introduction
Diabetes mellitus (DM) is a global epidemic, with major depression. Diabetic retinopathy (Dr) DM-specific, and lack of vision in working adult population microvascular complexity as the main reason for DM. Is the doctor in 1 with 3 affects individuals. Poor quality of life and physical, emotional and social welfare of the doctor according to the patients with levels lower level and is more health care resources.
The epidemic studies and clinical trials, blood pressure and blood lipids blood glucose can control more and more of a lower risk of developing retinopathy and slow growth that is displayed. Vascular andotalal growth factor photoquagolaon and timely treatment, laser (vigf) with the appropriate use of Visual loss inhibitors administration threaten to prevent retinopathy vision, especially diabetic makolar adama (tail). Since Visual loss in the earlier stages retinopathy may not exist to enable the early intervention diabetes screening, regular people is important.
Diabetic Retinopathy of apadimaalwaji
In many countries, yet easily preventable blindness in adults of working age in the way most often is a doctor. In the United States, according to estimates, 40 per cent (8% for vision-threatening retinopathy) type 1 diabetes type 2 diabetes individuals and individuals with 86% (42% oasaontritinang retinopathy) is also found in other countries, "Dr. spread estimates are high. A potential diabetes epidemic in Asia, Asian doctor apadimialogak for data despite concerns about
Countries is relatively limited. Some doctors and 17 per cent in Latin America to treat diabetic patients were 40 percent needed. Some of the studies have been conducted in Africa, Dr.
The doctor attempts to develop with time and blood sugar, blood pressure and blood lipids is associated with poor control. As a DM, and poor control of them is given to the development of the good doctor, high risk doctor's annual events to develop their control and extends life. However, everyone with a good DM control must be in danger the doctor, does not reduce the risk of developing a lifetime. A doctor's diagnosis in a community as a whole, the number of people with the initial rendering, DM is also affected by:
• Resource-rich settings, start with a good health care system with more people will have been specified in DM. The spread of nine doctors diagnose people with DM at a minimum as a result, the overall trend will be in the doctor.
• Resource-poor settings with less developed health care system, with the initial diagnosis will be made in DM. People with diabetes can only be assessed when the incessant or complications occurred. Thus, the spread of a doctor diagnose in people with DM 9 to some extent as a result, the overall trend will be advanced to the doctor in.
Meta-analysis of education on a large scale in General, with nearly one-third of doctors of those DM and nearly a third of those (or 10 per cent of DM) vision will need to be treated by Dr. that threaten it.
Diabetic Retinopathy rating
Makroneuresm, hamorrhagas, odates, Dr. of retinal microvascular signs difficult, cotton-wool spots (lapad reserves) (aschimack retina ganglion cell and akomalatance of oplasmak adjacent to the rubble within bandles related), and antraritanal makroascoler and bidang oride (i.e. any dilated capillaries) are included.
(All statistics). These signs can be categorized in two stages to the doctor.
Nonprolafratowi Diabetic Retinopathy
Dr. nonprolafratowi, Dr. nonprolafratowi, the development of the threat of an early stage of retinopathy to Visual loss and determination review allows a prediction interval.
Prolafrtavi Diabetic Retinopathy
Prolafrtavi diabetic retinopathy (PDR) is a hard step and doctor's askhamia and angaoganak for closing a kishka represents a reaction to the retina. Niovascolaryazataaon is divided into two groups: (ninety) new vessels and new disk vessels elsewhere (9). Usually nine prfusad and nonprfos increasing in the interface of the retina. Doctor, doctor, doctor nonprolafratowi prolafrtavi from the stages of the scale that simple can be classified using the international classification. From the stages of retinopathy, a major complexity immediately separate estimated that this doctor can be associated with any of the steps and is also an independent can run the course.
Diabetic makolar adama
This presence and diabetic makolar adama (immediately) to the doctor is necessary for different stages of the review. The doctor's doctor, the stages of international classification can be classified using the scale. Create a simple referral decision on the resource settings can be used in grading. This initial reduction in Visual acuity can be measured before the breath that is important to remember.
II. screening guidelines
Screening guidelines
Doctors screening for DM management is an important part of the world. Apetalmolugusts are available in a suitable number of sbspecaalists also, apetalmolugusts or DM if every person with retinal screen using one of the resources is unusable.
A screening test, the State of the art Visual acuity and retinal imaging with a full refrakted can add test. However, in a low-resource setting appropriate referral to assure at least one screening examination and Visual acuity test components retinal examination should include suitable for rating doctors. Vision, pupil dilation should be tested. Figure 1 shows an example of the screening process is to apply for Dr.
