An afternoon of diabetic retinopathy run July 2005

An interactive afternoon David Kinshuck...see invitation/comments..timings all wrong

Ice breaker 2.30
Medical aspects of prevention of retinopathy…a reminder/update…DK Powerpoint 2.45
Laser tricks/update…DK Powerpoint  
Case…Sam Mirza 3.00
Groups ..cases…use cases for discussion...will not have time for all the cases
  • case 1  maculopathy & prolif, good outcome  Powerpoint 5mb
  • case 2 maculopathy & prolif, bad outcome  Powerpoint 4mb
  • case 3 prolif, good outcome Powerpoint 4mb
  • case 4
3.10
Break 3.50
Feedback from groups…..discussion
Groups must be very interactive, and answer member issues/concerns, each with a facilitator		 4.10
DK…to tie up lose ends, check everyone’s topics discussed, ..discuss them…?use a common database 4.40
summary..home ?4.55 4.50

program/comments (word)

learning points

  • laser earlier but lighter

  • for those patients you catch early ..you still need plenty of laser...but plenty of lighter laser

  • for those patients you catch later you need LOTS of laser and results will not be good

  • to do this you need to pick up patients early from screening..you need to work with the screening team

  • practice nurses look after diabetics..you set the targets..there are set targets, but if the retinopathy is progressing the lower the better as long as the patients feels well (BP, glucose, cholesterol, weight, exercise, healthy diet)

  • ideally you need to attend the diabetic team meetings..they should have weekly meetings
    any retinopathy means uncontrolled diabetes..need lower bp, glucose, etc.

  • And you need to input...recommending ACE/ARBs, statins, and identify the patients with poor control, identify obesity, and take action where needed

  • basal bolus insulins (lantus or retemir long acting, rapid acting before meals...produce 33% the retinopathy of bd insulin...but bd insulin is very common in this part of the UK (this is controversial)

  • generally diabetic care in this area of the UK is not good...patients who are not well controlled need regular weekly checks until their control is good, and this can take 6 months...patients are often given 3 monthly appointments even if badly controlled...

  • naturally we should look at our results, discuss with colleagues and try and do better next time (we seldom do this..that is one reason we make so little progress)

  • don't laser within one disk diameter of the fovea...laser burns expand