Term
| Approx how many Americans have undiagnosed diabetes |
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Definition
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Term
| Name 3 ethnicities that show a higher prevalence of diabetes |
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Definition
African Americans
Native Americans/Alaska natives
Hispanics |
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Term
| In diabetics, approx how many have ocular manifestations |
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Definition
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Term
| How does diabetes affect the risk of blindness |
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Definition
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Term
| Dr. Lingel emphasized these 2 things we should tell ALL our diabetic pts |
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Definition
1. Early intervention in diabetic retinopathy can help save vision if the pt is seen by the optometrist enough
2. Keeping blood sugar under control goes a long way in preventing vision problems |
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Term
| The DCCT study found what correlation between retinopathy and A1C |
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Definition
| Retinopathy was uncommon when A1C <7% |
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Term
| DDCT study found what correlation between DR and glycemic control |
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Definition
| Reduction in DR was directly related to tight glycemic control |
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Term
| Name 4 aspects of medical management to ask your diabetic patient about |
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Definition
1. Treatments
2. Medications/Dosage
Method/frequency of sugar monitoring
4. Average blood sugar |
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Term
ABC's of Diabetes
Specify the A |
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Definition
| A=HbA1C <7%, monitored q 6mo |
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Term
ABS's of Diabetes Care
Specify the B |
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Definition
| B=Blood Pressure <130/80 mmHg |
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Term
ABC's of Diabetes Care
Specify the C |
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Definition
| C=Cholesterol with LDL <100 mg/dL |
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Term
| What is the target cholesterol level for diabetics with cardiovascular disease |
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Definition
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Term
| ADA and AAOguidelines for eye exams for pts with Type I Diabetes |
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Definition
| 3-5 years after diagnosis and then annually |
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Term
| Guidelines for eye exams for pts with Type 2 Diabetes |
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Definition
| At initial diagnosis and then annually |
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Term
| Guidelines for eye exams for pts with diabetes who are also pregnant with <Moderate DR |
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Definition
First within the 1st trimester and then every 3 months
Then 6-8 weeks postpartum and follow closely for 1 year |
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Term
| Guidelines for eye exams for pts with diabetes who are also pregnant with >Moderate DR |
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Definition
First within the 1st trimester and then every 1-3 months
Then 6-8 weeks postpartum and follow closely for 1 year |
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Term
| Name 4 FUNCTIONAL Ocular Complications of Diabetes |
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Definition
Tritan color vision deficiencies
Refractive error changes
Accommodative dysfunction
Visual field defects |
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Term
| Name 3 neurological ocular manifestations of diabetes |
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Definition
EOM anomalies
Sluggish pupillary reflexes
APD |
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Term
| List corneal changes associated with diabetes |
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Definition
Reduced sensitivity
reduced healing
BM abnormalities
Descemet's wrinkling
Endothelial changes
Increased thickness |
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Term
| List 5 anterior segment complications associated with diabetes |
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Definition
Bulbar microaneurysms
Dry eye syndrome
corneal changes
Iris changes
Cataracts |
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Term
| Name 3 manifestations of diabetes within the iris |
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Definition
Depigmentation
NVI
Peripheral Anterior Synechiae |
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Term
| In a diabetic exam, should the iris be examined before or after dilation |
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Definition
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Term
| Name 3 optic nerve complications associated with diabetes |
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Definition
Disc edema
Ischemic optic neuropathy
Glaucoma |
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Term
| Name 4 posterior segment complications associated with diabetes |
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Definition
Vitreous heme
Optic nerve complications
Retinopathy
Macular Edema |
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Term
| Management of a vitreous heme |
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Definition
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Term
| The pathogenesis of DR is primarily due to … |
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Definition
| Metabolic effects of chronic hyperglycemia |
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Term
| Name 4 aspects of DR due to chronic hyperglycemia |
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Definition
Vascular changes
Retinal injury
Ischemia
inflammation/vasoactive substances |
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Term
| Specify how impaired autoregulation of blood flow affects vasculature in DR |
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Definition
| Increased glucose impairs the autoregulation of blood flow, results in increased blood flow which creates shear stress. This results in the release of vasoactive substances and vessel leakage |
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Term
| Describe the cascade that results from the accumulation of sorbitol in retinal cells |
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Definition
| ^sorbitol --> ^ prostaglandins --> alteration in protein kinase C --> Affects VEGF and permeability |
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Term
| 2 affects of the accumulation of AGE's in ECF |
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Definition
AGE's affect collagen which causes microvascular changes
Age's increase vascular inflammation |
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Term
| Describe retinal microthrombosis |
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Definition
| occlusion of capillaries, damage to endo, leakage |
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Term
| How may angiotensin receptor blockers change the affects of AGE's |
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Definition
| ARBs can inhibit increased vascular inflammation |
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Term
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Definition
| Advanced Glycosylation End Products |
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Term
| Name 5 types of growth factors released in response to ischemia |
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Definition
Insuling-like Growth Factor (IGF-1)
Vascular Endothelial Growth Factor (VEGF)
Platelet Derived Growth Factor ( PDGF)
Fibroblast growth factor (FGF)
Erythropoietin |
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Term
| How do hard exudates and drusen differ in terms of depth in the retina |
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Definition
Drusen=RPE BM
Hard exudates are more superficial |
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Term
| IRMA typically occurs in which layer |
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Definition
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Term
| Best differential between IRMA and flame hemorrhages |
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Definition
Their depth
Flame=NFL
IRMA=GCL |
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Term
| According to Dr. Lingel, what is the best lens for depth perception |
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Definition