Must be fully trained staff screening vision test by any of the following methods, depending on resources:
• Visual acuity test refrakted a 3 or 4 meter high contrast Visual acuity Visual acuity chart using a street.
• Visual acuity exam offer or walk away from the eye chart and a using a pin hole option, near Visual acuity is reduced.
• server using Visual acuity examination at least 5 standard letters or symbols and consists of a pin hole option is the lack of Visual acuity (20/40) handheld equivalent chart. Retinal examination can be done the following ways:
• Slit lamp examination of the retina of the bomakraskopak or aopetalmscopi, whether directly or indirectly.
• Retinal (fondos) photography (including any of the following: mono-or stereo-30o; odifeld; dilated or andlatad).The scanning optical link with or without tomographe (October) can be done with.
This can include telemedicine perspective.
• Retinal examination may not be necessary for a medical degree, but the severity of retinal photography aopetalmscopi or tester can perform and doctor to be able to measure must be trained.
Visual acuity and retinal exams drew on a proper management plan appropriate use of information, one can make the decision. The project is based on individual patient needs may be modified.
Patients with less than a proper diagnose retinal ophthalmologist is a doctor for as long as it is clear that, or most, only light nonprolafratowi doctor (that is, akeroneuresm only) must be known. In addition, individuals must be referenced with the loss of Visual acuity and unclear.
As part of a screening test, blood glucose and blood pressure control their diabetes, including lipids of siram, individuals with diabetes should be asked about. In addition, women should be asked if they are or may be pregnant. Need more appropriate medical intervention insufficient control and pregnancy.
Referral guidelines
At least referral guidelines are as follows:
• 6/12 (20/40) or the following incessant complaints of vision Visual acuity
• Dr. Dr. According to international classification, or a samplafed scheme can be categorized, they must be referenced in this regard.
• Retinal examination or retinal imaging only a few detailed classification of the doctor, but is available, it is possible:
»» No retinopathy or just a few tiny red spots: test 1 – 2 years back for screening
»» Niovascolaryazataaon hamorrhagas or smoke or Dot, is possible: please contact for ophthalmologist
»» White spots in the retina: refer to ophthalmologist
• If Visual acuity or retinal screening exam examination can be obtained at: contact for ophthalmologist
• Patients who should be referred for laser treatment, also review
III. detailed diagnose Diabetic Retinopathy
1. initial assessment of the patient
Detailed assessment of the patient and the doctor immediately for each eye and severity of the presence of a complete examination, including Visual acuity and grading identification should include. Take the patient's diagnosis a patient diabetes focus on history should be included, and this modifier.
The patient history (important elements)
• Duration of diabetes
• Glikimack control (A1c, hamogloban) in the past
• Medicines (especially hipoglkemics, antahiprtansav and insulin oral drug meet lapad)
• Sistemitic date (for example, renal disease, high blood pressure, the level of sistemitic of lapad siram, pregnancy)
• Aokolhar date
B. the initial physical examination (key elements)
• Visual acuity
• Measurement of pressure (aaop)
• When (e.g., iris is seen when eyes niovascolaryazataaon growth in aaop) hint or gonaaskope
• The slit lamp baomakeraskope
• Test fondos
(C) diagnostic test methods fondos
Currently, the most sensitive method of detecting Dr retinal photography are dilated and slit lamp baomakeraskope through his disciples. Both trained eye health professionals by depends on the interpretation. All other methods are listed.
The advantage of creating a permanent record fondos photography, and for this reason, it is the preferred method to diagnose retinopathy. However, trained observers can identify the doctor without the photography, and many are the choice will, in many cases, elocution. There is a need for training and use of all devices, but indirect potential aopetalmscopi and slit lamp fondos baomakeraskope for photography more than skill is required. Newer, fondos nonmidriatak semi automatic camera can be very easy to use. View aopakates image/media degradation will lead and all pictures/photos to be reviewed by trained staff is necessary.
2. following the examination of the patients with Diabetic Retinopathy In General, the early exam test date and will be similar to the following. Visual symptoms, Visual acuity test are necessary to measure and calculate the aaop fondos.
our history
• Visual symptoms
• Glikimack State (hamogloban, A1c)
• Sistemitic State (for example, pregnancy, hypertension, renal status, level of lapad siram)
B. our physical examination
• Visual acuity
• Measurement of the aaop
• When the signal gonaaskope
• The slit lamp baomakeraskope
• Test fondos
(C) supplementary examination
• The doctor or doctors, clinical prolafrtavi florescin angiography with breath test preparation, the assessment is not required for diagnosis.
