., F.A.A.O. Tacoma, WA Specializing in Diabetes Eye Care & Education Part 2 Biochemical Influences In large vessels: Free fatty acids (FFAs) cause inflammation, dyslipidemia, and atherosclerosis Small, dense LDL Increased blood viscosity & vessel rigidity causes HTN Increased platelet adhesion Visceral Adipose Tissue Visceral fat releases substances that cause insulin resistance and mobilize non-esterified fatty acids (Free Fatty Acids) Insulin resistance a Hyperglycemia FFAs are oxidized by vascular endothelium a inflammatory cytokines (PAI-1, CRP & more) A Unifying Mechanism for Microvascular and Macrovascular Diabetes Complications Large vessel hFFAs Small vessel Polyol Hexosamine PKC AGEs hGlu Adapted source: Michael Brownlee, M.D. Hemodynamic Influences Conditions that increase retinal blood flow increase the risk of severe DRT – Hyperglycemia – Systemic hypertension – Pregnancy – Ocular hypotension Other Influences Genetic Susceptibilities Haptoglobin Lipid SNPs Endocrine Growth factors hormone (GH) and Insulin-like growth factors (IGF) Factors Contributing to Diabetic Eye Disease Diabetes Epidemic Macrovascular Biochemistry Glycated LDL, sticky platelets, CRP CAMs/leukocyte adhesion, 4 pathways Hypertension Diabetic Eye Disease Pericyte Damage Increased Blood Flow: Shear Stress Shunting Microvascular Biochemistry PKC, AGEs, Polyol Flux, Hexosamine Pericyte Damage Hormonal Factors & Individual Genetic Susceptibility It’s Not Just The Eye….. PDR Doubled the Risk of Cardiovascular Death in T1DM Over 8 Years (EURODIAB Complications Study, 2005) In T2DM, NPDR Conferred 1.3 -1.7 X Increased Risk of Death & PDR Increased Risk of Death 3-5 Fold Over 18 years (Diabetes Care 2007 Feb) Diagnosis & Management of Distinct Entities “Diabetic Eye Disease” refers to ocular pathologies more commonly seen in patients with diabetes All of these conditions are attributable, at least in part, to chronic hyperglycemia Ocular Diseases Associated With Diabetes Cataract Keratopathy Efferent Cranial Neuropathy Glaucoma Ischemic Optic Neuropathy Retinal Vascular Occlusion Diabetic Retinopathy