Introduction to DM

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Several pathogenic processes are involved in the development of diabetes. These range from autoimmune destruction of the -cells of the pancreas with conse uent insulin deficiency to abnormalities that result in resistance to insulin action. The basis of the abnormalities in carbohydrate, fat, and protein metabolism in diabetes is deficient action of insulin on target tissues. Deficient insulin action results from inade uate insulin secretion and!or diminished tissue responses to insulin at one or more points in the comple" pathways of hormone action. #mpairment of insulin secretion and defects in insulin action fre uently coe"ist in the same patient, and it is often unclear which abnormality, if either alone, is the primary cause of the hyperglycemia.

DM patient oftenly complains of frequent urination daily, sudden loss of weight, fatigueness and rarely over eating. Signs include: oedema of different parts of the body especially the foot, hyperglycemia (increased !"# $omplications include: D%, !angrene foot, &ervous destruction.

Investigations of diabetic retinopathy

Diabetic retinopathy often has no early warning signs. 'ven macular edema, which may cause vision loss more rapidly, may not have any warning signs for some time. In general, however, a person with macular edema is li(ely to have blurred vision, ma(ing it hard to do things li(e read or drive. In some cases, the vision will get better or worse during the day.

Visual acuity test: )his test uses an eye chart to measure how well a person sees at various distances (i.e., visual acuity#. Pupil dilation: )he eye care professional places drops into the eye to widen the pupil. )his allows him or her to see more of the retina and loo( for signs of diabetic retinopathy. *fter the e+amination, close,up vision may remain blurred for several hours Tonometry measures the increase intraocular pressure inside the eye.

Indirect opthalmoscopy is insufficient to rule out significant and treatable diabetic retinopathy.

)he gold standard for diagnosis is dilated retinal photography with accompanying ophthalmoscopy if the retinal photographs are of inadequate quality (eg, cataract clouding view or corneal clouding#.

-urther investigation such as optical coherence tomography (a sort of visual biopsy obtained in a similar fashion to an ultrasound scan but using light waves# or fluorescein angiography may be required to refine the diagnosis further and to guide management.

-undus photography and e+amination are sufficient for most patients: however, optical coherence tomography is playing an increasingly important role in assessing the presence of macular oedema (and recording its progression over several visits# and fluorescein angiography may be helpful (to guide laser treatment# and where the vision is une+pectedly poor (to assess for macular ischaemia#. -undus photography generally recreate considerably larger areas of the fundus, and has the advantage of photo documentation for future reference, as well as availing the image to be e+amined by a specialist at another location and.or time. 'arly methods of screening D%:

Digital Retinal Screening Programs: Systematic programs for the early detection of eye disease including diabetic retinopathy are becoming more common, such as in the /0, where all people with diabetes mellitus are offered retinal screening at least annually. )his involves digital image capture and transmission of the images to a digital reading center for evaluation and treatment referral. See 1anderbilt 2phthalmic Imaging $enter and the &3S Diabetic 'ye Screening 4rogramme Slit Lamp Biomicroscopy Retinal Screening Programs: Systematic programs for the early detection of diabetic retinopathy using slit,lamp biomicroscopy. )hese e+ist either as a standalone scheme or as part of the Digital program (above# where the digital photograph was considered to lac( enough clarity for detection and.or diagnosis of any retinal abnormality.

Non-proliferative diabetic retinopathy (NPDR)

2n the first stage which is called &on,proliferative diabetic retinopathy (&4D%# there are no symptoms, are not visible to the na(ed eye and have 56.56 vision, but can be detected by fundus photography: 7e can see microaneurysms (microscopic blood,filled bulges in the artery walls#. If there is reduced vision, fluorescein angiography can be done to

see the bac( of the eye. &arrowing or bloc(ed retinal blood vessels can be seen clearly and it is called retinal ischemia (lac( of blood flow#.

Macular oedema may occur in which blood vessels lea( contents into the macular region can happen at all stages of &4D%. Optical Coherence Tomography can show areas of retinal thic(ening (fluid accumulation# of macular oedema

proliferative diabetic retinopathy (PDR)

2n the second stage, as abnormal new blood vessels (neovascularisation# form at the bac( of the eye as a part of proliferative diabetic retinopathy (4D%#, they can burst and bleed (vitreous hemorrhage# and blurr vision, because the new blood vessels are wea(. )he first time this happens, it may not be very severe. In most cases, it will leave 8ust a few spec(s of blood, or spots, floating in a person9s visual field, though the spots often go away after a few hours. )hese spots are often followed within a few days or wee(s by a much greater lea(age of blood, which blurs vision. In e+treme cases, a person will only be able to tell light from dar( in that eye. It may ta(e the blood anywhere from a few days to months or even years to clear from the inside of the eye, and in some cases the blood will not clear. )hese types of large hemorrhages tend to happen more than once, often during sleep. 2n funduscopic e+am:cotton wool spots, flame hemorrhages, and dot,blot hemorrhages. References :
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