eBook - ePub
Current Management of Diabetic Retinopathy
Caroline R Baumal, Jay S. Duker
This is a test
Partager le livre
- 192 pages
- English
- ePUB (adapté aux mobiles)
- Disponible sur iOS et Android
eBook - ePub
Current Management of Diabetic Retinopathy
Caroline R Baumal, Jay S. Duker
DĂ©tails du livre
Aperçu du livre
Table des matiĂšres
Citations
Ă propos de ce livre
Stay current with recent progress in the field of diabetic retinopathy management with this practical resource by Drs. Caroline R. Baumal and Jay S. Duker. Concise, highly illustrated coverage includes summaries of the latest evidence and expert guidance on the rationale for each therapeutic option.
- Features a wealth of information for ophthalmologists, retinal specialists, and trainees on current management of this increasingly common condition.
- Covers how to select the best course of action between drug, laser, or surgical treatment and how to achieve optimal results.
- Includes high-quality images that detail before and after treatment, including OCT.
- Consolidates today's available information and guidance on diabetic retinopathy management into one convenient resource.
Foire aux questions
Comment puis-je résilier mon abonnement ?
Il vous suffit de vous rendre dans la section compte dans paramĂštres et de cliquer sur « RĂ©silier lâabonnement ». Câest aussi simple que cela ! Une fois que vous aurez rĂ©siliĂ© votre abonnement, il restera actif pour le reste de la pĂ©riode pour laquelle vous avez payĂ©. DĂ©couvrez-en plus ici.
Puis-je / comment puis-je télécharger des livres ?
Pour le moment, tous nos livres en format ePub adaptĂ©s aux mobiles peuvent ĂȘtre tĂ©lĂ©chargĂ©s via lâapplication. La plupart de nos PDF sont Ă©galement disponibles en tĂ©lĂ©chargement et les autres seront tĂ©lĂ©chargeables trĂšs prochainement. DĂ©couvrez-en plus ici.
Quelle est la différence entre les formules tarifaires ?
Les deux abonnements vous donnent un accĂšs complet Ă la bibliothĂšque et Ă toutes les fonctionnalitĂ©s de Perlego. Les seules diffĂ©rences sont les tarifs ainsi que la pĂ©riode dâabonnement : avec lâabonnement annuel, vous Ă©conomiserez environ 30 % par rapport Ă 12 mois dâabonnement mensuel.
Quâest-ce que Perlego ?
Nous sommes un service dâabonnement Ă des ouvrages universitaires en ligne, oĂč vous pouvez accĂ©der Ă toute une bibliothĂšque pour un prix infĂ©rieur Ă celui dâun seul livre par mois. Avec plus dâun million de livres sur plus de 1 000 sujets, nous avons ce quâil vous faut ! DĂ©couvrez-en plus ici.
Prenez-vous en charge la synthÚse vocale ?
Recherchez le symbole Ăcouter sur votre prochain livre pour voir si vous pouvez lâĂ©couter. Lâoutil Ăcouter lit le texte Ă haute voix pour vous, en surlignant le passage qui est en cours de lecture. Vous pouvez le mettre sur pause, lâaccĂ©lĂ©rer ou le ralentir. DĂ©couvrez-en plus ici.
Est-ce que Current Management of Diabetic Retinopathy est un PDF/ePUB en ligne ?
Oui, vous pouvez accĂ©der Ă Current Management of Diabetic Retinopathy par Caroline R Baumal, Jay S. Duker en format PDF et/ou ePUB ainsi quâĂ dâautres livres populaires dans Medicine et Opthalmology & Optometry. Nous disposons de plus dâun million dâouvrages Ă dĂ©couvrir dans notre catalogue.
Informations
Sujet
MedicineSous-sujet
Opthalmology & OptometrySection II
Treatment Of Diabetic Retinopathy
Chapter 6
Effect of Modifiable Risk Factors on the Incidence and Progression of Diabetic Retinopathy
Michael D. Tibbetts, MD
Abstract
The modifiable risk factors for diabetic retinopathy include glycemic control, hypertension, inhibition of the renin-angiotensin system, serum lipid levels, dietary intake of omega-3 fatty acids, physical activity, sedentary behavior, obesity, aspirin therapy, and smoking. Glycemic control is the most important modifiable risk factor for diabetic retinopathy. An exponential relationship between hemoglobin A1c (HgbA1c) and diabetic retinopathy progression has been demonstrated in multiple clinical trials. A target HgbA1c <7% is associated with a lower incidence and progression of retinopathy. Hypertension is also a primary risk factor due to the microvascular damage that may exacerbate the small vessel injury caused by elevated glucose levels. Blood pressure (BP) control can reduce the risk of retinopathy, but there may be a floor effect for systolic BP less than 120 mm Hg. Inhibition of the renin-angiotensin system by angiotensin converting enzyme inhibitors or angiotensin receptor blockers has been shown to reduce the progression of diabetic retinopathy. The reduction of lipid levels can reduce hard exudates and microaneurysms in diabetic retinopathy. In addition, multiple studies demonstrate that obesity increases the risk of retinopathy. There is also evidence that increased physical activity, reduced sedentary behavior, and increased dietary intake of omega-3 fatty acids may reduce retinopathy progression. Aspirin therapy and smoking are not linked to an increased risk of retinopathy. Eye care providers must communicate effectively with the patient's diabetes care team to encourage the management of systemic risk factors that can alter the course of the disease.