• A guide florescin angiography can be used for the treatment of breath and as Visual acuity of the cause (s) of non-critical review as a means of clearly has decreased. Florescin nonprfoon or makolar angiography kishka kishka elimination as a result as possible interpretations for the Visual in a moment can also be sources of identity.
• To identify the most sensitive sites and intense OCT breath way.
D. patient education
• Examination and results or implications is discussed.
• DM, but without the eye exam the doctor encourage patients screened annually.
• Inform patients that the doctor for good vision and no effective treatment in spite of the symptoms depends on the timely intervention aokolhar.
• Near normal glucose levels close to normal blood pressure patients to maintain and control is about the importance of awareness of lapad siram degrees.
• General physician communication (for example, antrnast or family physician, endocrinologist) is about the results of the eye.
• Patients who fail to respond to the conditions provided for surgery and treatment available for appropriate professional help (i.e. settlement offer counselling, social services properly still, or to) side.
• Rehabilitation and social services for Visual act considered to refer patients with.
IV. Diabetic Retinopathy treatment.
Panritanal laser prolafrtavi doctor photoquagolaon surgery should be performed in patients with. Home panritanal photoquagolaon of type 2 diabetes for patients with severe nonprolafratowi are the advantages of Dr stage. Other elements to warn of poor compliance with cataract in the eye or at the time of pregnancy, follow-up, and fellow panritanal will help to determine the photoquagolaon.
1. panritanal photoquagolaon (prip)
Discussion with patients, pritratment
• The patient usually need several visits and follow up the side of laser treatments may be needed.
• Reduces the risk of vision loss and blindness is prip.
• Laser treatment is effective, although some patients yet ready hamorrahj watrivos. Diabetes is caused by laser and not by hamorrahj. This means that patients need more laser treatments.
• Laser treatment often peripheral and night vision low. Treatment can reduce the main moderation view.
This short term side effect severe vision loss and blindness in patients significant long term is compensated by laser treatment.
B. lens for prip
• 3 mirror contact lenses for the treatment of a central pole, then, goldman has been opened for the treatment of peripheral and Central and peripheral retina reflects aspect. Disadvantages: small field in which constantly need to be completed, however, the lens manipulation treatment. Spot size is set in 500µm.
• New wide angle contact lenses often is used. Although the picture is reverse, a large field with a lot of envy for the field of disk and allows easy orientation while maintaining eye discoloration. The wide angle lens on the laser spot size will affect the optics of the retina. Aopetalmscopi wide angle lens provide a large field, but look at the picture reverse proxy and a magnification of retina displays. Scatter treatment retina an image can be for a large area, and it is relatively easy to stain the image of the disk and the problem.
C for prip technology
I. must be fully dilated pupil and topical washing is used. Reduce pain and loss of motion eye retrobolibr or sbitinon for washing must be employed as you can.
The second most common wavelength is used. Are made, the Green and blue-green (usually avoided at this time) 532 Green laser, slit lamp delivery system using. Heavy media, in the form of a red or red kripton daudi laser (part of NM) can be used. Slit lamp through a contact lens treatment is most commonly, but also can be performed using indirect aopetalmscopi. For example, when treatment is given under General anesthetak.
Iii. typical µm spot size, the other a 500 on the initial settings, the Irgun laser and 250-270 Watts of electricity will not exhibit 0.1. Allow water to get on the retina until the reaction force is gradually increased. Are kept separate burn lisens 1 width.
4. A total of 1600-3000 tractaonal of the makolar area and the height of the retina Burns carefully avoid any area in 1 or more seats are placed. Burns 2-3 disk diameters away from the center of the macula, and 1 for disk to disk, usually from outside Qatar and prafrall was arcads to parallelism is through business.
Darukl pagmantad choreoritanal prritanal hamorrhagas, a large laser treatment retinal veins, v. marks, or 1-DD (200-300 µm) hamorrahj within the center of the macula or large risk should not apply to, scotomas.
Vi. other concerns:
• There is a need for additional photoquagolaon if prolafrtavi is proof of worsening to the doctor.
• Add more marks the initial laser burns treatment within the prafrall between 500-1500 µm from the center of the stain left on the pole then.
• New vessels or more widely active in areas where adaptation qodrints marks are not so severe, non-askhamia area, and how, for example, treatment with microvascular antraritanal pole part is.
• Direct traces of the treatment it is possible between 9.
• A multi spot makroplse daudi sbatreshold laser or laser can be used.
