Diabetic Retinopathy for the Clinician Chandran Abraham, Annie Mathai
INDEX
×
Chapter Notes

Save Clear

1Diabetic Retinopathy for the Clinician
2Diabetic Retinopathy for the Clinician
Editors Chandran Abraham MBBS DO Consultant Ophthalmologist Apollo First Med Hospitals Chennai, Tamil Nadu India Annie Mathai MS FRCS (Ed) Consultant Smt Kannuri Santhamma Retina Vitreous Centre LV Prasad Eye Institute Hyderabad, Andhra Pradesh India Foreword Eva M Kohner
3Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India, Phone: +91-11-43574357
Registered Office
B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi - 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021
+91-11-23245672, Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683
e-mail: jaypee@jaypeebrothers.com, Website: www.jaypeebrothers.com
Branches
USA Office
1745, Pheasant Run Drive, Maryland Heights (Missouri), MO 63043, USA, Ph: 001-636-6279734
e-mail: jaypee@jaypeebrothers.com, anjulav@jaypeebrothers.com
Diabetic Retinopathy for the Clinician
© 2009, Chandran Abraham, Annie Mathai
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 2009
9788184485554
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset & Packagings Ltd., New Delhi
4
“Read not to contradict and confute nor to believe and take for granted nor to find talk and discourse but to weigh and consider”
Francis Bacon (1561-1626)
5Contributors 6Foreword
Diabetes has been with us for over 1000 years but retinopathy was not known until the middle of the 19th century when it became possible to examine the retina. The first case described by Von Helmholtz was in effect hypertensive retinopathy in a diabetic patient, but all lesions associated with diabetes were soon described. However, retinopathy did not become a problem until the middle of the 20th century when as a result of discovery of insulin, patients with type 1 diabetes lived long enough to develop this complication. With increasing numbers of both type 1 and type 2 diabetes, retinopathy has become the commonest cause of visual loss and blindness in the working age population in the developed countries. With increasing wealth and resultant changes in lifestyle, it is now common in many countries. For many years the only treatment for the proliferative type of retinopathy was pituitary ablation, which though preserved sight, shortened a miserable life. Photocoagulation with the xenon arc and later with the laser became the sight saver of thousands of patients, with both proliferative retinopathy and now much more common diabetic maculopathy.
We thought that laser treatment was the answer. If it had been, we would not need a new book on diabetic retinopathy. But in the last 30 to 40 years, it has been shown that the retinopathy, a microvascular disease, is influenced by a whole host of other conditions, all part of diabetes. It has become obvious that the disease starts long before visual impairment, and it became obvious that if treatment is to be effective, it must start much earlier with less invasive methods.
Because of the many associations of retinopathy and ever improving methods of managing diabetes, doctors have a real chance in improving the quality of life of their diabetic subjects. Now it is no longer just laser late in the disease, but management of blood sugar, renal disease, lipids and blood pressure. It is the Diabetes Management Team that has become important; ophthalmologists have to interact with diabetologists and their technicians who do the many complex investigations for accurate diagnosis of their patients in order to achieve the best results, possible through improved techniques.
This book, written by the experts encompasses all aspects of diabetic retinopathy. It is a handbook all diabetologists and ophthalmologists dealing with diabetic patients should read. Because of the very clear language and detailed description, it will also be an essential reading for the paramedical team working with the doctors, and often having greater influence on the patients’ lifestyle than the physicians will ever have.
The experts have compiled their knowledge, experience and skills about diabetic retinopathy and produced an instructive up-to-date publication.
It should be on the desk of all ophthalmologists observing and dealing with diabetic patients.
Eva M Kohner obe md frcp frcophth
Honorary Emeritus Professor of London University
United Kingdom
7Preface
Diabetic retinopathy is the most common retinal vascular disorder encountered by ophthalmologists, the most frequently treated retinal vascular disorder in retinal clinics and the most extensively studied retinal vascular disorder.
Yet another book on Diabetic Retinopathy can hardly be redundant because of its high prevalence, its potential to create visual loss, its association with a basic medical disorder, and the steady progress made towards its understanding and management. Several brilliant texts, monographs, atlases and chapters in textbooks presenting many different aspects of the condition, are well illustrated, extensively researched and based on evidences obtained from laboratories and many clinical trials. Putting together the voluminous literature on the subject that can be thoughtfully applied in clinical practice can, however, be challenging.
The chapters on diabetes mellitus and the other associated medical disorders should help the ophthalmologists understand the several underlying medical problems that their patients with retinopathy may have. Each chapter is comprehensive, self-contained and arranged for easy reading. Results from the extensive basic research and from several different clinical trials on diabetic retinopathy are summarised without too much simplification. Grey and controversial areas are addressed so that readers can make an informed choice when more than one management option exists.
This book is intended for clinicians and it should provide a comprehensive understanding of diabetic retinopathy, its established management, recent advances in treatment and potential therapies for the future. We hope that this book will be of interest to general ophthalmologists, retina specialists and trainees, diabetologists and physicians interested in diabetic retinopathy.
Chandran Abraham
Annie Mathai