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Term
| What is the 1st clinically detectable lesion of Diabetic Retinopathy |
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Definition
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Term
Microaneurysms vs. Dot/blot hemes
Description of borders |
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Definition
Micro have sharper borders since they are an outpouching of a vessel
hemes have less distinct borders since they are escaped blood |
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Term
| According to Dr. Lingel, what is way to visualize microaneurysms |
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Definition
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Term
Microaneurysms vs. Dot/blot hemes
Appearance on FA |
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Definition
Micro leak slightly thus they glow a little
Dot/blot are dark, they HYPOfluoresce |
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Term
| 4 Major Classifications of DR |
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Definition
1. No DR
2. Nonproliferative DR
3. Proliferative DR
4. Clinically Significant Macular Edema
Note CSME ca occur with 2 & 3 |
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Term
| List 9 things on the retina you must look for to rule out diabetic retinopathy |
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Definition
Venous beading
IRMA
Neovascularization of disc
Neovascularization elsewhere
Neovascularization of the iris
hemes/microaneurysms
Hard exudates
Cotton wool spots
CSME |
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Term
| Describe the appearance of mild NPDR |
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Definition
| ONLY microaneurysms present |
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Term
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Definition
Used to evaluate for SEVERE NPDR
4-more than 20 intraretinal hemes in EACH of 4 quadrants
2-Definite venous beading in 2 or more quadrants
1-Prominent IRMA in 1 or more quadrants |
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Term
| T or F A vitreal heme counts as a hemorrhage in 1 of the 4 quadrants in the 4-2-1 rule |
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Definition
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Term
| Why is it so important to monitor IRMA |
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Definition
| It is often where NEO sprouts from |
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Term
| What new 'structures' are made in addition to vessels (neo) in response to ischemia |
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Definition
| translucent fibrous tissue is laid adjacent to vessels and can result in traction/hemorrhage/detachment |
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Term
| Which bleeds more easily, NVE or NVD |
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Definition
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Term
| How close does Neo have to be to be termed NVD |
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Definition
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Term
| High Risk Proliferative DR is specified as one or more of the following: |
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Definition
NVD >1/4-1/3 Disc Area (DA)
NVD with VH or PRH
NVE >1/2DA with VH or PRH |
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Term
Criteria for CSME
thickening of the retina _________DD from the center of the macula |
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Definition
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Term
Criteria for CSME
HE ___________-DD from macula along with ______________________ |
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Definition
| 1/3DD from center of macula along with thickening of adjacent retina |
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Term
Criteria for CSME
Zone of retinal thickening > ___________in size, part of which is <________________ from center of macula |
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Definition
| <1 DA in size, <1DD from center |
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Term
| Specify the 3 criteria for CSME |
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Definition
1. Thickening of retina 1/3DD from macula center
2. Hard exudates 1/3DD from macula center with adjacent thickening
3. Zone of retinal thickening >1 DA in size within 1DD of macula center |
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Term
| Name 3 conditions which merit referral within 2-4 weeks |
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Definition
Macular Edema
Severe/very-severe NPDR
Early/non-high risk PDR |
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Term
| Name 2 conditions which merit referral within 24-48 hours |
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Definition
High risk PDR
Vitreous hemorrhage |
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Term
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Definition
1. High risk PDR including NVD
2. Rubeosis with or without glaucoma
3. Non-high risk PDR
4. Widespread ischemia and capillary non-perfusion |
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Term
| 6 short term complications of PRP |
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Definition
Pain
Increased IOP
Corneal Abrasion
Decreased Accommodation
Macular Edema
Vitreous heme |
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Term
| Treatment of vitreous hemorrhage and traction RD |
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Definition
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Term
| 6 complications of vitrectomy |
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Definition
Recurrent vitreous hemorrhage
RD
Rubeosis Irides
Severe Vision loss
Microbial endophthalmitis
Cataract |
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Term
| Surgical Treatment of CSME |
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Definition
| Focal Laser Photocoagulation |
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Term
| VA Goals for Focal Laser Photocoagulation |
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Definition
| Stabilization, not improvement (prevent further loss) |
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Term
| 5 complications of grid-laser tx |
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Definition
retinal scarring
para-central scotoma
choroidal NV
subfoveal fibrosis
misplaced foveal photocoagulation |
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Term
| 2 agents used for pharmacological treatment of CSME |
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Definition
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Term
| Risks of corticosteroid treatments |
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Definition
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Term
| 5 complications of intravitreal injections |
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Definition
cataract progression
Increased IOP
Endophthalmitis
transient sterile inflammation
stroke |
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Term
| Coding for DM without complications |
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Definition
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Term
| Coding for DM with complications |
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Definition
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Term
| Coding for DM type 2 or unspecified not stated as uncontrolled, may or may not be using insulin |
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Definition
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Term
| Coding for DM type 1 not stated as uncontrolled |
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Definition
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Term
| Coding for DM type 2 or unspcified, uncontrolled |
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Definition
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Term
| Coding for DM type 1 uncontrolled |
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Definition
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Term
| Coding for Diabetic retinopathy |
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Definition
| first is 250.5X, second is 362.0 |
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Term
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Definition
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
|
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Term
|
Definition
|
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Term
| Coding for Diabetic ME or retinal edema |
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Definition
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Term
| What other code must code 362.07 be accompanied with? |
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Definition
| Some code for diabetic retinopathy (362.01-362.06) |
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