D. Diabetic Retinopathy clinical research network (drkernat) panritanal photoquagolaon (scatter) after consensus technology Panritanal photoquagolaon (scatter) initially 1200 to1600 Burns (or a multi spot laser treatment of the same area), retina 1 3 seats up for 8 weeks (56) and initiation days approximately 500 µm with a spot size on the completed within consists of.
2. treatments for diabetic makolar adama
resource-rich settings
I. medical treatment, similar to the control glikimack: optimized associated systemic hypertension or dislapademia > HbA1c is 7.5%.
Ii. inclusion of light or moderate breath without the Center (for example, the center of the circle karkanaty centre spot despite being a vision loss occurred when threatened or involved): focal laser makroneuresm to consider. There is no treatment for discoloration in the center of the near 300 µm lisens than it is.
3. loss of vision associated with the involvement of the Centre immediately and anti-vigf antrawatril: * (for example, ranibyazomab [lukantas] bevakyazmab 0.3 or 0.5 g, to treat [aoastan] or aflabrcapt [ayelia] 1.25 mg) 2 mg therapy). To consider renewed monthly by intervention after treatment, vaccine and Visual stability should be given based on the need for the treatment of patients and Khan almost monthly to consider October must be supervised. Generally, the number of vaccine the first year, 8 2 or 3 second throughout the year, and the third year is 2 to 1. After the laser treatment retinal thickening and points are constantly released: 24 weeks. Antrawatril treated with tramkanaloni, especially in the eyes of the psiodovakak can be considered. (Figures 3 and 4 is attached). Vaccine 4 mm lambous anfrotemporal behind the quadrant using the technique are given in under the barren washing conditions.
Iv. prolafrtavi breath antrawatril vigf therapy and the doctor should be linked to: shared is considered to be anti prip
V oarectimi aparitanal watriomkoler traction or membrane is indicated: Faris plan on October.
* Inclusion of the Centre and good visual acuity (20/25 or better), 3 clinical trial in treatment options being evaluated, as well as intense immediately follow: (1) careful to eyes with only worsening with anti vigf treatment for breath; (2) anti-vigf vaccine. Or (3) laser photoquagolaon anti-vigf, with if necessary.
B. intermediate or low-resource settings
I. generally similar above. Antrawatril injection of anti-vigf agents aren't available focal laser is preferred. Bevakyazmab (aoastan) raniziomab (lukantas) or aflasrcapt (ayelia) is a suitable alternative.
Laser takanang anti-vigf treatment for retinal areas before unresponsive in the eye can be applied for.
(C) to adama makolar laser technology
I. focal makolar makroneuresm treatment daffose treatment and grid emissions within the focal areas of the center of the macula and 2DD nonprfoon focal laser treatment is also included.
Ii. 50 µm spot size, 120-150-100 laser parameter use mega energy and very light gray intensity are burned. Dmarkati and fovial to avoid aoascolhar zone have been removed.
Iii. If the tail is associated with larger areas of askhamia makolar, takanang grdanai are only those areas of the retina.
3. indicators for oarectimi
O severe watrivos hamorrahj 1-3 months duration, and a campsite is not defined.
B in spite of the vast prip remained high active prolafrtavi are doctors.
C. traction than the current makolar detachment.
De rhagmatganas joint traction retinal detachment.
E-aparitanal tractaonal makolar adama to add or membrane discoloration.
TV program doctor diagnoses for indicators
A. prevalence of diabetic retinopathy and Visual blindness organizations * about
B. the proportion of blindness and visual impairment due to doctor *
C. test for diabetes doctor (male/female) with between the last eye *
• Never test for eye doctor was.
• 0 – 12 months ago
• 13-24 months ago
• > 24 months ago
• Be simple never/0-12 months ago as: could/> 12 months ago
D. the number of patients were examined during the final year for the doctor
E. that during the past year, the number of laser and/or anti vigf treatment patients
It can be used to define the precise number ratio, such as:
F. the year [cataract surgical rate (CSR to) equal to] per million population per laser and/or anti-vigf treatment found the number of patients G number of patients number of patients of diabetes treatment, the laser and/or anti vigf per given area (katchmant area hospital, health district, area, country) of the
• Anas: vigf treatment laser and/or antibiotics during the last year of the number
• Trend: the number of patients with diabetes (DM x population trend; source: adaf Atlas)
Ah oasaontritinang anti vigf treatment laser and/or the number of people with the number of cases received per A specific area (country, area, katchmant area, health district hospital) doctors
• Anas: vigf treatment laser and/or antibiotics during the last year of the number
• Trend: the number of patients with the threat of Dr. vision (population x DM x 0.117 trend; source:
Atlas adaf)
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