Keywords
Diabetes Control and Complications Trial (DCCT); Glycemic control; Hypertension; Renin-angiotensin system; Risk factors; Serum lipids
Introduction
The identification of potential risk factors that affect the development and progression of diabetic retinopathy or response to therapy is an active area of investigation. Some of these risk factors are modifiable, such as lifestyle choices, whereas others, such as disease duration, are not. The duration of diabetes mellitus has been identified as a major risk factor associated with the development as well as the severity of diabetic retinopathy. This has been confirmed by multiple studies for individuals with both type 1 and type 2 diabetes. For patients with type 1 diabetes, after 5 years of diabetes duration, 25% will have some evidence of retinopathy, after 10 years, 60% have retinopathy, and after 15 years 80% have retinopathy.1â3 Proliferative diabetic retinopathy (PDR) may be present in 50% of patients with type 1 diabetes (often 30 years and younger) who have the disease for 20 or more years.2 PDR develops in 25% of individuals who have type 2 diabetes for 25 years or more and in only 2% of those with diabetes less than 5 years.1 In patients with type 2 diabetes over the age of 30 years who have the diagnosis for less than 5 years, the risk of diabetic retinopathy increases for those patients who require insulin. Forty percent of such patients have retinopathy, whereas 24% of patients not taking insulin have retinopathy.
In the current era in which ophthalmologists have a variety of tools to treat diabetic macular edema (DME) and PDR, the assessment of the modifiable risk factors that can reduce the onset and severity of diabetic retinopathy may be overlooked. The antiâvascular endothelial growth factor (anti-VEGF) medications, in particular, can improve vision in patients with DME, induce regression of neovascularization, and also reduce the diabetic retinopathy severity score (DRSS).4,5 Although anti-VEGFs may improve the retinopathy, these medications given by intravitreal injection do not affect the course of nephropathy, neuropathy, and other systemic sites of microvascular injury nor do they mitigate the risks of myocardial infarction and stroke, which are the leading cause of death in diabetic patients. Eye care providers must communicate effectively with the patientâs care team, including the primary care physician and endocrinologist, to encourage the management of systemic risk factors that can alter the course of the disease.
This chapter systematically reviews the evidence for modifiable risk factors that influence the onset and severity of retinopathy (Tables 6.1 and 6.2). The weight of the evidence varies for each factor and may not apply to every diabetic patient.
The modifiable risk factors for diabetic retinopathy include:
âą Glycemic control
âą Hypertension
âą Inhibition of the renin-angiotensin system (RAS)
âą Serum lipid levels
âą Dietary intake of omega-3 fatty acids
âą Physical activity and sedentary behavior
âą Obesity
âą Aspirin therapy
âą Smoking
Glycemic Control
Glycemic control is the most important modifiable risk factor for diabetic retinopathy.6 Numerous reports based on both clinical trials and epidemiologic studies have demonstrated that glycemic control forecasts the incidence and progression from earlier to later stages of diabetic retinopathy. In fact, glycemic control is a more important factor than the duration of diabetes to predict progression to more advanced stages of diabetic retinopathy.7 The mechanism by which hyperglycemia induces diabetic retinopathy is multifactorial, with glycosylated end products, oxidative stress, overactivation of protein kinase C, and upregulation of VEGF and other biochemical pathways disrupting vascular homeostasis and inducing retinal vascular injury. Chronic hyperglycemia causes retinal endothelial dysfunction and subsequent ischemia that can lead to proliferative vascular changes with neovascularization.
Table 6.1
Risk Factors for Diabetic Retinopathy
Risk Factors | Modifiable Risk Factors |
âą Duration of diabetes mellitus âą Age âą Genetic predisposition âą Ethnicity âą Gender âą... |