Visual Implication in Diabetes Mellitus These slides talk in detail about the visual implications of Diabetes Mellitus and how to address them systematically

1. Visual Implication In DiabetesVisual Implication In Diabetes
RetinopathyRetinopathy
Rabindra Adhikary
ravinems@iom.edu.np

2. Ocular ManifestationsOcular Manifestations
Lacrimal System- decreased tear production
EOM- 3rd
, 4th
,6th
N. palsies
Cornea- defective epithelium, decreased
sensation,
Iris- NVI, pupil abnormality
Lens- premature cataract
Retina- retinopathy
Refraction- fluctuation
Glaucoma

3. Visual acuity (central vision)Visual acuity (central vision)
Mild to severe loss
◦ Proliferative changes
◦ Macular edema
◦ Hemorrhage
Fluctuating visual acuity

4. Refractive statusRefractive status
Change in refraction with the fluctuation
in serum glucose level
◦ Refractive correction
Early presbyopia

5. Color visionColor vision
Tritan colour vision deficiency,
◦ Although both protan and tritan colour
thresholds may be raised
◦ May affect their ability to accurately use
colour-coded tests to measure blood glucose
levels

6. Contrast sensitivityContrast sensitivity
Background retinopathy was shown to produce a
loss of contrast sensitivity particularly at the low
and medium frequencies
 Contrast sensitivity in diabetics with retinopathy and cataract, sharon c. HOWES BSC 1
, TERRY CAELLI phd 2
,
* PAUL MITCHELL MD, FRACO
Early vascular damage in the eyes of diabetic
patients can be detected by contrast sensitivity
evaluation

7. Contrast sensitivityContrast sensitivity
 Below the Normal Range  Asymmetry Between Eyes
◦ .3 log units or more between eyes
indicates that a significant loss
20/20 diabetic patient with abnormal
contrast sensitivity.
Asymmetric contrast sensitivity in a 20/20
diabetic patient with no retinopathy

8. Contras sensitivity lossContras sensitivity loss
 Difficulties in reading certain types of prints
◦ News paper
◦ Old documents
◦ Color prints
 Orientation and mobility problems
◦ Staircase, elevations and depressions
◦ Edges of the objects
 Daily living activities
◦ Filling a glass with water
◦ Seeing white plate on white table cloth
◦ Self care and grooming

9. GlareGlare
Increased intraocular light
scatter
◦ Directly retinal pigment
epithelium destruction
◦ Indirectly reflection from
scars
Accentuated in the
presence of lenticular
opacities

10. Night Blindness After PRPNight Blindness After PRP
Reduced scotopic sensitivity
Mobility problems
Peripheral field defects
 No peripheral warning system
 Difficulty in individual mobility
 Driving difficulties
 Limitation in sports activities
 Daily living activities

11. Visual field defectVisual field defect
Eleanor E. FayeEleanor E. Faye
Patchy field defect/cloudy media
Central field defect
Peripheral field defect
 Sectoral field defects

12. DiplopiaDiplopia
Monocular diplopia
◦ Retinal membranes, tractional retinal
membranes
Binocular diplopia
◦ Nerve palsy
 III, IV and VI CN palsy
 Transient

13. Functional ImplicationsFunctional Implications
 Difficulty with fine details
 Visual fluctuations
 Seeing rippled images
 Blurred, hazy or double vision
 Some loss of field vision
 Difficulty seeing at night or in low light
 Sensitivity to light or glare
 Trouble focusing images

14.  The instability of visual acuity experienced in diabetic eye
diseases, loss of sight-dependent self-care skills, presence of
serious complications other than vision impairment and
resultant psychological ramifications are concerns that must
be addressed in the rehabilitation process.

15. Special ThanksSpecial Thanks
Rajendra Gyawali
Gauri Shankhar Shrestha